Levin G M
Albany College of Pharmacy, Union University, NY, USA.
Am Pharm. 1995 Nov;NS35(11):10-20.
Included in the variety of options for treating ADHD are several classes of pharmacologic agents with various side effects and monitoring parameters. The pharmacist must understand the issues involved with the use of the agents in each class. The pharmacist is often the most accessible health care professional and can take advantage of this fact to counsel and support both patients and family members. Table 5 offers counseling tips and additional information for the pharmacist. Of the medications discussed here, the stimulants are recognized as the most effective for treating ADHD, with the amphetamines and methylphenidate providing equal benefit. In some instances, pemoline has also been shown to be as effective as the other stimulants. Second-line agents are the TCAs, of which imipramine is the most commonly prescribed. However, the other TCAs are probably just as effective; some may have a less burdensome profile of side effects and may result in better compliance. Next in line is bupropion or clonidine, both of which show promise for ADHD treatment. Nevertheless, these agents need to be tested in more rigorous trials. Agents of last resort include the MAOIs, of which tranylcypromine has been the most studied. The ideal agent for treating ADHD would have an immediate onset, provide benefit throughout the day, have few or no side effects, lack the potential for abuse, be effective for most patients, and be relatively inexpensive. This ideal agent has yet to be discovered. Clinicians and researchers are still looking for a medication to come as close to the ideal therapy as possible. Therefore, it is not uncommon for a pharmacist to see a patient with ADHD try several different medications. In addition, children in whom ADHD is refractory to currently available options or who cannot tolerate these options may also be given other psychotropic medications not mentioned in this review.
治疗注意力缺陷多动障碍（ADHD）的多种选择中包括几类具有不同副作用和监测参数的药物制剂。药剂师必须了解每类药物使用中涉及的问题。药剂师通常是最容易接触到的医疗保健专业人员，可以利用这一事实为患者及其家庭成员提供咨询和支持。表5为药剂师提供了咨询提示和更多信息。在这里讨论的药物中，兴奋剂被认为是治疗ADHD最有效的药物，苯丙胺和哌甲酯具有同等疗效。在某些情况下，匹莫林也已显示出与其他兴奋剂同样有效。二线药物是三环类抗抑郁药（TCAs），其中丙咪嗪是最常用的处方药。然而，其他三环类抗抑郁药可能同样有效；有些药物的副作用可能较轻，可能会提高依从性。接下来是安非他酮或可乐定，这两种药物在ADHD治疗方面都显示出前景。然而，这些药物需要在更严格的试验中进行测试。最后手段的药物包括单胺氧化酶抑制剂（MAOIs），其中反苯环丙胺研究得最多。治疗ADHD的理想药物应起效迅速，全天有效，副作用很少或没有，没有滥用的可能性，对大多数患者有效，且相对便宜。这种理想药物尚未被发现。临床医生和研究人员仍在寻找一种尽可能接近理想疗法的药物。因此，药剂师看到患有ADHD的患者尝试几种不同的药物并不罕见。此外，对目前可用治疗方案难治或无法耐受这些方案的ADHD儿童也可能会使用本综述未提及的其他精神药物。
