Attention-deficit hyperactivity disorder (ADHD) affects approximately 5% of children and 2.5% of adults and presents as age-inappropriate inattention, hyperactivity, or impulsivity, or a combination.  ADHD is treated with a variety of different medications, including amphetamines, atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil. However, few head to head studies have compared the agents and guidelines are inconsistent in treatment recommendations.

A recent meta-analysis of 133 double-blind randomized controlled trials of various ADHD medications compared to each other or placebo, evaluated efficacy and adverse effects at 12 weeks.  Considering  both efficacy and safety, the authors recommend methylphenidate in children and adolescents, and amphetamines in adults, as preferred medications for treating ADHD.  Notably, modafenil was no more effective than placebo in treating ADHD in adults and in children, only modafenil and methylphenidate were consistently more effective than placebo. 

Additional information about methyphenidate, modafenil, bupropion and atomoxetine can be found in the Top 300 Pharmacy Drug Cards.  If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to the Top 300 Pharmacy Drug Cards.  If your institution does not provide access, ask your medical librarian about subscribing.

For more information: 

Cortese S,  Adamo N, Del Giovane C, et al.  Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018 Aug 7.