Medical management of ADHD in adults: part 2.

Methylphenidate and lisdexamfetamine are recommended as first-line pharmacological treatment options for adults with attention deficit hyperactivity disorder (ADHD). Formulations of methylphenidate can generally be classified into three groups according to their duration of action: one group lasts 12 hours, another group lasts 8 hours and the immediate-release group lasts 3-4 hours. Patients are usually able to substitute brands with one of the equivalent release profiles without significant problems. Lisdexamfetamine is a prodrug which has a slow onset and long duration (approximately 12 hours), ensuring minimal potential for abuse compared with its active metabolite dexamfetamine. Second-line treatments such as atomoxetine are also available for those who cannot tolerate or do not respond to methylphenidate or lisdexamfetamine. In the UK, ADHD has been previously managed largely in tertiary clinics, but many cases could be managed by appropriately trained clinicians in secondary or primary care (as already happens in some countries), with great benefit for patients and job satisfaction for clinicians.