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

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? Recent 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.

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

Find out more about our Consumer Reports Best Buy Drugs program that evaluates more than 200 drugs for dozens of common conditions.

Comments

[Janna]

As others have said, this article is awful and I hope that CR will have the guts to revise it so their readers don't pass up these medications. As someone else mentioned, Adderall is a controlled substance that doctors can't simply give out as samples. Lots of college kids use it to get high or to pull all-night study sessions for exams, so no doctor is going to just give that stuff out.

Which, in another note about samples, I'd like to point out that samples are not "evil". My psychiatrist treats many patients who are either on social security or Medicaid (either low income or disabled people), and he gives samples to help some of these people. I once saw him give a woman a whole year's worth of Depakote in samples because she needed this medication to function but couldn't afford it. He's a kind man, and while he does work with some drug company reps and gets samples and whatnot, he doesn't do it for personal gain. Are there docs who do that stuff? Yeah, of course, but there are others who are simply doing what they can to help.

The difference between a generic Adderall and Adderall XR is the XR part - *extended release*. If, like myself, you have ADD/ADHD and you already have a hard enough time remembering to take your meds once or twice a day, you are setting yourself up for failure if you switch from an XR to several smaller doses of the drug throughout the day.

Another thing I'd like to point out: this article completely ignores the realities of adult ADD/ADHD. I won't go into that now, though, because I'd fill up the page.... Hehe :) Either way, hopefully someday when there's a public health insurance option and everyone's covered, no one will feel they have to pass up a life-changing (or life-saving!) medicine because they can't afford it!!

[JK]

CR is completely wrong on this and is making an apples-to-oranges comparison. Strattera may be more comparable to Wellbutrin, which my prescribing doctor recommended since Strattera isn't covered by my HMO. Wellbutrin may not be listed as a mainline ADD/ADHD drug although it does work on some of the same areas of the brain as Strattera, something CR could have found out with simple research.

Full disclosure: I've used 'em all: Strattera, Wellbutrin, methylphenidates (concerta, Daytrana) & adderall & adderall XR, generic and name-brand. Comparing Strattera to a stimulant med is not a proper comparison, and CR should know better.

[Elizabeth H.]

You know what's really frustrating? No one can agree on ANYTHING!! And who's caught in the middle?? The parents and kids!! It's real, it's not real, use the natural cure, use the drugs, use biofeedback, generic works just as good as name brand....DRUG COMPANIES ARE RIPPING US PARENTS OFF!!!! I barely afford for my kids their meds, and really I can't anymore! So mr. worry about the quality above the $$ come pay for my kid's meds money bags!! It's so frustrating to have children struggling w/this, and not to be able to get a straight answer!! I'm tired of hearing they need a good spanking, my kids have had plenty of that and discipline....it hasn't cured the problem!! I have researched and researched and still am at a loss! I cannot tolerate my children w/o the meds, yet I cannot afford them! We parents aren't stupid, of course you get kick backs off promoting meds, and you may not give free samples but you give coupons for FREE SAMPLES! SAME THING! Why don't you doc's do your job and actually HELP your patients!

[Don Potochny]

Well, Local Doc. I see you do not have the guts to furnish your name. I am 6'3" 190 pounds, hardly considered short. As far as mouthy, you are more than welcome to attempt shutting me up.

I doubt you have the courage, considering you hide behind a name when you publish your online drivel. Change it to Local Crock. It is an appropiate moniker for your erractic disposition.

[Roger Mason]

Anyone who advocates children take these poisons is either wacko or paid off by the pharmaceutical industry. These meds are not a long term crutch; they eventually must cease and alternative methods for managing the symptoms must be implemented.

[Janice]

Since when has any drug comany been allowed to sample a controlled substance?? To the best of my knowledge, all the medications villanized in this report (Adderal XR, Concerta...) are Schedule II drugs and are therefore not allowed to be sampled. Straterra, which is a non-stimulant is an exception and is sampled to physicians.

So, Consumer Reports, please do your homework, I would challenge the claim that Drs are prescribing on the basis of samples alone. I would also love to see the source reference on the claim that Adderall XR was #2 in samples. Where is that from, and why was that reference not given??? I would suggest that to increase credibility when citing a statistic, give the source.

