ADHD Treatment Armamentarium in South Africa
Introduction General approach Current treatment options (registered for the treatment of ADHD) available in South Africa Medication schedule (registered, as well as off-label products available) Introduction Since the publication of the South African management guidelines for adult ADHD (Schoeman & Liebenberg, 2016), many generics and new formulations of available substances, as well as new m
Current treatment options (registered for the treatment of ADHD) available in South Africa
Medication schedule (registered, as well as off-label products available)
Introduction
Since the publication of the South African management guidelines for adult ADHD (Schoeman & Liebenberg, 2016), many generics and new formulations of available substances, as well as new molecules have entered the South African market. Please consult the guidelines which emphasise the importance of a comprehensive diagnostic assessment, holistic treatment approach, and individualised care.
General approach
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Current treatment options (registered for the treatment of ADHD) available in South Africa
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Medication schedule (registered, as well as off-label products available)
Methylphenidate immediate release
| Trade name | Doses | Dosing strategy |
| Ritalin® Douglas MPH® Biotech MPH® |
Available in 10mg tablets | Approximately 1mg/kg/dose. Initiate at 5mg bd or tds with daily or weekly increments according to efficacy and tolerability (max 100mg/day po). |
Methylphenidate extended release
| Trade name | Formulation | Doses | Dosing strategy |
| Ritalin LA® | Spheroidal oral drug absorption system (SODAS) | Available in 10mg, 20mg, 30mg, and 40mg capsules | Once or twice daily dose at equivalent of total daily dose of IR. |
| Medikinet MR® | Modified release pellets | Available in 5mg, 10mg, 20mg, 30mg and 40mg capsules | Once or twice daily dose at equivalent of total daily dose of IR. |
| Concerta® Neucon® Mefedenil® Unicorn MPH® |
Osmotic controlled release oral delivery system (OROS) | Available in 18mg, 36mg and 54mg capsules/tablets | Once or twice daily dose at equivalent of total daily dose of IR. |
| Contramyl XR® | Multi-unit pellet system (MUPS) | ||
| Radd® | Hydrophilic matrix release system | ||
| Acerta® | Extended release film coated tablets |
Dexamfetamine sulphate
| Trade name | Doses | Dosing strategy |
| Amfexa® *registered for children and adolescents aged 6-17 years |
Available in 5mg and 10mg snap tablets | Initiate at 5-10mg/day po, with 5mg increase per week, to a max of 20mg/d (40mg for older children in exceptional cases). |
Lisdexamfetamine dimesylate
| Trade name | Formulation | Doses | Dosing strategy |
| Vyvanse® *registered for adolescents and adults from age 13 years |
Amfetamine based pro-drug | Available in 30mg, 50mg and 70mg tablets | Initiate at 30mg per day, with 20mg increase after 2 weeks, to a max of 70mg/d. In patients with severe renal impairment, the maximum dose should not exceed 50mg/kg. |
Atomoxetine
| Trade name | Doses | Dosing strategy |
| Strattera® INIR® Attencit® Attentra® Atteze® Atastrat® Concitron® Strattex® |
Available in 10mg, 18mg, 25mg, 40mg, 60mg and 80mg capsules | Initiate at approximately 0.5mg/kg/day in patients <70kg with recommended daily dose 1.2mg/kg/day. In patients >70kg initiate at 40mg/day with monthly increments of 20mg/day to a maximum of 100mg/day *maintain at least 12 weeks before judging clinical response). |
Bupropion
| Trade name | Formulation | Doses | Dosing strategy |
| Wellbutrin XL® Budep® Weldep XR® |
XR (extended release) | 150mg and 300mg tabs | Initiate at 75mg – 150mg/day po. Dosage may be adjusted in increments of 150mg at approximately monthly intervals to a maximum dose of 450mg/day. |
| Voxra XL® | SR (slow release) | ||
| Bupropion XR Adco® | XR | 150mg capsules |
Venlafaxine HCl
| Trade name | Formulation | Doses | Dosing strategy |
| Efexor XR Venlor XR® Efegen XR® Sandoz Venlafaxine® Venlafaxine Unicorn XR® Venlafaxine XR Adco® |
XR | 37.5mg, 75mg and 150mg capsules | Initiate at 75mg/day po. Dosage may be adjusted in increments of 75mg at approximately monthly intervals up to a maximum dose of 300mg/day. |
| Illovex XR® | XR | 37.5mg, 75mg,150mg, 225mg and 300mg tabs | |
| Odiven® | 75mg and 150mg tabs |
Imipramine HCl
| Trade name | Doses | Dosing strategy |
| Ethipramine® Tofranil® |
10mg and 25mg tabs | Initiate at 20mg to 70mg/day (10mg in elderly patients) and increase gradually to a maintenance dose of 100mg to 150mg/day (50mg in elderly patients). |
Clonidine HCl
| Trade name | Doses | Dosing strategy |
| Equi Menoglo Drops® | 0.025mg/5ml sol | Initiate at 0.025mg bd po and increase gradually to a maximum dose of 0.075mg bd po. |
| Menograine® | 0.025mg tabs |
Modafinil
| Trade name | Doses | Dosing strategy |
|
Provigil® |
100mg tabs | Initiate at 100mg/day po. Can be increased to 200mg/day po. |
Armodafinil
| Trade name | Doses | Dosing strategy |
| Nuvigil® | 150mg and 250mg tabs | Initiate at 150mg per day po. Can be increased to 250mg/day po. |
Schoeman R, Liebenberg R. The South African Society of Psychiatrists/Psychiatry Management Group Management Guidelines for Adult Attention-Deficit/ Hyperactivity Disorder. S Afr J Psychiat. 2017;23(0), a1060. https://doi.org/10.4102/sajpsychiatry.v23i0.1060 - An Update on the ADHD Treatment Armamentarium in South Africa., Prof Renata Schoeman
South African Journal of Psychiatry; The South African Society of Psychiatrists/ Psychiatry Management Group the Management Guidelines for Adult Attention-Deficit/ Hyperactivity Disorder, 28 April 2017_An Update on the ADHD Treatment Armamentarium in South Africa, 2023