Nonstimulant Medications for Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common pediatric psychiatric disorders and is frequently diagnosed and treated by pediatricians. Stimulant medications are the first-line treatment for ADHD but may not be a good fit for many patients due to side effects, inadequate treatment response, or family preference. Non-stimulant ADHD medications provide a useful alternative for patients that cannot tolerate stimulants, have an incomplete treatment response to stimulants, are at risk for stimulant diversion, or whose family prefers to avoid stimulants. Nonstimulant ADHD medications can be used as monotherapy or added to a stimulant as an augmentation strategy. The recommended nonstimulant ADHD medications include alpha agonists (eg, guanfacine extended-release [ER], clonidine ER) and norepinephrine reuptake in-hibitors (eg, atomoxetine, viloxazine). Other nonstimulant medications (eg, buproprion, tricyclic antidepressants, polyunsaturated fatty acids) have been used off-label for ADHD but are not recommended and should only be considered as a third-line option.