Release mode Medications & Illustrations Delivery Duration ...

1 CADDRA GUIDE TO ADHD PHARMACOLOGICAL TREATMENTS IN CANADA - FEBRUARY 2020 Medications & IllustrationsDeliveryDuration of action1 Starting dose2 Release mode Immediate/Delayed (%)Dose titration per product monograph3 AMPHETAMINE-BASED PSYCHOSTIMULANTSF irstLine Capsules 5, 10, 15, 20, 25, 30 mgGranules can be sprinkled ~12 h5-10 mg 5-10 mg at weekly intervals Max. dose/day: Children = 30 mg Adolescents & Adults = 20-30 mgFirstLineCapsules 10, 20, 30, 40, 50, 60, 704 mg Capsule content can be diluted in liquid or sprinkled~13-14 h20-30 mg Applicable (Prodrug) 10-20 mg by clinical discretion at weekly intervals Max. dose/day: All ages = 60 mgChewable Tablets 10, 20, 30, 40, 50, 60 mgChewable tablets should be chewed thoroughlySecondLine Tablets 5 mgScored Tablet~4 hTablets = to 5 mg 5 mg at weekly intervals Max.

2 Dose/day: ( or ) Children & Adolescents = 20-30 mg Adults = 50 mgSpansules 10, 15 mgBeaded Formulation~6-8 hSpansules = 10 mg PSYCHOSTIMULANTSF irstLine Capsules 10, 15, 20, 30, 40, 50, 60, 80 mgGranules can be sprinkled~10-12 h10-20 mg 10 mg at weekly intervals Max. dose/day: Children & Adolescents = 60 mgAdults = 80 mgFirstLineConcerta Extended Release Tablets 18, 27, 36, 54 mgOsmotic-Controlled Release Oral Delivery System (OROS )~12 h18 mg 18 mg at weekly intervals Max. dose/day: Children & Adolescents = 54 mg Adults = 72 mgFirstLineFoquest Capsules 25, 35, 45, 55, 70, 85, 100 mgGranules can be sprinkled~16 h25 mg 10-15 mg in intervals of no less than 5 days Max.

3 Dose/day: Children & Adolescents = 70 mg Adults = 100 mgSecondLineMethylphenidateshort-actingT ablets 5 mg (generic) 10, 20 mg (Ritalin )Scored Tablet~3-4 h5 mg to 100/0 5-10 mg at weekly intervals Max. dose/day: All ages = 60 mgRitalin SRTablets 20 mgWax Matrix Preparation~8 hAdult = consider 20 mg100/0 NON-PSYCHOSTIMULANT - SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITORS econdLineStrattera (Atomoxetine)Capsules 10, 18, 25,40, 60, 80, 100 mgCapsule needs to be swallowed whole to reduce GI side effectsUp to24 hChildren & Adolescents: mg/kg/day Adults = 40 mg for 7-14 daysNot ApplicableMaintain dose for a minimum of 7-14 days before adjusting: Children = then mg/kg/day70 kg or Adults = 60 then 80 mg/day Max.

4 Dose/day: mg/kg/day or 100 mgNON-PSYCHOSTIMULANT - SELECTIVE ALPHA-2A ADRENERGIC RECEPTOR AGONISTS econdLineIntuniv XR (Guanfacine XR)Extended Release Tablets 1, 2, 3, 4 mgPills need to be swallowed whole to keep Delivery mechanism intactUp to 24 h1 mg (morning or evening)Not ApplicableMaintain dose for a minimum of 7 days before adjusting by no more than 1 mg increment weekly Max. dose/day: Monotherapy: 6-12 years = 4 mg 13-17 years = 7 mg As adjunctive therapy to psychostimulants 6-17 years = 4 mgIllustrations do not reflect actual size of pills/capsules. Longer-acting stimulants tend to have lower abuse potential than shorter-acting formulations. Non-stimulant formulations have no abuse potential.

5 1 Pharmacokinetic and pharmacodynamic responses vary from individual to individual. The clinician must use clinical judgment as to the Duration of efficacy and not solely rely on reported values for PK-PD and Duration of effect. 2 Starting doses in table are taken from product monographs. CADDRA recommends usually starting with the lowest dose available. 3 For specific details on how to start, adjust and switch ADHD Medications , clinicians should refer to the Canadian ADHD Practice Guidelines ( ). 4 Vyvanse 70 mg is an off-label dosage for ADHD treatment in Canada. Original version of this sheet developed by Dr. Annick Vincent in collaboration with Direction des communications et de la philanthropie, Laval University.

