New ADHD Medication: How Compounding Pharmacists Can Address Crucial Questions from Parents
When adults with ADHD try to describe their experience they say it feels like their brain never turns off or that every day is a struggle. Imagine the confusion and anxiety children must feel when they can’t pay attention, sit still or control their actions like all the other kids. More than half of youth with ADHD take stimulant medications and their parents usually have many questions. They’re concerned about medication safety, the effectiveness of generics, and how to deal with children who refuse medications. Compounding pharmacists who reach out to help parents manage ADHD medication make an important difference.
ADHD Challenges and Treatment Guidelines
ADHD is identified by its core deficits of hyperactivity and inattention, but it takes a skilled diagnostician to parse the complex range of nonspecific symptoms from other childhood challenges and potential comorbidities. Prevalence rates illustrate that this diagnostic process occurs often in doctor’s offices across the United States. Close to 3 percent of 4 to 5 year olds are diagnosed with ADHD. Prevalence rises to 9.5 percent in the 6 to 11 group and reaches nearly 12 percent in youth aged 12 to 17.1 Across all age groups, boys are diagnosed more than twice as often as girls.
Clinical practice guidelines released in 2011 by the American Academy of Pediatrics recommend behavior therapy as the first line of treatment for preschool-aged children, followed by methylphenidate if behavioral interventions are unsuccessful.2 By comparison, the CDC estimates that half of all preschoolers never receive behavioral therapy and half of them take ADHD medications.3 Prescription medication and behavioral therapy are advised for youth aged 6 and older. Treatment varies from one state to the next, with anywhere from 57 to 88 percent in this age group taking medications, while 33 to 61 percent participate in behavioral therapy.
New ADHD Medication on the Horizon and Generic Concerns
The Daytrana transdermal patch and oral methylphenidate are possible choices for children who struggle with swallowing pills, but parents will soon have a new option. The FDA recently approved a chewable tablet called QuilliChew that contains extended-release methylphenidate and is slated to be released in the first quarter of 2016.4 Since it’s approved for children ages 6 and older, compounding pharmacists remain a key resource for parents of preschoolers who may not know about formulating palatable medications using different flavors and forms.
Compounding pharmacists will encounter parents of children with ADHD—and adult ADHD patients—who are upset that a generic medication isn’t as effective as the brand-name product they used to take. Regardless of your confidence in generic products, it may be best to avoid saying that generic drugs have the same use, dosage, side effects, risks, safety profile and potency as brand-name drugs. It’s vital not to dismiss their concerns. When a parent reports their child’s behavior has worsened or regressed, it’s a red flag that medication adjustments may be needed or that a reassessment for comorbid disorders is necessary. Compounding pharmacists may be the last hope for guidance if health care providers have already offered firm assurances that generics are exactly the same.
As the opportunity arises to counsel parents about generic ADHD medications, keep these tips in mind:
- Differences in generic medications may be just enough to trigger a change in children’s behavior. Advise parents to consult their physician, but suggest that they note how quickly the medication takes effect and how long it lasts because this info will help the doctor’s evaluation.
- Parents may have searched the Internet and read about the FDA’s 2014 report over efficacy differences in two generic versions of Concerta extended release tablets.5 Assure them the medications are safe and talk about how each child’s metabolism affects the drug’s rate of delivery.
- Take the opportunity to talk about how compounding can help tailor treatments, doses and palatable options.
Counseling Support for Parents of Kids with ADHD
The first comprehensive review of methylphenidate’s benefits and risks was published in November 2015. The authors of the systematic review reported low quality outcomes in published studies. For example, some studies lacked peer review protocols, seven studies didn’t separate outcomes for inattention, hyperactivity or impulsivity, and 14 failed to report adverse events.6 The authors concluded that methylphenidate may improve behavior and symptoms of ADHD but the extent of the improvement remains uncertain due to the questionable quality.
The researchers found an association with methylphenidate and non-serious adverse events, such as sleep problems and decreased appetite. Such side effects aren’t serious according to the researcher’s definition for purposes of the review, but lack of sleep increases the risk of weight gain and chronic disease. Sleep-disrupted children impact parent’s sleep and the family’s quality of life. When parents fill prescriptions for ADHD medications, talk to them about common concerns:
- Parents may be apprehensive about using sleeping aids for children, so discuss natural solutions for sleep disorders. Whether you choose pre-formulated sleeping aids containing melatonin and GABA or mix a blend tailored to the patient, don’t miss the chance to counsel parents about the safety of natural products.
- Remind parents that ADHD medication takes time to achieve its full effect. Even if they have concerns, treatment shouldn’t be disrupted until they consult the prescribing physician.
- If parents are concerned about side effects from stimulant medications, encourage them to talk with their doctor about non-stimulant options such as clonidine.
- Be prepared to ask whether they’ve considered behavioral therapy. Parents may not know that outcomes are improved when medication is used together with therapy.7 Have a handout that gives an overview of multimodal therapy and lists mental health professionals in your area.
- Behavioral therapy concepts, such as reward charts, are also effective for motivating children to take medications. Compounding pharmacists can download behavior charts to give to parents, then take it a step further and build connections by asking the child to bring it back to the pharmacy when it’s full for a small reward.8
Compounding Pharmacists Can Help Make Sense of a Complex Disorder
ADHD disrupts a child’s ability to participate at school, in the community and at home. Depending on the severity of symptoms, it interferes with family life, as parents curtail activities due to the challenges of managing difficult behaviors. Medication often yields dramatic improvement, making the difference between success and failure at school, but medication comes with parental questions. Compounding pharmacists build loyal customers and help patients by stepping up to provide the answers.
Pharmaceutica North America remains committed to supporting compounding pharmacists as they work with patients to find solutions for ADHD. We provide bulk pharmaceuticals and compounding kits designed to fit your needs, so contact us today to discuss how we can help.
- “Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4-17 Years: United States, 2011-2013,” May 2015, http://www.cdc.gov/nchs/data/databriefs/db201.htm ↩
- “American Academy of Pediatrics: ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents,” November 2011, http://pediatrics.aappublications.org/content/pediatrics/early/2011/10/14/peds.2011-2654.full.pdf ↩
- Key Findings: Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) Among Children with Special Health Care Needs, April 2015, http://www.cdc.gov/ncbddd/adhd/features/adhd-keyfindings-treatment-special-needs-children.html ↩
- “FDA Clears Chewable Methylphenidate (QuilliChew) for ADHD,” December 2015, http://www.medscape.com/viewarticle/855572 ↩
- “Methylphenidate Hydrochloride Extended Release Tablets (Generic Concerta) Made by Mallinckrodt and Kudco,” November 2014, http://www.fda.gov/Drugs/DrugSafety/ucm422568.htm ↩
- “Methylphenidate for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Cochrane Systematic Review with Meta-Analyses and Trial Sequential Analyses of Randomised Clinical Trials,” November 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4659414/ ↩
- “The Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA): Questions and Answers,” November 2009, http://www.nimh.nih.gov/funding/clinical-research/practical/mta/the-multimodal-treatment-of-attention-deficit-hyperactivity-disorder-study-mta-questions-and-answers.shtml ↩
- “Download Free Printable Behavior Charts for Home or School,” 2015, http://latitudes.org/behavior-charts/ ↩