It is estimated that 10.2% of children and young adults in the United States are currently diagnosed with attention-deficit/hyperactivity disorder (ADHD). Furthermore, ADHD may also persist into adulthood; ADHD is prevalent in 4.4% of adults in the U.S. The signs of ADHD vary and can include hyperactivity, impulsivity, and/or inattention.
Unfortunately, the cause of ADHD is currently unknown, and there is no cure available at this time. Still, various treatment options are available to reduce symptoms and allow individuals to live a normal life. The different treatments recommended vary depending on age and include behavior therapy, medication, training parents in behavior management, or a combination of options.
If parental intervention and behavior therapy are ineffective, then medication is often recommended for the treatment of ADHD. Two classes of medication, stimulants and non-stimulants, are used to treat children age six and older. The most commonly used class of drugs is stimulants, which are more effective than non-stimulants and take effect within hours. Studies have shown that stimulants are 70-80% effective in reducing ADHD symptoms; they are hypothesized to work through increasing levels of the neurotransmitters, dopamine and norepinephrine. Increased dopamine and norepinephrine levels are then able to bind for longer periods to receptors on specific areas of the brain involved in reducing hyperactivity and enhancing attention.
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The two most commonly used stimulants, methylphenidate (Ritalin) and amphetamines (Adderall), have been utilized for over 60 years in treating ADHD. However, current medications may not be effective for all individuals depending on factors such as patient characteristics, lifestyle, and genetics. Therefore, there is an unmet need for new alternative treatments.
On March 2, 2021, the FDA approved Azstarys, a new drug used to treat ADHD. Azstarys consists of both dexmethylphenidate and serdexmethylphenidate. Dexmethylphenidate is the active component of Azstarys and is not required to be processed in the body to reduce ADHD symptoms. By not requiring additional processing, this allows the immediate reduction of ADHD symptoms within hours. Serdexmethylphenidate, on the other hand, is a prodrug, which means that it is actually inactive and doesn’t reduce ADHD symptoms until the body processes it into dexmethylphenidate. By using a prodrug, Azstarys can be processed over time. Processing the drug over time allows the brain to be exposed to steadier absorption of the drug, which results in the reduction of ADHD symptoms for a longer duration.
Extended usage of traditional stimulants can often come with significant safety issues, including a high risk of addiction, serious cardiovascular reactions, adverse psychiatric reactions, and long-term suppression of growth. Fortunately, Azstarys is an improvement on older stimulants, since researchers believe that the use of a prodrug to provide steady exposure to the brain can actually reduce the occurrence of these issues. Hopefully, these advancements in drug development will one day lead to additional effective treatments for ADHD that do not carry a risk of abuse and dependence.
Featured Image Credit: Marco Verch Professional Photographer
