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Which medication is best for adult ADHD Medically reviewed by Alexandra Perez, PharmD, MBA, BCGP — By Rachel Ann Tee-Melegrito on August 29, 2022Selecting the best medication for an adult with ADHD can be a process of trial and error. The most effective type of medication and its timing and dosage depends on a person’s history, genetics, and response to the drug.
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Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders healthcare professionals diagnose in children. It often continues into adulthood, and increasing numbers of people receive a diagnosis later in life. The condition makes it difficult for a person to focus, stay organized, feel calm, and manage impulses.
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Medications help adults with ADHD manage symptoms so they can focus, do better at work, and improve interactions with friends and families. Eight million adults in the United States have ADHD. Of these, less than 20% receive a diagnosis or treatment, and less than a quarter seek help.
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This article explores adult ADHD and the best medications for adults with ADHD. Medication for adults with ADHD
Share on PinterestNICK VEASEY/SCIENCE PHOTO LIBRARY/Getty ImagesThe medications doctors prescribe for children and adults with ADHD are mostly the same. However, a child with ADHD may need different medications as they grow.
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Their bodies and brains change, and symptoms may also look different at older ages. A doctor will consider specifically how a person’s ADHD affects them to prescribe a medication tailored to their needs.
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Learn more about how to tell if ADHD medication is working. ADHD medications fall into two categories:
Stimulants
Also called psychostimulants, stimulants are the first line of treatment for ADHD. They work by slowing down the absorption of dopamine and norepinephrine (neurotransmitters) in the brain.
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By increasing the availability of these chemicals in the brain, pathways in the brain communicate and work more effectively with each other. These drugs have a rapid effect.
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They are controlled substances because they are habit-forming and have the potential for misuse. Common stimulants used in ADHD treatment include:methylphenidate (Concerta, Ritalin, Metadate, Focalin)amphetamine (Adderall, Adderall XR)dextroamphetamine (Dexedrine, Desxtrostat)lisdexamfetamine (Vyvanse)
The most common side effects of stimulants include:lack of appetitetrouble sleepingdry mouthstomach painnauseaanxietyweight lossdizziness
People with glaucoma, advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, and hyperthyroidism should not take these medications.
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A person who took monoamine oxidase inhibitors (MAOIs) in the last 14 days should not take stimulant drugs. Nonstimulants
A doctor may prescribe nonstimulants when a person experiences an adverse reaction or does not respond to stimulant drugs. They may also recommend nonstimulants if the person has a history of drug misuse or certain heart conditions, such as severe hypertension or cardiovascular diseases.
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Compared with stimulants, nonstimulants do not have a potential for misuse. However, they are not as effective as stimulants and have a slower onset. Commonly used nonstimulant medications for ADHD include:atomoxetine (Strattera)guanfacine (Intuniv)clonidine (Kapvay)bupropion (Wellbutrin), prescribed off-label for adults with ADHDviloxazine (Qelbree)
Learn more about nonstimulant ADHD medication.
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Types of medication
Below are the most commonly prescribed medications for adults with ADHD. Adderall dextroamphetamine amphetamine
Adderall is a combination of dextroamphetamine and amphetamine. This central nervous system (CNS) stimulant helps improve concentration and reduce impulsivity.
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It has two types: immediate release (IR) and extended release (XR). The standard dose is 5 to 20 milligrams (mg). A person takes this drug by mouth once daily, with or without food.
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A person may take Adderall IR one to three times per day, while they only need to take Adderall XR once daily. The effect of Adderall IR lasts for about 4–6 hours, while Adderall XR may last up to 12 hours. Adderall takes effect within 30 minutes to an hour, but a person can feel its peak effect within 1–3 hours.
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Concerta methylphenidate
Concerta is another stimulant. A person typically needs to take this drug once daily in the morning. It is available in 18, 27, 36, and 54 mg, designed to have a 12-hour effect.
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Compared with Adderall, Concerta’s effects last longer because the drug releases more slowly. It has an advanced formulation and works within an hour, with peak levels at 6–10 hours. Dexedrine dextroamphetamine
Dexedrine is a stimulant that contains dextroamphetamine as its active ingredient.
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It comes in short-acting and long-acting forms. A person prescribed a short-acting Dexedrine may need to take the drug two to three times per day, 4–6 hours apart.
