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注意力不足過動症的治療：修订间差异

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→‎藥物治療：​ // Edit via Wikiplus
第56行： 第56行：
==藥物治療==
==藥物治療==
{{See also|注意力不足過動症#藥物治療}}
{{See also|注意力不足過動症#藥物治療}}
=== 中樞神經刺激劑 ===
{{see also|苯丙胺#醫療|注意力不足過動症的治療#第一線中樞神經刺激劑}}

治療注意力不足過動症的第一线药物为中樞神經[[兴奋剂]]（又名為中樞神經刺激劑），其中包括：

{| class="wikitable sortable"
|-
! style="width: 96px;"|藥物名 !! 藥物（主成分/有效成分）學名 !! 作用時間 !! 生效時間 !! 備註
|-
| 利他能（Ritalin） || [[哌甲酯]]{{efn|又稱為「派醋甲酯」}} || 短：3.5小時左右 || 約服用後30分鐘 ||
*安保美喜錠為利他能的副廠藥品。 副廠名：{{tsl|en|Apotex|Apotex Incorporation|安保美喜公司}}
|-
| [[阿得拉尔|Adderall]] || [[右旋苯丙胺]]和[[左旋苯丙胺]] || N/A || N/A ||
*為[[安非他命]]产品
|-
| Desoxyn || [[甲基苯丙胺]] || N/A || N/A ||
*為安非他命产品
|-
| 利他(長)能LA（Ritalin LA/利長能） || 哌甲酯 || 中：8小時左右 || 約服用後30分鐘 ||
*[[生物半衰期|藥物之半衰期]]介於利他能與專思達之間。有10MG、20MG、30MG、40MG及60MG等劑型。
|-
| [[專思達|專思達/專注達]] || 哌甲酯 || 長：12小時左右 || 約服用後30分鐘 ||
*台灣譯作專思達，有18MG、27MG、36MG、54MG等數種劑量。
*中華民國中央健康保險署已經核定醫師可將此藥物作為十八歲以下患者的第一線處方。<ref name="New Approval">{{cite web| url =http://www.nhi.gov.tw/Information/bbs_detail.aspx?menu=9&menu_id=545&bulletin_ID=2651| title =衛生福利部中央健康保險署　公告| date =2017-02-06| website =衛生福利部中央健康保險署| publisher =衛生福利部中央健康保險署| access-date =2017-04-10| deadurl =no| archiveurl =https://web.archive.org/web/20170410132941/http://www.nhi.gov.tw/Information/bbs_detail.aspx?menu=9&menu_id=545&bulletin_ID=2651| archivedate =2017-04-10}}</ref><ref>{{cite web| url =http://www.nhi.gov.tw/Resource/bulletin/6838_1060034854-1.pdf| title =「藥品給付規定」修正規定| date =2017-02-06| website =衛生福利部中央健康保險署| publisher =衛生福利部中央健康保險署| access-date =2017-04-10| deadurl =no| archiveurl =https://web.archive.org/web/20170410132954/http://www.nhi.gov.tw/Resource/bulletin/6838_1060034854-1.pdf| archivedate =2017-04-10}}</ref>
*中國大陸翻譯為專注達。
|}
<ref name="找回專注力"/>
<ref name="label of Ritalin LA">{{cite web
|title = Label of Ritalin LA
|date =2015
|url = https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/ritalin_la.pdf
|publisher = Novartis
|access-date = 2017-01
|deadurl = no
|archiveurl = https://web.archive.org/web/20170830025139/https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/ritalin_la.pdf
|archivedate = 2017-08-30
}}</ref>
<ref name="new release of label of Ritalin LA">{{cite web
|title = Label of Ritalin LA
|date = 2017-01-05
|url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=effd952d-ac94-47bb-b107-589a4934dcca
|publisher = Novartis Pharmaceuticals Corporation
|access-date = 2017-01
|quote = Ritalin LA 10, 20, 30, 40, and 60 mg capsules provide in a single dose the same amount of methylphenidate as dosages of 5, 10, 15, 20, or 30 mg of Ritalin tablets given b.i.d.
