Medications to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents are available in short- and long-acting formulations. Short-acting formulations of methylphenidate (e.g., Ritalin) and dextroamphetamine (e.g., Dexedrine) are generally given two to three times daily. They have been shown to be effective in reducing ADHD symptoms and provide dosing flexibility. Compared with short-acting formulations, long-acting formulations are given less frequently, but are more expensive and are not covered in all insurance plans. Recommendations about the use of long- or short-acting formulations are largely derived from expert opinion of best practices. Discourse on the use of long-acting formulations have centred on the following issues: compliance, social stigma, in-school dosing, and drug diversion.

In 2010, publicly funded drug plans in Canada spent more than $35 million on long-acting formulations, which represented 77% of total expenditures on ADHD medications. As expenditures on ADHD medications continue to rise, health care decision-makers require evidence-based information on the issue of selecting the most appropriate formulation for treating ADHD in children and adolescents.

Contents

• EXECUTIVE SUMMARY
• ABBREVIATIONS
• 1. INTRODUCTION
  • 1.1 CONDITION
  • 1.2 PHARMACOLOGICAL TREATMENTS
• 2. ISSUE
• 3. OBJECTIVES
• 4. METHODS
  • 4.1 Guidelines and Recommendations
  • 4.2 Economic Data
• 5. SUMMARY OF FINDINGS
  • 5.1 Guidelines and Recommendations
  • 5.2 Limitations
• 6. CONCLUSIONS AND IMPLICATIONS FOR DECISION- OR POLICY-MAKING
• REFERENCES
• APPENDIX 1 RECOMMENDATIONS FROM NATIONAL EVIDENCE-BASED GUIDELINES DEVELOPED USING RIGOROUS SCIENTIFIC METHODS
• APPENDIX 2 SUMMARY OF EVIDENCE AND RECOMMENDATIONS FROM GUIDELINES ON ADHD

Production of this report is made possible through a financial contribution from Health Canada and the governments of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Prince Edward Island, Saskatchewan, and Yukon.

This report is prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). This report contains a comprehensive review of existing public literature, studies, materials, and other information and documentation (collectively the “source documentation”) available to CADTH at the time it was prepared.

The information in this report is intended to help health care decision-makers, patients, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services.

The information in this report should not be used as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete, and up-to-date, CADTH does not make any guarantee to that effect. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or as a result of the use (or misuse) of any information contained in or implied by the information in this report.

CADTH takes sole responsibility for the final form and content of this report. The statements, conclusions, and views expressed herein do not necessarily represent the view of Health Canada or any provincial or territorial government.