DIAGNOSING,
TREATING, AND
SCREENING
FOR ADHD

What is ADHD?

ADHD is a neurobehavioral disorder that affects both children and adults. ADHD is most often diagnosed during childhood, but the disorder may continue into adulthood in most cases.1

What are the symptoms of ADHD?

Some common symptoms of ADHD include inattention, hyperactivity, and impulsivity. According to the DSM-V, ADHD typically presents in 1 of 3 ways2:

ADHD Boy Balances Pencil On Nose During Class

Combined

(inattentive/hyperactive/impulsive)

ADHD Girl Falls Asleep During School

Inattentive only

(formerly known as attention-deficit disorder, or ADD)

Hyperactive ADHD Boy Having Tantrum

Hyperactive/Impulsive

Is there a cure for ADHD?

While there is no scientifically proven cure for ADHD, most treatment plans include a combination of behavior therapy and medication to help manage the symptoms of ADHD.1 Treatment success can vary by patient and family. Read about Tris Pharma treatments for patients 6 years and older with ADHD, including:

Is there a genetic link?

Research to date has shown that ADHD is a biological condition whose symptoms are also dependent on a number of factors, including genetics.1

Who else should be screened when a patient has been diagnosed with ADHD?

If you have diagnosed a young patient with ADHD, you may consider screening their parents and siblings for ADHD.3

What are the categories of ADHD treatments?

There are many options available for treating ADHD in children and adult patients. Stimulant medications are often used in the treatment of patients with ADHD. There are 2 types of stimulants4:

  • Methylphenidate—A CNS stimulant believed to work by blocking the reuptake of dopamine from the synaptic cleft
  • Amphetamine—A CNS stimulant believed to work by increasing availability of norepinephrine and dopamine at the synaptic cleft

Knowing the difference between the 2 is key in determining which treatment is appropriate for your patient. While responses to methylphenidate and to amphetamine in patients with ADHD are generally similar, patients may respond very differently to the 2 classes of stimulant. If a patient has an unsatisfactory response to 1 class, prescribing the other class is recommended, as the proportion of patients who respond to 1 of the drugs may be as high as 95%.5

Do methylphenidates and amphetamines have the same mechanism of action?

Methylphenidates and amphetamines are both stimulants and are often used interchangeably to treat ADHD, but they have distinct mechanisms of action. Because they affect dopamine and norepinephrine differently, patients may respond differently to each.4

Is a methylphenidate or an amphetamine right for my patient?

Deciding whether to prescribe a methylphenidate like Quillivant XR or QuilliChew ER, or an amphetamine like DYANAVEL XR, depends largely on the individual needs of the patient, prior patient response or lack of response to methylphenidate or amphetamine, patient preference for liquid vs tablet formulation, and any other conditions the patient may have.

Prior to treatment with Quillivant XR, QuilliChew ER, or DYANAVEL XR, patients should be assessed for the presence of cardiac disease and risk of abuse. During treatment, careful prescription records should be maintained and patients should be informed about abuse and monitored for signs of abuse and overdose. The need for continued stimulant medication use should be periodically reevaluated and if necessary, dosage reduced or treatment discontinued.

CNS, central nervous system; DSM-V, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Tris Methylphenidate Treatments

Tris Amphetamine Treatment

Quillivant XR® (methylphenidate HCl) Extended Release 25mg Logo Tris ADHD Liquid Medicine Droplet Icon

Liquid methylphenidate

For your newly diagnosed patients with ADHD

QuilliChew ER® (methylphenidate HCl) Extended Release 20mg 30mg 40mg Logo Tris ADHD Chewable Tablet Icon

Chewable tablet methylphenidate

For your patients with ADHD who are looking for a chewable tablet

Tris Amphetamine Treatment

DYANAVEL® XR (amphetamine) Extended Release 2.5mg Logo Tris ADHD Liquid Medicine Droplet Icon

Liquid amphetamine

For your patients with ADHD who are ready for an amphetamine

Important Safety Information

WARNING: ABUSE AND DEPENDENCE

CNS stimulants, including DYANAVEL XR, Quillivant XR, QuilliChew ER, and other amphetamine-containing or methylphenidate-containing products, have a high potential for abuse and dependence. Assess the risk of abuse prior to prescribing and monitor for signs of abuse and dependence while on therapy.

  • DYANAVEL XR (amphetamine), Quillivant XR (methylphenidate HCI), and QuilliChew ER (methylphenidate HCI) are contraindicated:

    • in patients known to be hypersensitive to amphetamine, methylphenidate, or other components of DYANAVEL XR, Quillivant XR, and QuilliChew ER. Hypersensitivity reactions, such as angioedema and anaphylactic reactions, have been reported.

    • in patients taking monoamine oxidase inhibitors (MAOIs), or within 14 days of stopping MAOIs, because of risk of hypertensive crisis.

  • Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmias, coronary artery disease, and other serious cardiac problems. Sudden death, stroke, and myocardial infarction have been reported in adults treated with CNS stimulants at recommended doses. Sudden death has been reported in pediatric patients with structural cardiac abnormalities and other serious cardiac problems when taking CNS stimulants at recommended doses for ADHD. Further evaluate patients who develop exertional chest pain, unexplained syncope, or arrhythmias during treatment with DYANAVEL XR, Quillivant XR, and QuilliChew ER.

  • CNS stimulants cause increase in blood pressure (mean increase approximately 2 to 4 mm Hg) and heart rate (mean increase about 3 to 6 bpm). Monitor all patients for tachycardia and hypertension.

  • CNS stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a preexisting psychotic disorder. They may induce a mixed/manic episode in patients with bipolar disorder. Assess for presence of bipolar disorder prior to initiating treatment. At recommended doses, stimulants may cause psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania, in patients without prior history of psychotic illness or mania. If such symptoms occur, consider discontinuing DYANAVEL XR, Quillivant XR, or QuilliChew ER.

  • CNS stimulants have been associated with weight loss and slowing of growth rate in pediatric patients with ADHD; monitor weight and height during treatment with DYANAVEL XR, Quillivant XR, and QuilliChew ER. Treatment may need to be interrupted in children not growing or gaining weight as expected.

  • CNS stimulants are associated with peripheral vasculopathy, including Raynaud’s phenomenon. Signs and symptoms are usually intermittent and mild; very rare sequelae include digital ulceration and/or soft tissue breakdown. Careful observation for digital changes is necessary during treatment with ADHD stimulants.

  • Cases of painful and prolonged penile erections and priapism have been reported with methylphenidate products. Immediate medical attention should be sought if signs or symptoms of prolonged penile erections or priapism are observed.

  • Serotonin syndrome risk is increased when DYANAVEL XR is co-administered with serotonergic agents (e.g., SSRIs, SNRIs, triptans), MAOIs, and during overdosage situations. If it occurs, discontinue DYANAVEL XR and any concomitant serotonergic agents immediately, and initiate supportive treatment.

  • QuilliChew ER contains phenylalanine, a component of aspartame, and can be harmful to patients with phenylketonuria (PKU).

  • Most common adverse reactions observed with amphetamine products: dry mouth, anorexia, weight loss, abdominal pain, nausea, insomnia, restlessness, emotional lability, dizziness, and tachycardia.

  • Based on limited experience with DYANAVEL XR in controlled trials, the adverse reaction profile of DYANAVEL XR appears similar to other amphetamine extended-release products. The most common (≥2% in the DYANAVEL XR group and greater than placebo) adverse reactions reported in the Phase 3 controlled study conducted in 108 patients with ADHD (aged 6 to 12 years) were: epistaxis (DYANAVEL XR 4%, placebo 0%), allergic rhinitis (4%, 0%) and upper abdominal pain (4%, 2%).

  • Based on accumulated data from other methylphenidate products, the most common (≥5% and twice the rate of placebo) adverse reactions are: appetite decreased, insomnia, nausea, vomiting, dyspepsia, abdominal pain, weight decreased, anxiety, dizziness, irritability, affect lability, tachycardia, blood pressure increased.

  • There is limited experience with Quillivant XR and QuilliChew ER in controlled trials.

    • Quillivant XR: The most common (≥2% in the Quillivant XR group and greater than placebo) adverse reactions reported in the Phase 3 controlled study conducted in 45 ADHD patients (ages 6 to 12 years) in Quillivant XR compared to placebo were affect lability (9% Quillivant XR, 2% placebo), excoriation (4%, 0%), initial insomnia (2%, 0%), tic (2%, 0%), decreased appetite (2%, 0%), vomiting (2%, 0%), motion sickness (2%, 0%), eye pain (2%, 0%), and rash (2%, 0%).

    • QuilliChew ER: The most common (≥2% in the QuilliChew ER group and greater than placebo) adverse reactions reported in the Phase 3 controlled study conducted in 90 pediatric subjects (ages 6 to 12 years) in QuilliChew ER compared to placebo were decreased appetite (2.4% QuilliChew ER, 0% placebo), aggression (2.4%, 0%), emotional poverty (2.4%, 0%), nausea (2.4%, 0%), headache (2.4%, 0%), and weight decreased (2.4%, 0%).

  • DYANAVEL XR, Quillivant XR, and QuilliChew ER use during pregnancy may cause fetal harm.

  • Breastfeeding is not recommended during treatment with DYANAVEL XR, Quillivant XR, or QuilliChew ER.

INDICATION

DYANAVEL XR, Quillivant XR, and QuilliChew ER are indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in patients 6 years and older.

See Full Prescribing Information for DYANAVEL XR, Quillivant XR, and QuilliChew ER, including Boxed Warning about Abuse and Dependence.