The National Institute for Health and Clinical Excellence (NICE) today issued guidance to the NHS in England and Wales on the use of methylphenidate, atomoxetine and dexamfetamine for treating attention deficit hyperactivity disorder (ADHD) in children and adolescents. This updates previous guidance (TA no. 13) issued in October 2000, which gave recommendations on methylphenidate only.
The NICE guidance says that where drug treatment is considered appropriate, methylphenidate, atomoxetine and dexamfetamine are recommended, within their licensed indications, as options for the management of ADHD in children and adolescents.
The updated guidance makes it clear that the decision regarding which product to use should be based on a number of factors, including the presence of other conditions such as epilepsy; the different adverse reactions of the drugs, specific potential problems with compliance (for example, difficulties around administering doses at school), whether the drug might be passed on to others for non-prescription use or misuse, and preferences of the child/adolescent and their parent or guardian.
The guidance also recommends that if there is a choice of more than one appropriate drug, having taken into account the cost per dose and number of daily doses, the product with the lowest cost should be prescribed.
Andrea Sutcliffe, Executive Lead for the Appraisal said: "This guidance extends the range of drugs recommended for treating ADHD in children and adolescents. Where drug treatment is considered appropriate, methylphenidate, and now also atomoxetine and dexamfetamine, are recommended as options for use within their licensed indications. Importantly the guidance highlights that only appropriately qualified healthcare professionals with ADHD expertise should initiate drug treatment based on a comprehensive individualised assessment and diagnosis. Decisions on which product to use will depend on clinical factors, the potential for adverse effects and practical considerations, as well as the preference of the child/adolescent and their parent or guardian. If there is more than one suitable drug, the least expensive should be used."
About the NICE guidance on methylphenidate, atomoxetine and dexamfetamine for treating attention deficit hyperactivity disorder (ADHD) in children and adolescents:
1 - ADHD is defined by core signs of inattention, hyperactivity, and impulsiveness, often co-existing with other conditions such as learning disorders, epilepsy, and Tourette syndrome. It is estimated that 5% of school aged children in England and Wales would meet the Diagnostic and Statistical Manual of Mental Disorders 4th Edition clinical definition of ADHD (equivalent to approx. 366,000 children and adolescents in England and Wales), but not all of these children would require treatment.
2 - Children with severe ADHD often have low self-esteem, emotional and social problems, and underachieve at school. ADHD persisting into adolescence and adulthood may be associated with continuing emotional and social problems, substance misuse, unemployment and crime.
3 - There are various non-pharmaceutical treatments for ADHD, including social, psychological, behavioural and dietary interventions.
4 - The Medicines and Healthcare Products Regulatory Agency (MHRA) advise that the use of methylphenidate, dexamfetamine and atomoxetine (Strattera) should only be initiated by or under the supervision of a specialist, and that advice on the safety of atomoxetine from experts on the Commission on Human Medicines (CHM) considered that the benefits of taking atomoxetine for the treatment of ADHD outweigh the potential risks
5 - Whilst the guidance recommends that only appropriately qualified healthcare professionals with ADHD expertise should initiate drug treatment based on a comprehensive assessment and diagnosis, continued prescribing and monitoring of drug therapy may be performed by general practitioners under shared care arrangements.
6 - NICE plans to publish a clinical guideline on pharmacological and psychological interventions for ADHD in children, young people and adult in 2008.
About NICE
7 - On 1 April 2005 the National Institute for Clinical Excellence took on the functions of the Health Development Agency to form the National Institute for Health and Clinical Excellence (NICE). NICE is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
8 - NICE produces guidance in three areas of health:
public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
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View drug information on Strattera.
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