Further, the short acting agents can be a huge inconvenience in the life of patients. There are greater considerations than cost when choosing a treatment, think of a child in school who needs to take a second dose of their medication during the day. What about the stigma from fellow students, what if the efficacy of that medication is beginning to wane before their next dose?? I would suggest that you consider the human factor and not just consider the $$'s.

[Roger Mason]

Health care reform is about prevention, which is absent from any current health care reform discussions. You cannot take these drugs-brnad name or generic-forever. Hopefully, you already understand that.

[merrily]

Like many readers/commenters above, I was diagnosed with adult ADD ten years ago. Adderall changed my life - all positively. About six years ago I tried a generic and experienced much the same symptoms Beth reports in her comments 7/9/09. Then strattera, which had no discernible effect. Back to adderall which has remained effective. Recently because my insurance refused to cover adderall brand name any more, I tried the generic again, made by Barr and re-experienced those devastating side effects so intensely I could not function for close to a week. You'll never convince me, my body or my brain that the generic is 'equivalent'. Why has the price doubled this year?
Hmmm, Is this an argument for health care reform?

[Gina Pera]

FYI -- IMPORTANT NOTICE FOR GENERIC ADDERALL CONSUMERS

For those who take generic Adderall, this is an important notice (I've also heard many problematic reports from consumers of another generic Adderall maker, Teva; I understand Teva is also producing the brand-name Adderall, which is now off-patent. This is anecdotal but worth checking out.)

http://www.fda.gov/Safety/Recalls/ucm177321.htm
*FOR IMMEDIATE RELEASE* - August 13, 2009 - Barr Laboratories, Inc. is
initiating a voluntary recall of Dextroamphetamine Saccharate,
Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate
(Mixed Salts of a Single Entity Amphetamine Product) 20mg Tablets, 100
count bottles, lot number 311756. The product identified is being
recalled because the affected lot may contain some tablets exceeding
weight requirements which may lead to super-potent tablets.

Potentially clinically significant adverse reactions to a
supratherapeutic dose could include cardiovascular, neurologic,
psychiatric and gastrointestinal reactions such as: palpitations,
tachycardia, hypertension, headache, tremor, tic, dyskinesia, dizziness,
blurred vision, sweating, insomnia, agitation, euphoria, mania, anxiety,
restlessness, nausea, diarrhea, constipation, dry mouth, and decreased
appetite.

This product can be uniquely identified as an oval peach colored tablet,
debossed with b/973 on one side and 2/0 on the other side. Barr
distributed the affected lot between 06/11/09 and 06/16/09. Only lot
311756 is affected by this recall.

Customers who have this lot in their possession are instructed to cease
using the product and return it to their pharmacy/distributor.
Wholesalers and retailers should cease distribution and examine their
inventory immediately.

Consumers with questions may contact 888-742-5578 from 8:00am - 8:00pm
EDT Monday-Friday.

[Local doc]

Michael Elder/Don Potochny, you remind me of that short mouthy guy at the bar who's always looking for a fight. You don't know what you're talking about -- just shooting off your mouth trying to get your brain in gear. Your "message" about ADHD is self-contradictory with every other sentence (not to mention pages at your crazy website http://www.adhd-information-exchange.com/

If you care about people with ADHD -- as you profess so, in trying to sell your e-book -- then you will stop spreading vicious lies about Gina Pera. She's been a volunteer for 10 years and has NO ties with the pharmaceutical industry. You wouldn't know anything about people like her, because you are the polar opposite: selfish and bitter. Go away and stop polluting the Internet.

[Stan Rison]

Wikipedia? Are you nuts? Much of the information on Wikipedia is garbage. We are not allowed to use Wiki as a source for our online articles.

[Michael Elder]

Gee, Gina, which brand name ADHD medication company employs you?

Conflict of Interest. Ignore the trolls posts

[Gina Pera]

Sorry, Chris, but that just isn't true.

This is from Wikipedia and sums up the situation more intelligibly than FDA publications:

Most nations require generic drug manufacturers to prove that their formulation exhibits bioequivalence to the innovator product. In the U.S., the FDA must approve generic drugs just as innovator drugs must be approved.[citation needed] The FDA requires the bioequivalence of the generic product to be between 80% and 125% of that of the innovator product.

