Clinically significant interactions with stimulants and other non-stimulants for ADHD

Abstract

The pharmacologic treatment of attention deficit and hyperactivity disorder (ADHD) involves the use of stimulant and non-stimulant agents. These agents have been implicated in various pharmacokinetic and pharmacodynamic interactions that could result in clinical outcomes that are either favorable or unfavorable to the patient’s treatment. This chapter provides a discussion of such interactions and their management. Genetic polymorphisms associated with certain drug transporter systems and cytochrome P450 alleles have been shown to potentially alter treatment response when stimulant and non-stimulant agents are used for the management of ADHD. Some of the pharmacokinetic and pharmacodynamic interactions may not be considered clinically significant. However, patient-specific factors will often determine whether a potential drug interaction is clinically significant, and it is important for the treating physician to evaluate each patient’s regimen to discern the significance of a potential interaction in that patient. Similarly, the area of pharmacogenomics continues to evolve, and as more becomes known in this area, treatment outcomes could be affected. After evaluation of the drug regimen and associated drug interaction, the clinician must determine whether therapy should be continued without changes or altered. Nonetheless, clinicians should adhere to recommended medication monitoring parameters and dose adjustments based on patient-specific parameters, as outlined by product labeling and clinical guidelines.