Titrating to the optimal dose in crucial, as described in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivities Disorder (MTA) and Preschool ADHD Treatment Study (PATS) studies that utilized double-blind procedures to determine the optimal dose level (Greenhill et al. In addition, early studies did not routinely dose the two medications comparably. 2002 Faraone and Buitelaar 2010), although reviews and meta-analyses are likely to over-represent data from older studies, many of which utilized older IR stimulant formulations. Other reviews and a recent meta-analysis of 23 studies have concluded that effect sizes are somewhat greater for AMP (Arnold 2000 Faraone et al. For example, the Texas Algorithm for ADHD recommends using either class of stimulant medication as the initial treatment for ADHD, and switching to the other stimulant class if the first is either not effective or not well tolerated (Pliszka et al. MPH and AMP formulations have equal efficacy and similar side effect profiles according to several reviews, practice guidelines, and algorithms (American Academy of Child and Adolescent Psychiatry 2002 Daughton and Kratochvil 2009). Yet, we know relatively little about the similarities and differences between the two main classes of stimulants due to a paucity of head-to-head studies with newer, long-acting agents. S timulant medications, including immediate release (IR) and extended release (ER) methylphenidate (MPH) and amphetamine (AMP), have been shown to be highly efficacious for improving attention-deficit/hyperactivity disorder (ADHD) symptoms in literally hundreds of placebo-controlled trials (Swanson 1993 Wilens and Spencer 2000).
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