A systematic review and economic model of the effectiveness and ...

6
Background
Concerta XL
Concerta XL is administered orally once daily in
the morning and must be swallowed whole with
the aid of liquids, and must not be chewed,
divided or crushed. Concerta XL may be
administered with or without food. Dosage should
be individualised according to the needs and
responses of the patient. Dosage may be adjusted
in 18-mg increments to a maximum of 54 mg per
day taken once in the morning. In general, dosage
adjustment may proceed at approximately weekly
intervals. The manufacturers of this drug claim
that its effects last through 12 hours. 26
Dexamfetamine sulphate
(dexamphetamine sulphate)
DEX is a symphathomimetic amine with central
stimulant and anorectic activity. It is indicated in
narcolepsy. It is also indicated for children with
refractory hyperkinetic states under the
supervision of a physician specialising in child
psychiatry.
Dexedrine ® (Celltech Pharmaceuticals Ltd) is
available in 5-mg tablets.
The usual starting dosage for children aged
3–5 years is 2.5 mg per day, increased if necessary
by 2.5 mg per day at weekly intervals. For children
aged ≥ 6 years, the usual starting dose is 5–10 mg
per day, increasing if necessary by 5 mg at weekly
intervals. The usual upper limit is 20 mg a day
although some older children have needed 40 mg
or more for optimal response.
Atomoxetine hydrochloride 27
ATX is reported to be a selective noradrenaline
reuptake inhibitor. The precise mechanism by
which ATX works on ADHD is not known. It is
currently licensed in the USA and the UK under
the brand name Strattera ® (Eli Lilly & Co. Ltd).
The manufacturers claim that it is the first nonstimulant
medication approved for the treatment
of ADHD in children ≥ 6 years of age. In
adolescents who have shown a clear benefit from
treatment, and whose symptoms persist into
adulthood, treatment may be continued into
adulthood. However, starting treatment with
Strattera in adults is not appropriate. It is
indicated as an integral part of a total treatment
programme for patients with ADHD.
Strattera is available in 10-, 18-, 25-, 40- and
60-mg capsules (for oral administration with or
without food).
In children and adolescents up to 70 kg body
weight, Strattera should be initiated at a total daily
dose of approximately 0.5 mg/kg and increased
after a minimum of 3 days to a target daily dose of
approximately 1.2 mg/kg administered either as a
single daily dose in the morning or as evenly
divided doses in the morning and late
afternoon/early evening. The total daily dose in
children and adolescents should not exceed
1.4 mg/kg or 100 mg, whichever is less.
In children and adolescents >70 kg body weight,
Strattera should be initiated at a total daily dose of
40 mg and increased after a minimum of 3 days to
a target total daily dose of approximately 80 mg
administered as stated above. After 2–4 additional
weeks, the dose may be increased to a maximum
of 100 mg in patients who have not achieved an
optimal response.