The question often arises why a physician chooses a particular medication to give to an individual to treat ADHD/ADD. Recently the focus on treatment has been to give a medication that is longer lasting, requiring only one pill a day. Previously, short acting preparations were available which required dosing every three to four hours. The start and stop effect can be quite problematic as well as inconvenient. The two major classes of stimulant treatments are methylphenidate and dextroamphetamines. This blog entry will discuss the pros and cons of the class of methylphenidate and next week I'll address dextroamphetamines. Below are frequently prescribed methylphenidates and their advantages and disadvantages: Concerta: Doses 18, 27, 36, 54, and 72mg. Commonly start with the lower dosage and titrate upward. The medication has a lower amount of medication initially and peaks around four to six hours, then gradually tapers off. The advantage of this medication is that it generally lasts throughout a 12 hour day, but may have lower effects early and late in the day, where problems with attention may arise. A short acting stimulant medication can be used to "pad" those times if needed. Advantages: Smooth in its onset and long lasting; multiple dosing options.Disadvantages: May require an additional short acting supplement, requiring a prescription for two medications. Focalin XR: Doses are 10, 20, 30 mg This medication starts rapidly with maximum blood levels occurring within 30 minutes of dkrutkaistration, and lasts at the high level for the duration of the effectiveness of the medication. It has fewer side effects than its isomer-counterpart called Ritalin. But some individuals are rapid medication metabolizers and the effects of the medicine may stop working earlier than is needed. Advantages: Rapid onset; comes in a sprinkle capsule which can be opened and sprinkled on foods for people unable to swallow a pill. Disadvantages: May not last through the entire day and short acting stimulants may need to be added. Metadate CD: Doses are 10 20, 30, 40, 50, 60mg. This medication works very well for many people who need sustainability without high levels after immediate intake of the medication. A little slower to start working, when the dosage is correct, may stay in the system for a longer time at a steady level. Advantages: Lots of dosing flexibility; fairly long activation period, fairly smooth in its onsetDisadvantages: May need higher doses in the beginning of the day; often not on Drug Formularies. Daytrana Patch: Doses 10, 20,30mg. This is a patch that is applied to the skin daily. It is generally placed in the lower back- buttock area, usually not visible after dressing. It has a slightly slower onset, but has a sustained blood level the entire time it is applied. This has huge advantages for the individual that needs constancy of the medication instead because they may be very sensitive to the release of the medicine in the other delivery systems. Advantages: Smooth and constant blood levels with good ability to regulate the medication amount.Disadvantages: Skin irritation can occur. This can usually be managed by lubricants and sometimes hydrocortisone cream. Sometimes the skin never adjusts to the patch and it has to be discontinued. Some individuals do not do well on the methylphenidate medications and need to be tried on other classes of medications. As always, make sure and consult with your physician about what medication is best for you. In my next blog, I will discuss the group of dextroamphetamines.