Attention deficit/hyperactivity disorder: pharmacotherapy.

Pharmacotherapy, one of the effective modalities of treatment for attention deficit/hyperactivity disorder (ADHD), was discovered serendipitously and, until recently, consisted primarily of short-acting methylphenidate and dextroamphetamine compounds. The US Food and Drug Administration's (FDA) approval of Concerta in 2000 followed by approval of additional long-acting methylphenidate (Ritalin LA; Metadate CD) and amphetamine formulations (Adderall XR) expanded the repertoire. By providing sustained efficacy for most of the school day, mid-day administration is avoided, privacy is preserved, and adherence to treatment improves. In 2001, an isomer preparation of methylphenidate, Focalin, was approved, and in 2002, Strattera, a selective noradrenergic agent expanded treatment options to non-controlled agents. At this time, stimulant preparations continue to remain the first-line agents due to their unparalleled efficacy and safety record. However, current treatment remains empirical due to lack of scientific data guiding the choice of agent as well as dose.