Bioequivalence, however, does not mean that generic drugs must be exactly the same (“pharmaceutical equivalent”) as their innovator product counterparts, as chemical differences may exist (different salt or ester – a “pharmaceutical alternative”).

[Chris]

Not addressing the ADHD comments, but as to Beth's comment about generics, they must by law be the same as the brandname in every respect. If they are FDA approved this is true, unless you got some form of blackmarket drug the side effects you described were from some other condition. Generics are safe and effective and there is NO reason to not use them when available.

[Selena]

I agree with the comments of Gina and can confirm Beth's experience with generic vs. name brand Adderall XR. The blog is pure opinion and uninformed option at that.

My husband was diagnosed with ADHD as an adult after years of trying to "manage" his symptoms without medication. Despite being very brilliant, school as torture for him and wouldn't have been if he was diagnosed and treated earlier. After diagnosis it then took another 5 years under the care of an extremely competent psychiatrist who specializes in ADHD to find the right combination of medications. His life and his contribution to society is so drastically better now it's hard to quantify.

This so-called "consumer report" is inaccurate, misinformed, and frankly dangerous to consumers because of it's utter lack of accuracy, fact-checking or source citation for it's ridiculous claims.

[Gina Pera]

Taking the "easy way out," Saturday Health Blog? Sorry to be blunt, but you obviously know nothing about ADHD.

Choosing to take medication for ADHD symptoms -- a valid medical treatment for a legitimate medical condition -- seldom makes one's life easy. There are often insurmountable obstacles in the form of insurance coverage, a dearth of competent physicians, cost, and then slow titration that can take years of trying different classes of stimulants and then second-line medications until the right choice is found.

Moreover, roughly 75 percent of adults with late-diagnosis ADHD suffer a co-existing condition (such as anxiety, depression, bi-polar disorder, substance use disorder) that can make finding the right medication (or combination) extremely difficult. It is NOT easy. And if our society hadn't been so ignorant for the last 30 years -- and continues to be, if the majority of comments in the blogosphere are any indication -- perhaps these adults would have been diagnosed and treated a long time ago. That might mean they would not be suffering from all these co-existing conditions. For your information, living with untreated ADHD can be highly stressful and debilitating.

If your friend and brother are taking Adderall and building up a "tolerance" to it, there are many possible reasons for that -- the primary reason being ignorance about how this medication should be prescribed and taken. So, before you jump on any bandwagon, adding more myths to misinformation, I suggest educating yourself.

And for those who think free samples are evil, I'm sorry, but you are equally ignorant. Many people with ADHD must try many medications in order to find the one that works for their unique neurobiochemistry. It can be an extremely costly and lengthy process, working within insurance limitations, to give a broad range of medications a fair trial.

Moreover, many people with ADHD are struggling from job loss and the financial hardship so often found with untreated ADHD. In short, many compassionate physicians use these samples to help these people.

For more information on why this Consumer Report is woefully misguided, you can read a recent blog post here: http://tinyurl.com/nmulcl

Gina Pera, author
Is It You, Me, or Adult A.D.D.?
Winner - 2008 Psychology Book of the Year - ForeWord Magazine

[Gina Pera]

This Consumer Report is nothing short of outrageous. Obviously, no one involved with it truly understands ADHD or the horrible "roller coaster" side effects of the older formulations -- the ones they recommend. No one takes those formulations who can afford otherwise -- and with good reason. The new formulations last longer, have less "jerky" starts and stops, are less likely to create side effects, and much more.

What's worse, CR recommends generics!!!

We know that the proper titration with ADHD medications means there's often a very narrow "therapeutic window." A few miligrams more or less, and the medication is not only less effective but also side effects can outweigh benefits.

We also know that the FDA allows a generous leeway of effectiveness (I think it's 20 percent up or down). That means for people who need a fine-tuned dose (that is, most people with ADHD), they experiment every time they take a generic stimulant medication. Then, when their pharmacy changes supplier, they risk experiencing even more side effects, from the filler and additives that create many problems for people with ADHD who have allergies or sensitivities to these additives, colorants, etc.

