Dr. Dale Mortimer's Brief Guide to the Stimulants Used In Treating Attention–Deficit/Hyperactivity Disorder (ADHD)


This convenient, pithy, Brief Guide provides an overview of: the current stimulant options for ADHD treatment; their duration of action; and dose equivalences. The dose equivalences and durations of action below have been accurate for about 95% of Dr. Mortimer's patients. Please note that “out of pocket” prescription medication costs are: illogical; vary widely across different pharmacy chains; and can change daily.

THE AMPHETAMINES (dextroamphetamine alone; or in combination with levoamphetamine; and methamphetamine alone):

Dextrostat (dextroamphetamine is the generic name) is available in 5 & 10 mg tablets. Dextroamphetamine is oldest stimulant (available since 1887). Duration of benefit of dextroamphetamine (Dextrostat): usually 4 hours per dose. Dextrostat 5 mg is equivalent in efficacy (but not in duration) to Desoxyn 5 mg.

Dexedrine Spansules (dextroamphetamine) is available in 5, 10, & 15 mg time–release capsules. Duration of benefit of the Spansules: usually 5 hours per dose. Dexedrine Spansules 5 mg is equivalent in benefit (but not duration) to Desoxyn 5 mg.

Desoxyn (methamphetamine is the generic name) is available in 5 mg tablets. Duration of benefit is usually 7–8 hrs per tablet. Desoxyn is the stimulant least likely to increase blood pressure or pulse. And yes, it has been a legal, legitimate prescription medication since probably the 1940s (if not earlier).

Adderall regular (“IR” or immediate release tablets) is composed of 75% dextroamphetamine and 25% levoamphetamine. Adderall tablets are available in 5, 7.5, 10, 12.5, 15, 20, & 30 mg tablets. Duration of benefit from Adderall tablets is somewhere between 4–7 hrs per dose (duration of benefit varies for each patient). The Adderall IR 5mg tablet is equivalent in efficacy (but not duration) to Desoxyn 5 mg.

Adderall XR is available in 5, 10, 15, 20, 25 & 30mg time–release capsules (composed of 75% dextroamphetamine and 25% levoamphetamine). Duration of benefit of Adderall XR capsules: 8–10 hrs per dose. Adderall XR 10 mg is equivalent in efficacy to Desoxyn 5 mg, with Adderall XR duration of benefit usually lasting a few hours longer than Desoxyn.

Vyvanse is available in 10, 20, 30, 40, 50, 60, & 70 mg capsules (Vyvanse is a dextroamphetamine [or lisdexamfetamine] time–released, pro–drug in a water–soluble powder). The duration of benefit of Vyvanse lasts until bedtime in 90% of Dr. Mortimer's patients. In the other 10% of Dr. Mortimer's patient population, the duration of benefit is 8 hours. There isn't a reliable stimulant formula for the conversion of mg of Vyvanse to other mg of other stimulants.

Evekeo (50% dextro – and 50% levo–amphetamine) 5mg & 10mg tablets. Duration of benefit of Evekeo: 4 hours per dose. The 5mg Evekeo tablet is equivalent to 5 mg Desoxyn in efficacy (but not necessarily in duration).

Zenzedi (dextroamphetamine) is available in 2.5, 5, 7.5, 10, 15, 20 & 30 mg immediate–release tablets. Duration of benefit of Zenzedi is about 6 hrs per dose. The 5 mg Zenzedi tab is equivalent to 5 mg Desoxyn in efficacy, but not in duration.

Adzenys XR ODT [orally disintegrating tablets designed to mimic Adderall XR benefit and duration]. Adzenys XR ODT is available in 3.1, 6.3, 9.4, 12.5, 15.7 & 18.8 mg tablets. Adzenys 6.3 mg equivalent in efficacy (but not necessarily in duration) to Desoxyn 5mg per dose.

