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Dr. Kacir's ADHD Blog

ADHD Medicines

Congressmen investigate ADHD drug shortage

CQ Roll Call, a subscription service reporting on congressional activity reported that 4 House Democrats wrote inquiries to the DEA, Shire (the producer of Adderall, AdderallXr, Intuniv and Vyvanse) and Novartis (the maker of Focalin and FocalinXR).  The inquiries explore the allegation that the two companies are making too much of the more expensive brand name drugs and not enough of the generic form with the amount of raw materials they are allowed by annual regulation.
 
I think they are asking the wrong question of the DEA.  There are several smaller companies that ONLY produce generic medications... and usually at a lower price than the generics from big companies.  Why hasn't the DEA funneled more of the raw materials to those companies?  More importantly, why haven't the quotas increased with the increase in prescriptions for these medications?  It is estimated that 4.4% of the U.S. adult population has ADHD.  Five years ago less than 10% of these people were being treated.  I saw a more recent estimate of 30% -- that's a lot more prescriptions!
 
Expensive though they may be, Big Pharma companies operate in a free market. Novartis and Shire risk alienating their customers who prefer their generic products if they are indeed funneling their allotted materials into name brand medication.  In the case of Vyvanse, there is no generic equivalent and in many cases, Vyvanse is a better medication than generic Adderall or Dexedrine with which it shares an element of the raw materials.  Vyvanse is usually smoother acting, lasts longer and has less of a let down at the end of the day.  It is also the least expensive of the brand name medications.
 
The congressional inquiry is a good idea so that it may publicize decisions made by the DEA and pharmaceutical companies.  It is my opinion that the basic problem is that regulations have not kept up with the medical need for controlled substances.  Brand name pharmaceutical companies have behaved in a manner befitting private industry, maximizing their profit margins, but this does not account for the shortages of brand name Adderall.

Methylphenidate in Adults

Eighteen studies of methylphenidate, the active ingredient in Ritalin, Concerta and Metadate, were reviewed to explore its role in treating adults with ADHD.  From these studies, methylphenidate had a "moderate" effect on ADHD symptoms that increased with increasing doses.  The average dose in adults was about 60 mg per day.  The reviewers were unable to determine if there was a difference in effect for different forms of the medicine.  (For example, long acting vs short-acting.)  Those patients who had problems with substance use did not respond as well as those without substance use disorders.  My experience in using methylphenidate in adults with ADHD is consistent with these findings -- I find that Concerta and generic methylphenidate are both effective and that the main differences are in the side effects and the length of action rather than in how effective they are.
 

ADHD medications in The Netherlands

I just read a summary of a study that looked at the records of prescriptions filled for ADHD medicines in The Netherlands.  The first conclusion was that 75.5% of children from age 6-17 who were prescribed ADHD medicine reached a stable dose of such medicine during the 3 years reviewed.  (2003-2006)  The second conclusion was that the medicine for which a stable dose was reached most quickly was long-acting methylphenidate.  (They do not specify whether this is Concerta, Ritalin LA, Metadate CD or FocalinXR.  It may be a combination of all or some of them.)  Unfortunately, I don't think that this information is particularly useful.  It does, however, support the observation that 80% of people with ADHD respond well to the first stimulant they try.
 
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