|deadurl = no
|archiveurl = https://web.archive.org/web/20170326230529/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=effd952d-ac94-47bb-b107-589a4934dcca
|archivedate = 2017-03-26
}}</ref>
<ref name="leaflet of Concerta">
{{cite web
|url = http://www.concerta.net/pdfs/Prescribing_Info-short.pdf
|title = Label of Concerta
|date = 2013
|website = concerta.net
|publisher = Jassen Cilag
|access-date = 2017-01
|deadurl = yes
|archiveurl = https://web.archive.org/web/20170117135801/http://www.concerta.net/pdfs/Prescribing_Info-short.pdf
|archivedate = 2017-01-17
}}</ref>
<ref name="guidelines for Ritalin">{{cite web
|url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c0bf0835-6a2f-4067-a158-8b86c4b0668a
|title = Label of Ritalin
|date = 2017-01-05
|website = DailyMed
|publisher = Novartis
|access-date = 2017-03
|deadurl = no
|archiveurl = https://web.archive.org/web/20170320052349/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c0bf0835-6a2f-4067-a158-8b86c4b0668a
|archivedate = 2017-03-20
}}</ref>

利他能<ref name="guidelines for Ritalin"/>、利長能<ref name="label of Ritalin LA"/>、專思達<ref name="leaflet of Concerta"/>、安保美喜錠<ref name="label of Apo-Methylphenidate">
{{Citation
|contribution-url = http://www.fda.gov.tw/MLMS/H0001D.aspx?Type=Lic&LicId=02025016
|location = Canada
|title = Information for the patient
|contribution = 安保美喜錠 10 毫克 衛署藥輸字第 025016 號
|editor = 鴻汶醫藥實業有限公司
|author = Apotex Incorporation.
|date = 2006-03-27
|year =
|url = https://www.apotex.com/ca/en/products/downloads/di/0263_PIL.pdf
|access-date = 2017-03-19
|deadurl = no
|archiveurl = https://web.archive.org/web/20091122124123/http://www.apotex.com/ca/en/products/downloads/di/0263_PIL.pdf
|archivedate = 2009-11-22
}}</ref>
，所含之有效成分皆為哌甲酯，各自在[[藥效學|藥效動力學]]上具有相同屬性；在[[藥物代謝動力學]]上的作用則有些微差異。<ref name="Lopez Silva Pestreich Muniz 2003 pp. 545–55">{{cite | last=Lopez | first=F | last2=Silva | first2=R | last3=Pestreich | first3=L | last4=Muniz | first4=R | title=Comparative efficacy of two once daily methylphenidate formulations (Ritalin LA and Concerta) and placebo in children with attention deficit hyperactivity disorder across the school day. | journal=Paediatric drugs | volume=5 | issue=8 | year=2003 | issn=1174-5878 | pmid=12895137 | pages=545–55| quote =While both Ritalin LA and Concerta were shown to be effective, the different release profiles of each formulation can result in distinct differences between the effects on measures of attention and deportment.}}</ref><ref name="Coghill Banaschewski Zuddas Pelaz p. correction addition">{{cite journal | last=Coghill | first=David | last2=Banaschewski | first2=Tobias | last3=Zuddas | first3=Alessandro | last4=Pelaz | first4=Antonio | last5=Gagliano | first5=Antonella | last6=Doepfner | first6=Manfred | title=Erratum to: Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies | journal=BMC Psychiatry | publisher=Springer Nature | volume=15 | issue=1 | date=2015-08-25 | issn=1471-244X | pmid=26302778 | pmc=4549088 | doi=10.1186/s12888-015-0581-z | page=}}</ref><ref name="Coghill Banaschewski Zuddas Pelaz p. ">{{cite journal | last=Coghill | first=David | last2=Banaschewski | first2=Tobias | last3=Zuddas | first3=Alessandro | last4=Pelaz | first4=Antonio | last5=Gagliano | first5=Antonella | last6=Doepfner | first6=Manfred | title=Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies | journal=BMC Psychiatry | publisher=Springer Nature | volume=13 | issue=1 | date=2013-09-27 | issn=1471-244X | pmid=24074240 | pmc=3852277 | doi=10.1186/1471-244x-13-237 | page=}}</ref>醫師可依患者的需求，視各種藥品之藥物動力學的特性，調整處方藥物，實現{{le|個人化醫療|Personalized medicine}}<ref name="Coghill Banaschewski Zuddas Pelaz p. II">{{cite journal | last=Coghill | first=David | last2=Banaschewski | first2=Tobias | last3=Zuddas | first3=Alessandro | last4=Pelaz | first4=Antonio | last5=Gagliano | first5=Antonella | last6=Doepfner | first6=Manfred | title=Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies | journal=BMC Psychiatry | publisher=Springer Nature | volume=13 | issue=1 | date=2013-09-27 | issn=1471-244X | doi=10.1186/1471-244x-13-237 | page=}}</ref>。
常見的專思達，其12歲以下的使用者每日最大劑量上限為54毫克；13到17歲的使用者之每日最大劑量上限為72毫克<ref>{{cite web
|url = http://epaper.ntuh.gov.tw/health/201209/project_3.html
|title = 過動兒與藥物治療
|website = 台大醫院
|access-date = 2018-04-06
|author = 江雅暄
|deadurl = no
|archiveurl = https://web.archive.org/web/20170313063637/http://epaper.ntuh.gov.tw/health/201209/project_3.html
|archivedate = 2017-03-13
}}</ref><ref>{{cite journal | last=Newcorn | first=Jeffrey H | last2=Ivanov | first2=Iliyan | title=Psychopharmacologic Treatment of Attention-Deficit/Hyperactivity Disorder and Disruptive Behavior Disorders | journal=Pediatric Annals 2007 | volume=36 | issue=9 | date=2007-09-01 | doi=10.3928/0090-4481-20070901-08 | page=564-574 | url=https://www.healio.com/pediatrics/journals/pedann/2007-9-36-9/%7B6bc30397-acb9-418e-bd9d-f8c81b3f92b4%7D/psychopharmacologic-treatment-of-attention-deficithyperactivity-disorder-and-disruptive-behavior-disorders | quote=The labeled daily maximum dose of d,l-MPH is 60 mg, with the exception of OROS-MPH, which is approved for 54 mg in children and 72 mg in adolescents | deadurl=no | archiveurl=https://web.archive.org/web/20180406163538/https://www.healio.com/pediatrics/journals/pedann/2007-9-36-9/%7B6bc30397-acb9-418e-bd9d-f8c81b3f92b4%7D/psychopharmacologic-treatment-of-attention-deficithyperactivity-disorder-and-disruptive-behavior-disorders | archivedate=2018-04-06 }}</ref>。若患者早上服用的中長效劑型藥物之藥效在傍晚開始消退，患者可視需要再服用短效劑型藥物，彌補隨著長效型藥物藥效退去後產生的空窗期。<ref name="幫助ADHD孩子快樂成長"/>

雖中樞神經刺激劑藥效約於服用後半小時左右開始，並不表示症狀會在服用後半小時就消失，如同其他疾病的治療一樣，病情的改善需要一定（段）時間的持續治療（時間長度因人而異）。藥物（包含：中樞神經刺激劑、非中樞神經刺激劑、......）會在這些患者的背後推他們一把，助他們一臂之力<ref name="auto"/>。然而，即便如此，患者本身仍需認真努力地改變自己。藥物是注意力不足過動症整體治療的其中一環。<ref name="找回專注力"/><ref name="books2000" /><ref>{{cite web|url=http://www.concerta.net/contact-us.html|title=CONCERTA® - Contact Us|author=|date=|publisher=Janssen Cilag|access-date=2017-01|deadurl=no|archiveurl=https://web.archive.org/web/20171006212033/https://www.concerta.net/contact-us.html|archivedate=2017-10-06}}</ref>