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However, those prescribed the long-acting form may only need to take them first thing in the morning. Similar to Adderall, Dexedrine only takes about 30 minutes to take effect. The tablet (short-acting) may stay effective for 4–6 hours, while the Dexedrine Spansule (long-acting) may be effective for 8–12 hours.
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Compare Dexedrine and Adderall here. Focalin dexmethylphenidate
Focalin is the brand name for dexmethylphenidate, another CNS stimulant.
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This drug comes in IR and XR forms. A person may need to take two doses 4 hours apart for the IR form.
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Meanwhile, a person only needs to take one Focalin XR, typically first thing in the morning. The length of effect of Focalin IR and XR are similar to that of Adderall. People with trouble swallowing pills may open the capsule and sprinkle the contents with applesauce to make swallowing easier.
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Ritalin methylphenidate
Ritalin shares the same active ingredient as Concerta. The primary difference between the two is that Ritalin is a short-acting drug immediately released into the body. Even the long-acting formulation of Ritalin does not last as long as Concerta.
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This drug may be helpful in individuals who need immediate symptom relief. To absorb the medication fully, a person needs to take Ritalin two to three times per day, preferably 30–45 minutes before meals. Vyvanse lisdexamfetamine
Vyvanse is an amphetamine-based drug.
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Experts believe it helps ADHD symptoms by restoring the balance of chemicals in the brain. Healthcare professionals prescribe this stimulant medication to individuals with ADHD and binge eating disorder. It comes in capsule and chewable tablet forms.
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The typical starting dose for this drug is 30 mg, with a maximum dose of 70 mg. Strattera atomoxetine
Strattera is the first nonstimulant medication approved by the Food and Drug Administration (FDA) to treat ADHD.
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It is a selective norepinephrine reuptake inhibitor, a group of antidepressants. A person usually takes Strattera once or twice per day, with or without food. It has an excellent safety profile, and the reported side effects, which include sleepiness and lack of appetite, are generally mild.
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Learn about more types of ADHD medications here. Off-label medications for adult ADHD
Doctors may sometimes use drugs off-label. This means that the FDA does not approve these medications for use in ADHD.
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Antidepressants
Antidepressants such as tricyclic antidepressants and MAOIs, bupropion, and venlafaxine increase the levels of norepinephrine in the brain. This action has a positive effect on ADHD symptoms. Moreover, many doctors also prescribe antidepressants to people with ADHD with coexisting anxiety, depression, or bipolar disorder.
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Bupropion
Bupropion (Wellbutrin) is a norepinephrine-dopamine reuptake inhibitor antidepressant. It is approved for use in conditions like depression, seasonal affective disorders, and smoking cessation. Adults typically take a 100-mg dose three times per day, while they may take the sustained release formulation in a 150-mg dose once or twice per day.
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The maximum dose is 450 mg. Venlafaxine
Venlafaxine (Effexor) is another antidepressant that doctors may prescribe off-label to people with ADHD. It is a serotonin-norepinephrine reuptake inhibitor.
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Doctors also prescribe it to manage conditions such as:post-traumatic stress disorderobsessive-compulsive disorderdiabetic neuropathymigraine prevention
Blood pressure medications
Guanfacine (Intuniv) and clonidine (Kapvay) are two blood pressure medications under the class of alpha-2 agonists. The exact mechanisms are unknown, but experts believe that they mimic norepinephrine and affect the receptors in the prefrontal cortex. This leads to the improvement of inattention, impulsivity, and distractibility in those with ADHD.
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The FDA has approved these drugs to treat ADHD, but only in children and adolescents, not adults. Since both these drugs are approved for adults with hypertension, many doctors feel comfortable prescribing them off-label for adults with ADHD.
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Both are not recommended for children and adolescents with severe depression, as these drugs may worsen depressive symptoms. Common side effects of these drugs include:dry mouthdrowsinesssedationdizzinessheadachesconstipation
Wake-promoting agents
Modafinil (Provigil) is an FDA-approved drug for narcolepsy. It activates different attention and arousal systems in the brain to increase frontal cortical activity.
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In a controlled study, almost half of adults responded positively to the medication. Other treatment options
As well as taking medication, behavioral therapy may also be an effective treatment for a person with ADHD.