Mydayis [triple–beaded, time–released Adderall]. Mydayis is available in 12.5, 25, 37.5 and 50 mg capsules. Mydayis 15 mg is probably equivalent in benefit to about Desoxyn 5 mg (but there isn't yet a reliable formula for converting mg of Mydayis to mg of other stimulants). Duration of benefit of Mydayis: all day! Available since 9/2017.

METHYLPHENIDATE PREPARATIONS (Ritalin is the brand name for methylphenidate tablets):

Methylphenidate generic (Methylin IR, Metadate ER, Ritalin IR) is available in 5, 10, and 20 mg tablets. Methylphenidate tablets have been available since 1957.  Duration of benefit of methylphenidate: no more than 4 hrs per dose. 10 mg of methylphenidate tablets is equivalent in efficacy (but not in duration) to Desoxyn 5 mg.

Metadate CD  (methylphenidate) is available in 10, 20, 30, 40, 50 & 60 mg time–release capsules. Metadate CD 10 mg is equivalent in benefit to Desoxyn 5 mg. Duration of benefit of Metadate CD: 8–9 hours per capsule.

Concerta (methylphenidate) is available in 18, 27, 36 & 54 mg time–release tablets. Duration of  benefit: 11–14 hrs per tablet. Concerta 36 mg equivalent in efficacy to 5-6 mg of Desoxyn (– While Concerta has a longer benefit duration, it is mg for mg very weak in its effects). Be aware that the round tablets of being advertised as generic Concerta is not equivalent to the brand Concerta and has been associated with a wide range of bizarre side effects.

Focalin IR tablets (generic immediate release dexmethylphenidate) is available in 2.5, 5 & 10mg tablets. Duration of benefit of Focalin tablets: 5–6 hours per dose. Focalin 5 mg tablets are equivalent in efficacy (but not in duration) to Desoxyn 5 mg.

Focalin XR (– a single isomer of methylphenidate) is available in 5, 10, 15, 20, 25, 30, 35 & 40 mg time–release capsules. Benefit duration of Focalin XR capsules: 10-12 hrs. Focalin XR 10 mg is equal in efficacy (but not duration) to Desoxyn 5 mg.

Quillivant XR (methylphenidate) liquid suspension. Duration of benefit of Quillivant XR: 8–10 hours per dose.

Aptensio XR (methylphenidate) extended release capsules, available in: 10, 15, 20, 30, 40, 50 & 60 mg capsules. Duration of benefit of Aptensio XR: 10–12 hours.

Cotempla XR ODT (methylphenidate oral disintegrating tablets) extended release tablets (– this is the same delivery system as Adzenys XR ODT) is available in 8.6, 17.3 & 25.9 mg tablets. Duration of benefit of Cotempla XR ODT is 12+ hrs. Cotempla 8.6 mg is probably equivalent to Desoxyn 5 mg. Available since 10/2017.

Jornay PM (methylphenidate in delayed time–release) is available in 20, 40, 60, 80, 100 mg capsules (can be sprinkled). Jornay PM has been available since 5/2019.


DR. MORTIMER'S ONE–PAGE BRIEF SUMMARY ON ADHD, THE STIMULANTS LISTED ABOVE, AND – IF THE PATIENT IS A MINOR – WHO SHOULD ADMINISTER  THESE MEDICATIONS

    Attention deficit/ hyperactivity disorder (ADHD) for most affected persons is a life–long, medical/ neurological disorder of executive functioning of the brain’s frontal lobes, resulting in chronic problems with motivation, inattention, impulsivity, planning, motivation, and/or hyperactivity. ADHD is one of the most strongly inherited (i.e., ADHD is strongly genetic) conditions in all of medicine: in 90% of all persons with a valid diagnosis of ADHD, the etiology of ADHD is genetic. If one child meets criteria for ADHD, then there is a 32% chance that a sibling will also have ADHD; and there is an 80% likelihood that one or both parents will have ADHD. If a parent continues to have ADHD symptoms as an adult, then there is a 57% likelihood that the adult’s children will also meet diagnostic criteria for ADHD.

