Two new treatments for ADHD are now available in Canada: a new medication, an amphetamine-based pro-drug, lisdexamfetamine (VyvanseTM) and Novo-Methylphenidate ER-C, a methylphenidate-based long acting product, just approved by Health Canada as a generic for ConcertaTM.
In Canada, pharmacological treatment options for ADHD include two different families of products: non stimulant medication (atomoxetine, StratteraTM) and psychostimulants. Psychostimulants are divided into two groups: amphetamine-based and methylphenidate-based products. Some are immediately released and others are delivered progressively through different mechanisms. CADDRA suggests using long-acting medications first line and short-acting medication, second line. The Medication Chart illustrating available dosages, starting doses and augmentation strategies has been updated with information concerning VyvanseTM.
Lisdexamfetamine (VyvanseTM) is a pro-drug and is a new addition to the amphetamine-based product portfolio in Canada. It contains a clinically inactive complex of dextro-amphetamine coupled to lysine. For dextro-amphetamine to be released, this product has to be biologically activated by an enzyme present mostly in blood and some in the gut. This delivery mechanism produces a clinical effect of 12 hours or more (12h: monograph information, 13h in a clinical trial in children and 14h in adults). This medication is highly soluble and can be diluted in water for titration if needed. This kind of delivery system is not influenced by gastric PH or transit time. Clinical effects have been described as more stable over time for each individual and more constant from one person to the other. Because of its pro-drug design, its delivery curve is not changed by mode of administration (oral, inhalation or injection), reducing its abuse potential.
Novo-Methylphenidate ER-C is a generic methylphenidate-based product, with a progressive delivery system, that has just been approved by Health Canada as a generic for ConcertaTM. CADDRA recommends Novo-Methylphenidate ER-C be considered an additional ADHD treatment option, instead of a product that can automatically replace ConcertaTM. Each case is unique and it is crucial to personalize treatment taking into account the needs of each patient.