ADHD Treatment Guidelines
Treatment guidelines recommend longer acting methylphenidates as preferred treatment children, adolescents and adults.
The aim of treating ADHD is to optimise the child’s cognitive, social and emotional functioning so as to prevent the development of secondary emotional distress or psychiatric disorders and allow the child to reach his/her full developmental potential. Symptoms of inattentiveness and hyperactivity/impulsivity should be targeted, but the child’s overall functioning, including family and social relationships, leisure activities and self-esteem must also receive attention.
General aspects of treatment
It is important to develop a treatment plan once the diagnosis has been established. This plan can be changed in the light of responses to treatment options, the emergence of other issues that need to be addressed and changing family circumstances. The treatment plan should always include psychoeducation of the patient, their caregivers and educators. It should include information about ADHD, helping parents and teachers to anticipate developmental challenges that are difficult for children and adolescents with ADHD, and general advice to improve the child’s academic, social and behavioural functioning.
In recent years, much research attention has been focused on the relative indications for various forms of management, from which a considerable degree of consensus has emerged. Based on the existing guidelines, we propose that behavioural treatments may be applicable as first-line treatment if:
- The ADHD is mild or (perhaps) moderate, with minimal impairment
- The diagnosis is uncertain
- The parents (or patient) reject medication as a treatment option
- There is disagreement between key stakeholders about the diagnosis
- There are no comorbid diagnoses or significant life stressors
- An urgent response is not required.
addressed by an appropriate child and adolescent mental health professional.
Children who are taking stimulant medication require monthly prescriptions (repeat prescriptions are not permitted for Schedule 6 medicines) and at least 6-monthly reviews by a psychiatrist.
- Schoeman R, Liebenberg R. The South African Society of Psychiatrists/Psychiatry Management
- Fisher AJ, Hawkridge S. Attention deficit hyperactivity disorder in children and adolescents. S Afr J Psychiat. 2013;19(3):136-140.
Methylphenidate Mode of Action
Norepinephrine and dopamine are key neurotransmitters for prefrontal functioning. Methylphenidate blocks the norepinephrine and dopamine transporters, leading to increased availability of norepinephrine and dopamine at the synaptic space .
Indication, Mode of Release and Bioequivalence
Contramyl XR, an extended-release formulation of Methylphenidate is classified as a long-acting Methylphenidate available in 4 tablet strengths.
- Contramyl XR 18 mg
- Contramyl XR 27 mg
- Contramyl XR 36 mg
- Contramyl XR 54 mg
Extended-release methylphenidate once daily reduces the fluctuations between peak and trough concentrations associated with immediate-release methylphenidate three times daily.1
Following oral administration of extended-release methylphenidate to adults, plasma methylphenidate concentrations increase reaching an initial maximum at about 1 to 2 hours, then increase gradually over the next several hours. Peak plasma concentrations are achieved at about 6 to 8 hours after which a gradual decrease in plasma levels of methylphenidate begins.1
CONTRAMYL XR INDICATION
CONTRAMYL XR is indicated for the treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents aged 6 to 17 and adults aged 18 to 65 who meet DSM-IV criteria for ADHD.
CONTRAMYL XR MODE OF RELEASE
Contramyl XR extended release for once daily dosing utilizes a Multi-Unit Particulate System (MUPS) for immediate and extended release of methylphenidate
The coating of the tablet contains the immediate release layer of 21% of methylphenidate and an inner layer delivering 79% of the methylphenidate through pellets with a spherical core that contains the active ingredient. The spherical core has protective layers to control drug release.
Compared to other delivery systems, MUPS formulations offer a lower risk of local irritation and toxicity, reduced dose dumping, minimal plasma concentration fluctuations and the ability to administer high potency products
CONTRAMYL XR BIOEQUIVALENCE
In a single dose (18mg), randomized, open label, two-treatment, two period, two-sequence crossover oral bioequivalence study in healthy, adult human subjects under fasting conditions Contramyl XR proved to be bioequivalent to the Originator
- MUPS (Multiple Unit Pellet System) Production [online] [cited 23 March 2021]; Available from URL: https://www.gea.com/en/pharma-healthcare/solid-dosage/mups.jsp.
- Starr HL, A new treatment option for attention deficit/hyperactivity disorder. Paediatr Child health . 2004; 9 (Suppl B): 13B-16B.
Dosing & Administration
CONTRAMYL XR Dosage for Patients new to methylphenidate:
CONTRAMYL XR Dosage for Patients currently using methylphenidate:
Dosing recommendations are based on current dose regimen and clinical judgement
CONTRAMYL XR is administered orally once daily. As the effect has been shown to be present 12 hours after dosing, it should be taken in the morning.
CONTRAMYL XR must be swallowed whole with adequate amounts of liquids and must not be chewed, divided or crushed. Even though the tablets have a score line, it is not intended as a break line and the tablets should not be divided and taken at different intervals.
CONTRAMYL XR may be administered with or without food.
Dosage should be individualised according to the needs and responses of the patients.
Reference: Package Insert