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4.4 Central nervous stimulants

Methylphenidate tablets; MR capsules and tablets - 1st line attention deficit hyperactivity disorders (ADHD)
Atomoxetine - capsules (2nd line option ADHD)
Dexamfetamine tablets (2nd line option)
Lesdexamfetamine capsules  (2nd line option)

Click here for the NICE TA 98: 'Attention deficit hyperactivity disorder (ADHD)'

Click here for the ADHD SCG in children and adults

Modafinil tablets - specialist initiation only - see NOTE


1. Atomoxetine can cause clinically important increases in blood pressure or heart rate in a small proportion of patients. It should not be used in patients with severe cardiovascular or cerebrovascular disorders. See Drug Safety Update for Jan 2012.

2. Methylphenidate - The National Institute for Clinical Excellence has recommended that methlyphenidate should be used as part of a comprehensive treatment programme for children and adolescents with a diagnosis of severe attention deficit/hyperactivity disorder (ADHD). Treatment should be initiated by a specialist in ADHD but may be continued by general practitioners, under a shared care arrangement. When a child receiving methylphenidate shows improvement and the condition appears stable, treatment can be suspended periodically in order to assess the need for continuation of therapy.

3. Modafinil is listed for neurologist treatment of excessive sleepiness in adults with narcolepsy secondary to Parkinson's disease only. Other indications, e.g. in multiple sclerosis are not evidence-based and are considered BLACK on the local Traffic Light Classification. Only patients who have been established on treatment and have been reviewed by the neurologist with respect to risk vs benefit, may be continued on treatment. No new patients may be started on modafinil for these other indications.

A baseline ECG should be done before starting treatment with modafinil. Abnormal findings should be evaluated by a cardiologist before treatment can be initiated. Cardiovascular function, especially blood pressure and heart rate should be monitored regularly during treatment. Caution in patients with a history of psychosis, depression or mania or alcohol/drug abuse (see Drug Safety Update March 2011).



For link to BNF section: 4.4 CNS stimulants and drugs used for attention deficit hyperactivity disorder