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Behavioral therapies can complement medication to address behavioral, social, and emotional issues and help a person with ADHD cope with their condition. This is especially important because ADHD often has several comorbidities. Half of people with ADHD also have anxiety disorders, while 1 in 13 has a coexisting bipolar disorder.
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Below are other treatment options that can help adults with ADHD:Cognitive behavioral therapy (CBT): CBT can help people identify problematic thoughts and behaviors and implement strategies to help them cope, self-regulate, and change their maladaptive behaviors.Coaching: People with ADHD may look for coaches who can offer them guidance and feedback as they handle daily life challenges. They can help people with practical skills like planning, setting goals, time management, and organization.Social skills training: This training aims to help a person improve their social interaction and interpersonal skills. Activities focus on skills like communication, controlling emotions, judgment, and problem-solving.Marital counseling and family therapy: Counseling can help family members and couples communicate better and help them understand the underlying causes behind a person’s forgetfulness and other habits.
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Learn more about types of therapy here. Tips for living with ADHD
Managing daily life can be difficult for a person with ADHD. The following tips can help:Use reminders and to-do lists.Use organizational tools, such as planners, journals, or time management apps.Avoid multitasking.Create and follow a routine.Break down big tasks into smaller chunks.Declutter and remove distractions.Create a dedicated space for personal or professional work.Turn off notifications from devices when focusing on a task.Use visual cues to help remember items and tasks.Keep things novel and exciting by making minute changes in the environment or workplace.Practice self-compassion.Set boundaries and learn to say no to help deal with impulsivity.
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A person can also seek ADHD support groups. Support groups can help individuals with ADHD understand themselves better and offer resources to help them cope with daily life.
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People may be able to find support groups near them on the Attention Deficit Disorder Association website. Learn more about coping skills and strategies for adults with ADHD. When to speak with a doctor
A person should reach out to their doctor if they are experiencing any of the following:new symptoms or worsening of symptomsmedications no longer workdrugs cause intolerable side effects
The doctor may change a medication’s dosage or try a different drug in such cases.
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A person should never adjust the timing and dosage of their medications without first informing their doctor. Summary
ADHD is a condition that affects a person’s ability to control their behavior, attention, and concentration. There are several types of medications available for ADHD.
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However, the best medication depends on the person’s symptoms and personal experiences, health status, and how they respond to the drug. A person should work closely with their doctor to identify the best medication and other possible treatments to help prevent ADHD from negatively impacting their careers and relationships.
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Last medically reviewed on August 29, 2022Mental HealthADHD / ADDPsychology / PsychiatryDrugs 13 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references.
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We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Adderall XR capsules.
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(n.d.).https://www.accessdata.fda.gov/drugsatfda_docs/label/2004/021303s005lbl.pdfAdult ADHD (Attention deficit hyperactive disorder). (n.d.). https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhdBrown, K., et al. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: A review for practitioners.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803014/Bupropion (Wellbutrin).
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(2020).https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Bupropion-(Wellbutrin)Concerta (methylphenidate HCl) Extended-release tablets CII. (n.d.). https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021121s014lbl.pdfDealing with ADHD: What you need to know. (2016).https://www.fda.gov/consumers/consumer-updates/dealing-adhd-what-you-need-knowDexedrine (dextroamphetamine sulfate) Spansule sustained release capsules CII.
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(n.d.).https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/017078s052lbl.pdfDextroamphetamine. (2019). https://medlineplus.gov/druginfo/meds/a605027.htmlFocalin XR (dexmethylphenidate hydrochloride) extended-release capsules. (n.d.). https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/021802lbl.pdfHow to take Vyvanse.
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(n.d.). https://www.vyvanse.com/dosesMedication management. (n.d.). https://chadd.org/for-adults/medication-management/Schiweck, C., et al. (2021). Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis.https://www.sciencedirect.com/science/article/pii/S0149763421000312Verbeeck, W., et al. (2017).
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Bupropion for attention deficit hyperactivity disorder (ADHD) In adults.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485546/FEEDBACK:Medically reviewed by Alexandra Perez, PharmD, MBA, BCGP — By Rachel Ann Tee-Melegrito on August 29, 2022
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