Consider clinically relevant pharmacokinetic drug interactions when co-prescribing drugs in attention-deficit/hyperactiv
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DRUG REACTIONS AND INTERACTIONS
Consider clinically relevant pharmacokinetic drug interactions when co‑prescribing drugs in attention‑deficit/hyperactivity disorder Esther Kim1 · Young‑A. Heo1
© Springer Nature Switzerland AG 2020
Abstract Polypharmacy is common in the treatment of attention-deficit hyperactivity disorder (ADHD). However, the use of multiple drugs increases the risk of pharmacokinetic drug–drug interactions (DDIs) and subsequent adverse safety outcomes. Clinically relevant pharmacokinetic DDIs can be prevented by adjusting the dose of the ADHD drug or, if possible, by using an alternative drug that would not have a pharmacokinetic effect on the ADHD drug.
Polypharmacy is common in ADHD Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often presents as part of a spectrum of emotional, physical and social conditions [1]. Comorbidity is a rule, rather than an exception, in ADHD. The majority of preschool-aged children and adults with ADHD have ≥ 1 at least one concurrent disorder with ≥ 3 concurrent disorders being seen in more than half and ~ 14% of patients in the respective age groups [1]. First-line treatment of ADHD involves pharmacotherapy, with polypharmacy becoming an increasingly common strategy in patients who have comorbidities or an insufficient response to monotherapy [2]. Polypharmacy, however, increases the risk of drug–drug interactions (DDIs) and adverse safety outcomes [2]. Therefore, identifying potential DDIs with ADHD drugs is critical [1]. This paper summarizes clinically significant pharmacokinetic DDIs associated with ADHD drugs [1–3]
Be familiar with ADHD treatments… Several medications are widely approved for the treatment of ADHD [2], and are categorized as stimulants (i.e. methylphenidate, methylphenidate-based formulations, amfetamine and amfetamine-based formulations) and non-stimulants (i.e. * Young‑A. Heo [email protected] 1
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atomoxetine, clonidine and guanfacine). In general, stimulants increase the synaptic activity of noradrenaline and dopamine [2], whereas the mechanisms of actions of nonstimulants are, although not fully understood, believed to be different and complementary to that of stimulants [4]. Stimulants are used as first-line pharmacological treatment in children and adults, and non-stimulants are usually used when a patient does not respond to, or cannot tolerate, stimulants [1]. In addition, off-label treatments (e.g. first- or secondgeneration antipsychotics, mood stabilizers) are commonly used in the treatment of ADHD [2]. Natural health products (NHP), such as echinacea, ginkgo biloba and St John’s wort, are also used to treat ADHD [3]. A wide array of adverse effects, most of which are mild and transient, are associated with ADHD medications [1]: • Stimulants Abdominal pain, decreased appetite, increased
heart rate and blood pressure (adults), nausea/vomiting, sleeping issues • Atomoxetine Anorexia, fatigue, gastrointestinal sympto
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