DISCLAIMER: Not a pharmacist, not medical, I do not prescribe. This is informational only to help you know what medications may be presribed to you, in Australia, if you are an ADHDer and you and your physician (usually psychiatrist and/or paediatrician & parent) decide medication is a suitable option.
All states and territories within Australia and New Zealand have their own laws about Schedule 8 (ie dangerous drugs/poisons) which includes stimulants.
Of the approved stimulant medications, they all use only one of two molecules – methylphenidate or amphetamine. These are the stimulant medications prescribed in Australia:
Methylphenidate is available as a short-acting preparation (e.g. Ritalin® 3-4hrs short acting tablet) and as a long-acting or extended release preparation used in the treatment of ADHD and narcolepsy.
Methylphenidate is a closely regulated controlled substance.
Ritalin LA® 6-8hrs uses a beaded system with 50% immediate-release beads and 50% delayed-release, with the second peak approx 4 hours later.
Concerta® 10-12hrs uses an osmotic pump technology, with a two-phase release, with an initial peak at 1 hr (22% of dose) and 78% gradual release over 9-10 hours.
Methylphenidate acts by binding on to the dopamine transporter, releasing the neurotransmitters dopamine and norepinephrine from storage vesicles.
Lisdexamfetamine is the only long-acting stimulant medication listed on the Pharmaceutical Benefits Scheme (PBS) in Australia, for those diagnosed with ADHD after turning 18-years.
Lisdexamfetamine is used in the treatment of ADHD and binge eating disorder, and is available as a controlled release preparation.
Vyvanse® 10-13 hours is usually a capsule that peaks in 3.5 hours; it is a prodrug of dexamphetamine (ie, it is converted to dexamphetamine by hydrolysis in the blood, with peak concentrations of Dexamphetamine approx 3.5 hours after the initial dose). It is assumed (putatively) that lisdexamfetamine increases the balance of norepinephrine and dopamine pathways.
For some people, stimulant medications do not work or are unsuitable or need to be used in combination with non-stimulant medication options. Three main non-stimulants are approved and used in Australia:
Clonidine (Catapres®), an alpha-2 noradrenergic agonist, thereby enhancing noradrenergic tone to help reduce the symptoms of ADHD: inattention, hy- peractivity, and impulsivity. It is may be prescribed for ADHD individuals who are experienceing sleep disturbances. However, has cardiovascular side effects (can reduce blood pressure, and was originally developed for the treatment of high blood pressure or hypertension).
Atomoxetine (Strattera) is a Non-Stimulant medication approved by the Australian TGA for the treatment of ADHD.
Atomoxetine primarily inhibits the reuptake of norepinephrine, a neurotransmitter, but it can also inhibit reuptake of another neurotransmitter, dopamine. It is classified as a selective norepinephrine reuptake inhibitor (SNRI).
During neurotransmission, neurotransmitters (chemical substances that transmit nerve impulses between brain cells) are released by a brain cell (presynaptic neuron) across a gap known as the synapse and bind to sites known as receptors on another brain cell (postsynaptic neuron). Neurotransmission is essentially the process of communication between brain cells. The chemical signal is attenuated (reduced) by the presynaptic neuron through a process known as reuptake, whereby neurotransmitters are recaptured back into the cell, removing excess neurotransmitters from the synapse. Drugs that inhibit reuptake of neurotransmitters from going back into presynaptic neurons can therefore amplify neurotransmission.
Through the inhibition of norepinephrine and dopamine reuptake, atomoxetine boosts neurotransmission of these neurotransmitters.
Guanfacine (Intuniv) was also originally developed for the treatment of hypertension. It’s off-label use for unapproved indications includes ADHD, Tourette/s and tics.
Guanfacine acts by stimulating norepinephrine receptor (alpha 2-adrenergic receptors, which decreases activity in that part of the central nervous system, lowering both heart rate and blood pressure.
It is hypothesized that guanfacine directly stimulates the α -adrenergic receptors (guanfacine is classified as an αlpha 2-adrenergic agonist), thereby enhancing noradrenergic tone to help reduce the symptoms of ADHD: inattention, hyperactivity, and impulsivity.
Reliable Resources:
https://www.health.nsw.gov.au/pharmaceutical/patients/Pages/faq-adhd-consumers.aspx
If you’re looking for a Psychiatrist or other prescribing professional to support your exploration of medication treatment options for ADHD symptoms, check out the AADPA website as it is building a professional member resource.