Saturday, March 10, 2007

Combining medications for ADHD

It had become common for both children and adults to take more than one medication in the treatment of ADHD. It is prudent to remember that the more medications one takes, the higher the risk for drug-drug interactions as well as potential negative side effects. At this point, there is a limited amount of published research data on combination treatment. Despite the limited data to back up the practice, the strategy of using more than one medication continues to become more popular.

The most common scenario where combining medications is considered is when one medication is partially effective and there is still a need for improvement and increasing the dose is not an option because negative side effects have already occurred at the higher dose. It is much more prudent to do a medication trial with another medication before adding a second medication. There are many times where changing the medication results in improved effectiveness. Sometimes, that might mean going back to a medication that has been tried in the past.

It is essential that there is a discussion with the prescribing physician about realistic expectations regarding the potential benefit of medication treatment. Unrealistic expectations can lead to mutliple medications and unnecessary high doses. The approach to combination treatment needs to be the same as making any other medical decision. There need to be a clear undertanding of the goal of treatment; evaluating the potential benefit versus the potential risk of the treament being considered, exploring alternative options; and finally recognizing the potential risks of not utilizing that treatment option. These 4 essential points must be considered and discussed with the prescribing physician before combination treatment is initiated.

See Making the Connection: A Parent's Guide to Medication in ADHD (