    ADHD is a clinical diagnosis and a medical disorder. Thus, only a treatment that can improve or normalize the underlying neurological deficit in behavioral inhibition and motivation will improve the executive functions dependent on such inhibition. The only existing treatments that have any hope of achieving an improvement in ADHD symptoms are prescription medications – not herbs, special diets, vitamins, minerals, over–the–counter supplements, caffeine, neurobiofeedback, acupuncture, prayer, or hypnosis!

    ADHD and stimulants. Inhibition is an essential precondition for deliberation, planning, philosophizing, and thoughtful execution. The stimulants are the mainstay of effective ADHD treatment. As a group, the stimulants are among the most researched medications in all of medicine, with well over 300 controlled studies involving well over 7,000 children, adolescents, and adults demonstrating stimulant efficacy and safety. Regardless of which stimulant is selected first, there is a 70–90% positive response rate. At least 30% of those who respond poorly to one stimulant will show a positive response to a trial of a second stimulant. In order to increase the likelihood of identifying the optimal ADHD treatment for a particular patient, most ADHD–affected patients probably deserve a trial of at least two different stimulant medications. Prescription stimulants enhance the effects of the brain’s natural dopamine, thus boosting the "signal" in executive functions “computer programs" located in the brain's frontal lobes. Prescription stimulants also indirectly decrease norepinephrine’s unwanted effects on brain functioning, thereby calming the "noise" that accompanies neuronal messages to the executive centers of the brain. Thus, the use of prescription stimulants in the treatment of ADHD boosts the "signal to noise" ratio in the brain’s neurotransmitter messages. (Please note: caffeine is not effective for the treatment for ADHD symptoms.)

    In those with ADHD, prescription stimulants improve the brain’s efficiency and capacity for: working memory, paying attention, planning, time management, concentration, and the ability to inhibit impulsive speech and otherwise impulsive behaviors. The prescription stimulants increase the general alertness and thinking efficiency of the brain, thereby: decreasing activity level and inattention; improving learning and short-term memory; and improving classroom behavior. Stimulants also improve: fine-motor coordination (e.g., handwriting becomes noticeably more legible for the duration of the stimulant dose); reaction time; speed of retrieval from memory; and information processing. Stimulants can dramatically improve the quality of social interactions; reduce off-task behaviors – and the stimulants typically decrease noncompliance.

    The most common side effects of stimulants are difficulty falling asleep and decreased appetite – especially for lunch. In those who are genetically predisposed to tics, stimulants might elicit tics (e.g., eye–blinking, sniffing, throat–clearing, jaw clenching, etc.) – but stimulants are just as likely to improve tic control. Behavioral over–focus (e.g., nonproductive over–cleaning or sorting) and dry mouth can occur at higher doses. Sadness, crying, and irritability are not more frequent than with placebo. Brief behavioral irritability occurring at the end of the immediate release (generic) stimulant’s duration of benefit (“rebound”) can usually be circumvented with the skillful dose adjustment of the stimulant by the prescribing physician.

    Prescription stimulant choice and dosage are individually determined. Medication choice is based on dosing convenience, medication cost, abuse potential, side effect profile, pharmacy availability, and whether or not there is a responsible adult in the household who is willing to carefully monitor the storage and administration of these politically sensitive, potentially abusable, federally–monitored Schedule II controlled substances.

    Since youths with ADHD have significant problems with distractibility, motivation, impulse control and planning; and since stimulant diversion from ADHD to non–ADHD youngsters continues to be a nationally highlighted political issue: The responsibility for administering and supervising prescription stimulants must remain with a responsible adult –  with the ADHD child, NOT with an ADHD adolescent, and certainly NOT with an adult with either untreated ADHD adult or an adult who is actively abusing substances (– and yes, both alcohol and cannabis are substances of abuse!!!).