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Parents: Don’t rush to Adderall XR, Concerta, Strattera to Treat ADHD

Published: July 08, 2009 05:11 PM

Not all children diagnosed with ADHD need to take a drug. But if one is warranted, the choice may be difficult in light of very effective drug advertising and free drug samples provided by doctors. Most parents of course will do everything they can to get the best treatment for their child. But when it comes to drugs for ADHD, shelling out thousands of dollars a year on the brand-name drugs may not provide it.

According to our new Best Buy Drugs report, no one drug to treat ADHD symptoms has been proven to work better than any another. So, for most children and adults, the generics dextroamphetamine or methylphenidate are as safe and effective as the heavily-advertised, brand-name drugs like Adderall XR (an extended-release mix of amphetamine salts), Concerta (extended-release methylphenidate) or Strattera (atomoxetine) to treat ADHD symptoms. Plus, you could save roughly $3,000 a year or more with one of the generic Best Buy drugs, depending on the dosage.

So why would you give the well-known, branded drugs to your child? And why do doctors prescribe them?

One answer is clear: free drug samples.

Drug companies gave away nearly $16 billion in free drug samples in 2004, and doctors often hand these out to patients—and, in pediatric practices, to parents. In fact, according to a 2004 study, about one out of every 10 kids already taking a medication received a free drug sample. Contrary to popular belief, children from well-off families with drug plans receive the bulk of those samples, not the most-needy children.

For drugs to treat ADHD symptoms, this has a special significance: the same study found that Strattera was the 4th most common free drug sample given to children; Adderall XR was in the top 15.

Freebie drugs may sound like a great idea; who doesn’t like something for nothing? Consumer Reports research shows that 80 percent of patients accept samples. But other studies also show that such samples can cause some doctors to hand out a drug that might not be the best treatment choice (for adults or children).

And once the samples run out, you are likely to end up with sticker shock when you fill the prescription yourself and discover how expensive the brand name really is.

Read more about what expect from a diagnosis and managing symptoms in our ADHD guide

And there’s more: Children taking any drug to treat ADHD—including Adderall XR, Concerta, and Strattera—need close monitoring to note any changes in blood pressure or heart rate, as well as mood and behavior. It’s also important for parents to closely monitor their child’s use of the medication to ensure the drug is not misused or even abused. This kind of monitoring, combined with an informative patient package insert, is more likely to take place if the drug is obtained from a pharmacy with a prescription than from the doctor. Patient information sheets are not usually handed out with samples as they are when drugs are purchased in the pharmacy.

But there is another hitch: studies show that at least one stimulant, methylphenidate, used to treat ADHD symptoms may only work for a few years. There is scant evidence to show a clear benefit beyond that. So be sure to routinely check in with your child’s doctor about whether the drugs are still working, since all stimulant drugs, including Strattera (a non-stimulant) may have long-term risks, including a rare risk of sudden death, stroke or heart attack and the possible suppression of growth (height or weight) in children.

Finally, many young patients who wind up taking these drugs either do not have ADHD or only mild symptoms. Before starting any drug treatment for ADHD, it’s essential to get an accurate diagnosis.

Children or teens with ADHD exhibit a persistent pattern, lasting six months or more, of a variety of symptoms including impulsive behavior, hyperactivity, lack of focus and inability to complete a task. A pediatrician, primary care doctor or mental-health professional should always begin by ruling out other possible reasons for their behavior. And you should question a doctor or therapist who diagnoses ADHD on the first visit and prescribes a drug on the spot.

Bottom line: Adderall XR, Concerta and Strattera are expensive drugs and are no more effective or safer than other, older drugs in the same category for treating ADHD symptoms. If you or your child needs treatment, ask your doctor first for a generic drug. The generics dextroamphetamine and methylphenidate are our Best Buy picks because they both are as safe, effective and considerably less expensive than other brand-name drugs to treat ADHD. (Please note, at press time, Adderall XR was newly-available as a generic drug, but its current price is nearly the same as the expensive, branded version.)

Our new Best Buy Drugs report on drugs to treat ADHD is based on a systematic review of several hundred research articles and studies, where the risks and benefits of one drug or many drugs against each other are evaluated. This kind of systematic review is known as comparative effectiveness and all Consumer Reports Best Buy Drugs reports use this process as the basis for our drug ratings.

Lisa Gill, editor, Prescription Drugs

Editor's Note:

These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).



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