What adjustments do you make for patients with ADHD who report their long-acting stimulant wears off too quickly?

There are essentially 3 options: 1) administer the medication later in the morning; 2) add a short-acting booster dose; 3) switch to a similar formulation with a longer duration of action. I typically discuss these options with patients/families and make individualized decisions depending on the par...

• Adjust the dose to the maximum potential
• Add a booster
• Change the form
• Add NRI like atomoxetine
• Adjust timing if allowable

I also counsel patients that citrus juices and high-dose vitamin C (ascorbic acid) should be avoided around the time of morning stimulant dosing because they act as gastrointestinal acidifying agents that lower the absorption of amphetamines, and as urinary acidifying agents that increase renal excr...