What's So Great About Adderall?

by Corydon C. Clark, M.D.

 There are several reasons for most people treated for ADHD with a stimulant medication to try Adderall.

• Flexibility
• Relatively long-acting
• Slower and smoother onset of action
• Drop-off of action is also slower and smoother
• May be less of problem with tic disorders
• This is a combination of drugs
• Too few people have been tried on a variety of medications

(The preceeding abstract/summary not in original article but provided as a guide by Balance Check; the full original article follows.)

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What's So Great About Adderall?

by Corydon C. Clark, M.D.

 There are several reasons for most people treated for ADHD with a stimulant medication to try Adderall.

First, this newly-approved preparation is, without any doubt, the most flexible medication available from the dose-management point of view. Tablets of 10 and 20 mg are double-scored, (editor’s note:which means they can easily be cut apart) therefore permitting accurate dosing at increments as low as 2.5 mg all the way through 20 mg.

Many individuals with ADHD have a very small "window" of effective dose response, i.e., the level that is effective between too low and too high a dose. Adderall is the only stimulant currently available permitting this small an incremental dosing schedule with accuracy.

Second, Adderall is relatively long-acting; it has a length of action for 5 or 6 to as many as 8 or 9 hours, depending on the individual and the dose. There are some individuals who report a single AM dose "covers" their full working day, and in some children and adolescents a single AM dose before school works the full school day, eliminating the need for noon medication.

Adderall is consistently longer-acting than Ritalin 20 SR (Sustained-Release), and much more predictable since it is more completely absorbed. (over 90% fully absorbed, compared to 30-60% Ritalin absorbtion). It is usually somewhat longer in action also than Dexedrine capsules.   This is less of an advantage over Dexedrine than Ritalin because the lengths of action of Adderall and Dexedrime SR capsules are closely comparable. However, since the Dexedrine capsules are 5, 10, and 15 mg, and since they cannot be split, dosing flexibility is much greater with Adderall,

Third, onset of action is slower and smoother with Adderall than any of the other SR preparations. Many people report a sense of "nervousness" or feeling "speedy" when standard stimulant tablets or SR preparations "kick in," but this is a rare report from people treated with Adderall due to the slow, smooth onset of action,

Fourth, drop-off of action is also slow and smooth; one normally does not feel the sense of "crash" or "rebound" evident when other preparations are used. This is a huge advantage in people treated for ADHD of all ages, since the "crash/rebound" effect is often very unpleasant when other preparations are used.

Fifth, since in many cases with tic disorders the aggravation of tics is associated with the rapid "kick in" of amphetamine impact from other stimulants, Adderall's slow onset of action may prove to be a feature less prone to aggravate tics.  There is now some clinical experience suggesting this is true, but no specific studies are yet evident in the literature on this point.

Sixth, as many as 20% of all people treated with a stimulant ultimately require a combination of stimulants for optimal impact, e.g. Dexedrine SR + Ritalin tablets, Ritalin SR + Desoxyn tablets,etc. Adderall is already a combination and this is almost certainly why during initial experience with this medication many people report better effect than with Dexedrine or Ritalin alone,

The ingredients of Adderall are:

• 1/4 Dextroamphetamine Saccharate
• 1/4 Dextroamphetamine Sulfate
• 1/4 Amphetamine Aspartate
• 1/4 Amphetamine Sulfate

The Saccharate and Aspartate conjugations are substantially responsible for the long-acting effects of Adderall.

Finally, there is another important experience we note that is well worth discussing: altogether too few people, especially children, have ever been tried on a variety of stimulants prior to deciding which one seems most effective and helpful, In fact, Ritalin accounts for nearly 90% of sales of all stimulants nationwide - not because it is necessarily any better than the others, but primarily because it is more familiar to most physicians: better known, and more effectively advertised  (editor’s note:  The ADHD Report recently reported on ADD chat rooms on the web.  When medicine was discussed 90% of the queries had to do with Ritalin, while less than 1% of the queries were about Adderall.  Clearly, this is a medication that is not widely used.)

In fact, Ritalin is very often a very poor choice at any age. It remains incomprehensible why the manufacturers have not developed scored tablets so one may accurately divide the 5, 10 and 20 mg tablets into 2.5 and 5 mg strengths to permit better dose flexibility.   Have you tried cutting a 5 mg tablet into halves recently to try to deliver a 7.5 mg dose?  You get a lot of crumbs no matter how good you are at cutting!  Dexedrine is better; the 5 mg tab is carefully scored, but the tabs are only 5 mg, none higher, not a lot of fun when one needs 12,5 mg twice per day. DextroStat is better since there is a 10 mg scored tablet, but these are very short-acting.

The slow onset of action of Adderall is a problem when one needs a "jump start" early in the day. GOOD NEWS: DextroStat, Dexedrine or Ritalin may be given along with Adderall to provide that initial boost in action without any difficulty with the combination; the short- acting medications work quickly when that effect is required and Adderall then slowly develops a sustained benefit. This short and long-acting combination is a huge advantage in treatment.