I've read a bit about John Santa, CR's medical director. It seems that he has a long history of seeking savings for state medical systems money. Sure, states want to save money. So do insurance companies (so I wonder about his connection and CR's connection there). But what he is NOT looking at is patient welfare. How could he? He's only an MD and an MPH? Apparently he doesn't know how to read the scientific literature and, more importantly, he does not know how to treat this population.

Consumer Reports has made a grave error by pretending to have scientific authority in this area. I propose a boycott of Consumer Reports products from every physician, every therapist, and every adult and child who treats or has ADHD. This is outrageous, and only sets the stage for ill-informed medical healthcare reform in this country. In countries where people depend on NHS for ADHD medication, they are limited to the short acting medications like the Dexedrine that Santa likes so well. And their side effects often mean they stop treatment altogether. This is a tragedy. If the U.S. were to sink to these substandard medications, that would be a double-tragedy.

Shame on you, Santa and CR. I will hope that you are simply out of your intellectual and professional depth -- arrogantly and ignorantly -- and not toadying up to Big Insurance and state medical programs, simply for the consulting fees or who knows what.

Gina Pera, author
Is It You, Me, or Adult A.D.D.?
http://www.ADHDRollerCoaster.com

[Beth]

Just from my own personal experience. I'm now 55 and a RN for the last 37 years. I was prescribed Adderall when I was around 46. On the Pharmacists suggestion I got the generic form of it. The side effects were nasty. I felt like my skin was crawling. I literally was scratching so hard I bled. I felt like I had drank 6 pots of coffee, which I did drink about 20 gallons of water from the dry mouth. I was twitchy and nervous. I couldn't sleep. I spoke with the Doctor that had prescribed it and we tried changing my dosage. I continued to take it for about 3 months thinking the side effects would go away or at least decrease, which they never did. On my follow up visit with my Dr. we discussed my continued side effects and he told me I shouldn't have hardly any. I should of just been able to gradually notice the ability to stay focused to the task at hand rather then flitting from project or thought to another. When I told him I was taking the generic brand he smiled and knew what the problem was. He said not to give up but to try the name brand version. To tell you the truth I never noticed if I was getting the benefits for my ADHA it was prescribed for because the side effects were so intense. I switched to the brand name prescription and my side effects were gone within a few short days. Just totally gone. Then I started getting the true benefit of the Adderall and it made a tremendous difference in my life.

In my case I don't agree that generics are the same as brand name. In some instances they use less pure, cheaper ingredients and they do make a difference. I couldn't imagine giving the generic to a child with the side effects I had. There are some wonderful generic drugs available but that doesn't make all of them good.

[Paula]

We get our Primary Care from a family practice group. So our whole family goes to the same practice. They do not accept ANY samples (or any other freebies) from Pharmaceutical companies. This allows them to have a clear conscience, which I appreciate. Although some of the office staff would appreciate a free lunch from time to time like they get at offices that DO allow freebies. ;-)

[Jessica Saberman]

Because Adderall XR and Concerta are controlled substances, doctors' offices are not allowed to receive free samples of these medications, although co-pay reductions cards are sometimes available for use at a pharmacy. Many parents and children appreciate the advantage that longer-acting "brand" prescriptions have over the generic shorter-acting medications, with potentially fewer break-through symptoms and no mid-day trips to the nurse's office. Dextroamphetamine and methylphenidate are on the top of the list in many states as the most abused prescription drugs, causing many physicians to shy away from people who specifically request these products. The decision of the best medication, if one is needed, is best left between the physician, parent and child.

[marcus]

Nice information. As what I have also know about people with ADHD is that it is manageable, i think it only needs some intervention, not technechaly medical interventions but interventions such as emotional support or family therapy. Correct me if i'm wrong but drugs can only lessen the symptoms but i think it cannot be totally eradicated, right? But ofcourse their are some drugs who are really effective but i would also suggest group or family therapy. Anyway, Nice Post!

By the way, you can actually post this on Free Press , so everyone can read about this.

marcus
Online Learning

[Saturday Health Blog]

Thats very true, and more people should be wise to this. I know my friend and my brother as well have been taking Adderall and have begun to build up a tolerance to it with some adverse side effects. Its important to keep your health in mind rather than taking the easy way out.