根據[[世界反運動禁藥組織]]，中樞神經刺激劑在未事先申請醫療許可及非醫療所需的情況下服用都將被視同違規行為。<ref>{{cite web |url=https://wada-main-prod.s3.amazonaws.com/resources/files/2016-09-29_-_wada_prohibited_list_2017_eng_final.pdf |title=THE PROHIBITED LIST Updated annually, the List identifies the substances and methods prohibited to athletes in- and out-of-competition |publisher=Wada-main-prod.s3.amazonaws.com |date= |accessdate=2016-12-27 |deadurl=no |archiveurl=https://web.archive.org/web/20161220073305/https://wada-main-prod.s3.amazonaws.com/resources/files/2016-09-29_-_wada_prohibited_list_2017_eng_final.pdf |archivedate=2016-12-20 }}</ref>

部分用來治療注意力不足過動症的藥品（例如：中樞神經刺激劑）在美国食品藥物管理局划分为二级[[管制藥品]]（Schedule II，即指有滥用可能性的药品），在台灣則列為第三級管制藥品。<ref name="NIDAAAS" /><ref name="medlineplus1">{{cite web |url=https://medlineplus.gov/attentiondeficithyperactivitydisorder.html |title=Home of MedlinePlus→ Health Topics → Attention Deficit Hyperactivity Disorder Attention Deficit Hyperactivity Disorder Also called: ADHD |publisher=Medlineplus.gov |date= |accessdate=2016-12-27 |deadurl=no |archiveurl=https://web.archive.org/web/20161225115235/https://medlineplus.gov/attentiondeficithyperactivitydisorder.html |archivedate=2016-12-25 }}</ref><ref name="Taiwan_FDA_on_controlled_medications">{{cite web |url=http://www.fda.gov.tw/TC/site.aspx?sid=41 |title=衛生福利部-食品藥物管理署-管制藥品 |publisher=Fda.gov.tw |date=2013-12-30 |accessdate=2016-12-27 |deadurl=no |archiveurl=https://web.archive.org/web/20170120033551/http://www.fda.gov.tw/TC/site.aspx?sid=41 |archivedate=2017-01-20 }}</ref><ref name="Taiwan_FDA_on_controlled_medications_2">{{cite web|url=http://www.fda.gov.tw/TC/siteList.aspx?sid=50|title=衛生福利部-食品藥物管理署-管制藥品的管理|publisher=Fda.gov.tw|date=|accessdate=2016-12-27|deadurl=no|archiveurl=https://web.archive.org/web/20161226221334/http://www.fda.gov.tw/TC/siteList.aspx?sid=50|archivedate=2016-12-26}}</ref>

中樞神經刺激劑如同多數藥物一樣，在正確使用下，造成內臟器官受損的機率非常低，但UpToDate仍''強烈'' 建議用藥者應定期追蹤自己的體重、心跳與血壓等<ref name="UpToDate long-term cardiovascular effect associated with long-term use of stimulants">{{cite web | title=Pharmacotherapy for adult attention deficit hyperactivity disorder | website=UpToDate | url=https://www.uptodate.com/contents/pharmacotherapy-for-adult-attention-deficit-hyperactivity-disorder | quote=Cardiovascular effects — Blood pressure and heart rate should be monitored when initiating stimulants for adult ADHD and ''over the course of treatment'', due to stimulants' potential for causing cardiovascular side effects....... | access-date=2018-02-27 | deadurl=no | archiveurl=https://web.archive.org/web/20180227034338/https://www.uptodate.com/contents/pharmacotherapy-for-adult-attention-deficit-hyperactivity-disorder | archivedate=2018-02-27 }}</ref><ref name="Wender 1998 pp. 76–9">{{cite journal | last=Wender | first=PH | title=Pharmacotherapy of attention-deficit/hyperactivity disorder in adults. | journal=The Journal of clinical psychiatry | volume=59 Suppl 7 | year=1998 | issn=0160-6689 | pmid=9680056 | pages=76–9}}</ref>，研究顯示中樞神經刺激劑造成的心血管作用與其攝取劑量多寡有關<ref name="Wender 1998 pp. 76–9"/><ref name="Wilens Hammerness Biederman Kwon 2005 pp. 253–9">{{cite | last=Wilens | first=TE | last2=Hammerness | first2=PG | last3=Biederman | first3=J | last4=Kwon | first4=A | last5=Spencer | first5=TJ | last6=Clark | first6=S | last7=Scott | first7=M | last8=Podolski | first8=A | last9=Ditterline | first9=JW | last10=Morris | first10=MC | last11=Moore | first11=H | title=Blood pressure changes associated with medication treatment of adults with attention-deficit/hyperactivity disorder. | journal=The Journal of clinical psychiatry | volume=66 | issue=2 | year=2005 | issn=0160-6689 | pmid=15705013 | pages=253–9}}</ref>（中樞神經刺激劑的副作用可能有：[[食欲不振|食慾降低]]、[[心率|心跳]]與[[血壓]]上升等；而輕度、中度的[[心悸]]及[[高血壓]]可能不會被人覺察到，然而長期血壓超越正常範圍可能會導致許多健康問題；食慾降低可能不自覺地引起[[低血糖]]，導致心悸等副作用<ref name="hypoglycemia ">{{cite web | title=Hypoglycemia: MedlinePlus | website=MedlinePlus | date=2017-11-07 | url=https://medlineplus.gov/hypoglycemia.html | access-date=2017-12-23 | quote=You can also have low blood sugar without having diabetes. Causes include certain medicines or diseases, hormone or enzyme deficiencies, and tumors. Laboratory tests can help find the cause. The kind of treatment depends on why you have low blood sugar. | deadurl=no | archiveurl=https://web.archive.org/web/20171222134524/https://medlineplus.gov/hypoglycemia.html | archivedate=2017-12-22 }}</ref><ref name="National Institute of Diabetes and Digestive and Kidney Diseases 2016">{{cite web | title=Low Blood Glucose (Hypoglycemia) | website=National Institute of Diabetes and Digestive and Kidney Diseases | date=2016-08-11 | url=https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia | access-date=2017-12-23 | quote=Fast or irregular heart beat | deadurl=no | archiveurl=https://web.archive.org/web/20170728180001/https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia | archivedate=2017-07-28 }}</ref>）。<ref name="American College of Cardiology 2015 long-term cardiovascular effects on people treated with stimulants">{{cite web | type=tertiary source | title=The Safety of Stimulant Medication Use in Cardiovascular and Arrhythmia Patients | website=American College of Cardiology | date=2015-04-28 | url=http://www.acc.org/latest-in-cardiology/articles/2015/04/28/10/06/the-safety-of-stimulant-medication-use-in-cardiovascular-and-arrhythmia-patients | access-date=2017-12-08 | deadurl=no | archiveurl=https://web.archive.org/web/20171209100055/http://www.acc.org/latest-in-cardiology/articles/2015/04/28/10/06/the-safety-of-stimulant-medication-use-in-cardiovascular-and-arrhythmia-patients | archivedate=2017-12-09 }}</ref><ref>Food and Drug Administration. FDA Drug Safety Communication: Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in children and young adults. Food and Drug Administration; November 1, 2011.</ref><ref>Biederman J, Mick E, Surman C, et al. A Randomized, Placebo-Controlled Trial of OROS Methylphenidate in Adults with Attention-Deficit/Hyperactivity Disorder. Biol Psychiatry2006; 59: 829-835.</ref><ref>Hammerness P, Wilens T, Mick E, et al. Cardiovascular Effects of Longer-Term, High-Dose OROS Methylphenidate in Adolescents with Attention Deficit Hyperactivity Disorder. J Pediatr 2009; 155: 84-9.</ref><ref>Adler L, Orman C, Starr L, et al. Long-term Safety of OROS Methylphenidate in Adults with Attention-Deficit/Hyperactivity Disorder. J Clin Psychopharmacol 2011; 31: 108-114.</ref><ref>Weisler RH, Biederman J, Spencer TJ, et al. Long-term cardiovascular effects of mixed amphetamine salts extended release in adults with ADHD. CNS Spectr 2005; 10(12 Suppl 20): 35-43.