Most commonly, attention deficit hyperactivity disorder (ADHD) is diagnosed in children, and this condition often persists through adolescence and later adulthood.  Children with ADHD fall into 3 categories:

• primarily hyperactive-impulsive
• primarily inattentive
• a combination. 

Although some people with ADHD, "outgrow" the disease, it's estimated that as many as 80 percent of individuals carry the condition through adulthood.

  Of note, adults with ADHD are by and large not hyperactive and instead inattentive. 

A number of medications are used to treat ADHD. The medications that are most commonly prescribed to treat ADHD are stimulants and include many brand-name drugs.  However, lower-cost generic alternatives also exist. 

(The use of stimulants to treat adults with ADHD is poorly understood.  Despite accounts of stimulants working in adults, concerns about efficacy and safety of stimulant use in this population cloud the picture.  Specifically, some research suggests that adults with ADHD who take stimulants are at increased risk for palpitations, anxiety and increases in blood pressure.)

Here is a list of medications used to treat ADHD.  Please note that I listed the brand name first followed by the generic designation in parentheses.

• Adderall and Adderall XR (amphetamine and dextroamphetamine)
• Concerta (methylphenidate)

• Daytrana (methylphenidate)
• Desoxyn (methamphetamine)
• Dexedrine (dextroamphetamine)
• Focalin and Focalin XR (dexmethylphenidate)
• Intuniv (guanfacine)
• Metadate CD and Metadate ER (methylphenidate)
• Methylin and Methylin ER (methylphenidate)
• Ritalin, Ritalin LA and Ritalin SR (methylphenidate)
• Quillivant XR (methylphenidate)

• Strattera (atomoxetine)
• Vyvanse (lisdexamfetamine)

Of note, the XR, ER and LR designations indicate extended-release preparations.  Furthermore, Ritalin SR is a controlled release form of Ritalin.  Finally, all these drugs except Intuniv are stimulants.  (Intuniv is an antiadrenergic medication which acts on the sympathetic nervous system to decrease blood pressure.  It is used to treat hypertension and ADHD.)

Of the medications listed above, only Intuniv, Quillivant XR, Strattera and Vyvanse are brand name.  All other medications can be purchased as generics.

As you probably know, brand-name drugs can get pretty pricey.  Generic medications are low-cost alternatives which work just as well as brand-name drugs and have been scrutinized and approved by the FDA, too. 

For example, as of June 2015, a 10-mg tablet of Focalin costs about $1.40.  A 10-mg tablet of dexmethylphenidate, on the other hand, costs $0.63.  If you do the math, it's apparent that switching to such generic medications can save you thousands of bucks on ADHD treatment a year.

Furthermore, as compared with generic equivalents, it can cost multiple times more to purchase extended-release preparations.  Although it's more convenient to take extended-release iterations because fewer doses are needed, you can save lots of money by switching to shorter-acting alternatives.

If you're having trouble paying for ADHD medications, immediately inform the prescribing physician and ask about generic alternatives.  The physician can offer you options and alternatives that will lower the cost of ADHD medications.  For example, CVS/Caremark -- like many other large pharmacy retailers -- offers a value formulary which can be prescribed from for cheap. Moreover, patient assistance programs are also available in many communities.  These programs can greatly subsidize the cost of treatment.

_{Selected Sources}

_{Ropper AH, Samuels MA, Klein JP. Chapter 28. Normal Development and Deviations in Development of the Nervous System. In: Ropper AH, Samuels MA, Klein JP. eds. Adams & Victor's Principles of Neurology, 10eSearight H, Shinabarger C. Attention Deficit Hyperactivity Disorder. In: Feldman MD, Christensen JF,}

_{Satterfield JM. eds. Behavioral Medicine: A Guide for Clinical Practice, 4e. New York, NY: McGraw-Hill; 2014.   Accessed June 09, 2015.. New York, NY: McGraw-Hill; 2014. Accessed June 09, 2015.}

 

Question: Is It Safe to Take Phenytoin, the Generic Version of Dilantin?

A number of readers have written in questions about the generic form of Dilantin. These are two examples:

My Medicare Part D provider informed me that they would no longer cover my seizure medication other than the generic. My neurologist told me that many generics used to treat seizures are not as good as the brand names. Is that true?

As an epileptic, my neurologist has told me to never get generic medication. My health plan is telling me they will only pay for the generic medicine. Help. Thank you for any information you can give me.

Answer:

Safety of Generic Medication

According to the U.S. Food and Drug Administration (FDA), the active ingredient in a generic drug is equivalent to the brand-name version. More than 55% of all the medications prescribed in the United States are generics.

For the most part, generic medications are as safe and effective as the brand-name version of the drug. Several of the major U.S. drug companies manufacturer generics, and the world's largest maker of generic drugs, TEVA, is an Israeli company with very high standards.

Generic pills do differ, however, in the inactive ingredients, such as color, flavoring, preservatives and the filler materials that hold the pill or tablet together. Although uncommon, some people may be allergic to one or more of these inactive ingredients.

Issues with Seizure Medications

For some people using certain medications, generics can be a problem. This is most often a problem with medications in which even a miniscule change in dose can be ineffective or cause side effects. Dilantin (phenytoin) is one of those medications.

Some people with epilepsy report problems with generic seizure medications.

Doctors who treat people with epilepsy have also reported that some people have “breakthrough” seizures when switching from brand to generic versions of a seizure drug -- or among generics made by different manufacturers. A “breakthrough” seizure is one that occurs unexpectedly in someone who has had good seizure control.

Organizations Provide Guidance

According to the Epilepsy Foundation, the organization has opposed “mandatory substitution of generic drugs for brand names since generics first became available because of concerns about reported breakthrough seizures in some people with epilepsy when they are switched from one version of a medication to another. Other medical organizations focused on the treatment of epilepsy have had similar positions.”

The Epilepsy Foundation notes that many people with epilepsy can safely use generic epilepsy medications to save money, but the decision to do so should be left up to you and your doctor. Your health plan should not mandate the use of generic medications to treat epilepsy.

According to the American Academy of Neurology, "The Food and Drug Administration has allowed for significant differences between name-brand and generic drugs. This variation can be highly problematic for patients with epilepsy. Even minor differences in the composition of generic and name-brand anticonvulsant drugs for the treatment of epilepsy can result in breakthrough seizures."

Dealing with Your Health Plan

If your health plan will not pay for the brand-name version of your epilepsy medication, you and your doctor can appeal. All health plans have appeal mechanisms and often a phone call from your doctor will allow you to get brand-name epilepsy medication, if appropriate.