López Frank A
Children's Development Center, Winter Park, Florida 32792, USA.
J Dev Behav Pediatr. 2006 Oct;27(5):410-6. doi: 10.1097/00004703-200610000-00008.
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder affecting school-age children. In many cases, symptoms persist into adolescence and adulthood, causing significant lifelong impairments in academic, career, and social functioning. The stimulants methylphenidate and amphetamines have been used for decades as first-line therapy for the treatment of ADHD. Short-acting stimulant formulations control symptoms only for a few hours, creating the need for multiple daily doses of the medication. For school-age children, this necessitates administering medication during school hours, creating the potential for embarrassment and noncompliance. To offset these problems, longer acting stimulant formulations have been developed. Long-acting medications often control symptoms for up to 8 hours with only one daily dose of the medication, eliminating the need for in-school administration. Some long-acting stimulants are designed to control symptoms for up to 10 to 12 hours. Although stimulants are effective in most cases, some children are unable to tolerate these medications. Nonstimulant options are available for the treatment of ADHD and include atomoxetine, alpha-adrenergic agents, and antidepressants. Of these, atomoxetine is the only medication approved to treat ADHD. In spite of the number of medications available for the management of ADHD, treatment options with greater flexibility and reduced side effects are still desirable. A transdermal methylphenidate patch has recently been approved, and advances to existing stimulants currently under development include an amphetamine prodrug and a longer acting formulation of amphetamine. In addition, a number of nonstimulant entities, including guanfacine and modafinil, are under development for the treatment of ADHD.
注意力缺陷多动障碍(ADHD)是影响学龄儿童最常见的神经行为障碍。在许多情况下,症状会持续到青少年期和成年期,对学业、职业和社交功能造成重大的终身损害。兴奋剂哌甲酯和苯丙胺类药物已被用作治疗ADHD的一线疗法数十年。短效兴奋剂制剂只能控制症状几个小时,因此需要每日多次服药。对于学龄儿童来说,这就需要在上学时间服药,从而有可能导致尴尬和不服药的情况。为了弥补这些问题,已经开发出了长效兴奋剂制剂。长效药物通常每日只需服用一剂就能控制症状长达8小时,无需在学校服药。一些长效兴奋剂的设计可将症状控制长达10至12小时。尽管兴奋剂在大多数情况下都有效,但有些儿童无法耐受这些药物。治疗ADHD还有非兴奋剂类药物可供选择,包括托莫西汀、α-肾上腺素能药物和抗抑郁药。其中,托莫西汀是唯一被批准用于治疗ADHD的药物。尽管有多种药物可用于管理ADHD,但仍需要更灵活且副作用更小的治疗选择。一种透皮哌甲酯贴片最近已获批准,目前正在研发的现有兴奋剂的改进剂型包括一种苯丙胺前体药物和一种长效苯丙胺制剂。此外,一些非兴奋剂类药物,包括胍法辛和莫达非尼,正在研发用于治疗ADHD。