</ref><ref>Simpson D, Plosker G. Atomoxetine: A Review of its Use in Adults with Attention Deficit Hyperactivity Disorder. Drugs 2004; 64(2): 205-222.</ref><ref>Wernicke J, Faries D, Girod D, et al. Cardiovascular Effects of Atomoxetine in Children, Adolescents, and Adults. Drug Safety 2003; 26(10): 729-740.</ref><ref>Adler L, Spencer T, Williams D, et al. Long-Term, Open-Label Safety and Efficacy of Atomoxetine in Adults With ADHD. J. of Att. Dis. 2008; 12(3): 248-253.</ref><ref>Habel L, Cooper W, Sox C, et al. ADHD Medications and Risk of Serious Cardiovascular Events in Young and Middle-Aged Adults. JAMA 2011; 306(24): 2673-2683.</ref>UpToDate指出，患者第一次用藥前必須先進行全面的心血管功能檢查，以確保患者沒有[[先天性心臟病]]或存有任何心血管問題。<ref name="UpToDate 2017">{{cite web | title=Cardiac evaluation of patients receiving pharmacotherapy for attention deficit hyperactivity disorder | website=UpToDate | date=2017-08-01 | url=https://www.uptodate.com/contents/cardiac-evaluation-of-patients-receiving-pharmacotherapy-for-attention-deficit-hyperactivity-disorder | access-date=2017-12-22 | quote=Evaluation of children with ADHD prior to initiation of medication should include a comprehensive, cardiovascular (CV)-focused patient history, family history, and physical examination | deadurl=no | archiveurl=https://web.archive.org/web/20171223042839/https://www.uptodate.com/contents/cardiac-evaluation-of-patients-receiving-pharmacotherapy-for-attention-deficit-hyperactivity-disorder | archivedate=2017-12-23 }}</ref>有研究指出ADHD用藥可能會引起[[血管硬化]]，然而尚需更多研究確認，並且也要再確認此現象是否有到臨床上界定需要治療的程度<ref name="affecting & sentimental">{{cite web | title=Cardiac evaluation of patients receiving pharmacotherapy for attention deficit hyperactivity disorder | website=UpToDate | date=2017-08-01 | url=https://www.uptodate.com/contents/cardiac-evaluation-of-patients-receiving-pharmacotherapy-for-attention-deficit-hyperactivity-disorder | access-date=2017-12-22 | quote=One small study suggested that there may be evidence of arterial stiffness, but further investigation is needed to confirm and determine any clinically significant effect | deadurl=no | archiveurl=https://web.archive.org/web/20171223042839/https://www.uptodate.com/contents/cardiac-evaluation-of-patients-receiving-pharmacotherapy-for-attention-deficit-hyperactivity-disorder | archivedate=2017-12-23 }}</ref><ref name="Kelly Rudser Dengel Kaufman 2014 pp. 755–759">{{cite journal | last=Kelly | first=Aaron S. | last2=Rudser | first2=Kyle D. | last3=Dengel | first3=Donald R. | last4=Kaufman | first4=Christopher L. | last5=Reiff | first5=Michael I. | last6=Norris | first6=Anne L. | last7=Metzig | first7=Andrea M. | last8=Steinberger | first8=Julia | title=Cardiac Autonomic Dysfunction and Arterial Stiffness among Children and Adolescents with Attention Deficit Hyperactivity Disorder Treated with Stimulants | journal=The Journal of pediatrics | publisher=Elsevier BV | volume=165 | issue=4 | year=2014 | issn=0022-3476 | pmid=25015574 | doi=10.1016/j.jpeds.2014.05.043 | pages=755–759}}</ref>。

