Impact of 3-Tier Formularies on Drug Treatment of Attention-Deficit/Hyperactivity Disorder in Children

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Abstract
Several safe and efficacious pharmaceutical treatments are now available for attention-deficit/hyperactivity disorder (ADHD), one of the most common chronic conditions of childhood.1 Numerous studies have shown that these medications are effective in controlling the principal symptoms of ADHD, including inattention, hyperactivity, and impulsiveness.1 Although overall efficacy for the various medications is similar, even though some have the same active ingredient but use different pharmacologic delivery systems, the efficacy and effectiveness of different medications may not be the same for a given child with ADHD.1,2 The drugs also differ with respect to their duration of action. For example, the generic drug methylphenidate has a duration of action of 3 to 6 hours, which means that a child would have to take multiple doses during the school day. By contrast, Concerta (ALZA Corp, Mountain View, Calif) has a duration of action of approximately 12 hours, so a single dose could last throughout the day.2 Differences in duration of action have implications for medication compliance, the possibility of breakthrough symptoms, and the potential for medication abuse and stigma.2 These issues suggest that each medication possesses attributes that may affect the drug’s suitability for treating a child given his or her clinical and life circumstances.