6 Access provincial and federal formulary information at XR Vyvanse Dexedrine Biphentin GUIDE CADDRA POUR LES TRAITEMENTS PHARMACOLOGIQUES DU TDAH AU CANADA F VRIER 2020 Type de mol cules et illustrationMode de lib rationDur e d action1 Posologie de d part2 Mode de lib ration imm diate/prolong e (%)Augmentation de la dose selon la monographie de produit3 PSYCHOSTIMULANTS BASE D AMPH TAMINESP remi re intention Capsules 5, 10, 15, 20, 25, 30 mgGranules saupoudrables ~12 h5-10 mg die 5-10 mg par palier de 7 j Dose max/j: Enfant = 30 mgAdolescent et adulte = 20-30 mgPremi re intention G lules 10, 20, 30,40, 50, 60, 704 mg Contenu des g lules peut tre dissout dans un liquide ou saupoudr ~13-14 h20 - 30 mg die objet (prom dicament) 10-20 mg selon discr tion du md par palier de 7 j Dose max/j: Tous ges = 60 mgComprim s croquer10, 20, 30, 40, 50, 60 mgLes comprim s croquer doivent tre croqu s compl tementDeuxi me intention Comprim s 5 mgComprim s cable ~4 h100/0 5 mg par palier de 7 j Dose max/j.

7 (die ou ) Enfant et adolescent = 20-30 mg Adulte = 50 mgSpansules 10, 15 mgFormulation granules~6-8 hComprim = 2,5-5 mg = 10 mg die BASE DE M THYLPH NIDATEP remi re intentionBiphentin Capsules 10, 15, 20,30, 40, 50, 60, 80 mgGranules saupoudrables~10-12 h10 - 20 mg die 10 mg par palier de 7 jDose max/j: Enfant et adolescent = 60 mg Adulte = 80 mgPremi re intentionConcerta Comprim s lib ration prolong e 18, 27, 36, 54 mgMode de lib ration contr l e par la pression osmotique (OROS )~12 h18 mg die 18 mg par palier de 7 jDose max/j: Enfant et adolescent = 54 mg Adulte = 72 mgPremi re intentionFoquest Capsules 25, 35, 45,55, 70, 85, 100 mgGranules saupoudrables~16 h25 mg die 10-15 mg par palier d au moins 5 j Dose max/j: Enfant et adolescent = 70 mg Adulte = 100 mgDeuxi me intentionM thylph nidate courte actionComprim s 5 mg (g n rique) 10, 20 mg (Ritalin )Comprim s cable~3-4 h5 mg 100/0 5mg par palier de 7 j Dose max/j.

8 Tous ges = 60 mgRitalin SRComprim s 20 mgMatrice base de cire~8 hAdulte - envisager 20 mg100/0 NON PSYCHOSTIMULANT INHIBITEUR S LECTIF DU RECAPTAGE DE LA NORADR NALINED euxi me intentionStrattera (atomox tine)Capsules 10, 18, 25,40, 60, 80, 100 mgCapsule doit tre aval e enti re pour r duire les effets secondaires GI24 hEnfant et adolescent: 0,5 mg/kg/j Adulte = 40 mg die x 7 14 jSans objetMaintenir dose au moins 7-14 j avant d ajuster: Enfant = 0,8 puis 1,2 mg/kg/j 70 kg ou adulte = 60 puis 80 mg/j Dose max/j: 1,4 mg/kg/j ou 100 mgNON PSYCHOSTIMULANT AGONISTE S LECTIF DES R CEPTEURS ALPHA-2A ADR NERGIQUESD euxi me intentionIntuniv XR (guanfacine XR)Comprim s lib ration prolong e 1, 2, 3, 4 mgComprim doit tre aval entier pour conserver le m canisme de lib ration intact24 h1 mg die (matin ou en soir e)Sans objetMaintenir dose pour au moins 7 j avant d ajuster par palier ne d passant pas 1 mg/semaineDose max/j: Monoth rapie: 6-12 ans = 4 mg 13-17 ans = 7 mgEn traitement d appoint avec un psychostimulant : 6-17 ans = 4 mgLa taille r elle des comprim s et capsules n est pas celle illustr e.

9 Les stimulants longue dur e d action ont tendance avoir un potentiel d abus inf rieur celui des formulations courte dur e d action. Les non-stimulants n ont pas de potentiel d abus. 1 Les r ponses pharmacocin tiques et pharmacodynamiques varient d un individu l autre. Le clinicien doit utiliser son jugement clinique quant la dur e de l efficacit et non seulement aux valeurs de courbes pharmacocin tiques et de dur e de l effet rapport es. 2 Les doses de d part sont tir es des monographies de produit. La CADDRA recommande de d buter en g n ral avec la plus petite posologie disponible. 3 Pour les informations sp cifiques concernant l instauration, l ajustement et le changement de m dicament pour le TDAH, les cliniciens sont invit s consulter les lignes directrices canadiennes sur le TDAH ( ).

10 4 Vyvanse 70 mg est un dosage hors indication pour le traitement du TDAH au Canada. La version originale de ce tableau fut d velopp e par Annick Vincent en collaboration avec la Direction des communications et de la philanthropie de l Universit Laval. Consultez l information sur les formulaires provinciaux et f d raux au Vyvanse Adderall XR Jusqu Ju squ