中樞神經刺激劑藥物可能的副作用包含[[口乾]]、[[失眠]]、[[应激性|急躁/急性子/靜不下來]]、[[煩躁]]、[[食慾]]降低、[[體重下降]]、[[頭痛]]、[[抖動]]、[[抽动综合症]]等<ref name="UpToDate edginess">{{cite web | title=Pharmacotherapy-for-Adult-Attention-Deficit-Hyperactivity-Disorder | website=UpToDate | url=https://www.uptodate.com/contents/pharmacotherapy-for-adult-attention-deficit-hyperactivity-disorder | access-date=2018-02-26 | deadurl=no | archiveurl=https://web.archive.org/web/20180227034338/https://www.uptodate.com/contents/pharmacotherapy-for-adult-attention-deficit-hyperactivity-disorder | archivedate=2018-02-27 }}</ref>{{NoteTag|name=|1=See {{tsl|en|Obsessive–compulsive_spectrum#Tic_disorders}} }}<!--為什麼此NoteTag無法放進前面的refernce的quote中?--><ref name="Santosh Sattar Canagaratnam 2011 pp. 737–763">{{cite journal | last=Santosh | first=Paramala J. | last2=Sattar | first2=Sanjida | last3=Canagaratnam | first3=Myooran | title=Efficacy and Tolerability of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder in Adults | journal=CNS drugs | publisher=Springer Nature | volume=25 | issue=9 | date=2011-09-01 | issn=1172-7047 | pmid=21870887 | doi=10.2165/11593070-000000000-00000 | pages=737–763}}</ref>
<ref name="UpToDate jitteriness">{{cite web | title=Pharmacotherapy-for-Adult-Attention-Deficit-Hyperactivity-Disorder | website=[[UpToDate]] | url=https://www.uptodate.com/contents/pharmacotherapy-for-adult-attention-deficit-hyperactivity-disorder | access-date=2018-02-26 | quote=An uncontrolled follow-up of 96 adults with ADHD who experienced improvement while taking extended release methylphenidate in a randomized trial found that improvement in ADHD symptoms was sustained at 30 weeks on the medication. Only 39 subjects (40.6 percent) completed the long-term follow-up period. Participants continued to experience decreased appetite, insomnia, and jitteriness | deadurl=no | archiveurl=https://web.archive.org/web/20180227034338/https://www.uptodate.com/contents/pharmacotherapy-for-adult-attention-deficit-hyperactivity-disorder | archivedate=2018-02-27 }}</ref><ref name="Biederman Mick Surman Doyle 2010 pp. 549–553">{{cite journal | last=Biederman | first=Joseph | last2=Mick | first2=Eric | last3=Surman | first3=Craig | last4=Doyle | first4=Robert | last5=Hammerness | first5=Paul | last6=Kotarski | first6=Meghan | last7=Spencer | first7=Thomas | title=A Randomized, 3-Phase, 34-Week, Double-Blind, Long-Term Efficacy Study of Osmotic-Release Oral System-Methylphenidate in Adults With Attention-Deficit/Hyperactivity Disorder | journal=Journal of clinical psychopharmacology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=30 | issue=5 | year=2010 | issn=0271-0749 | pmid=20814332 | doi=10.1097/jcp.0b013e3181ee84a7 | pages=549–553}}</ref>；而在不超量使用中樞神經刺激劑藥物的情況下，其引發[[幻覺]]<!--delusion-->、[[偏執]]<!--paranoid-->、[[心血管疾病|心血管問題]]等嚴重副作用的機率極低，大約千分之一到萬分之一，而且發生的機率和沒有服用藥物的人沒有差異。<!--Quoted from [[苯丙胺|苯丙胺#心理]]--><ref name="FDA Abuse & OD">{{cite web | title = Adderall XR Prescribing Information | url = http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021303s026lbl.pdf | page = 11 | publisher = Shire US Inc | work = United States Food and Drug Administration | date = 2013-12 | accessdate = 2013-12-30 | deadurl = no | archiveurl = https://web.archive.org/web/20131230233702/http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021303s026lbl.pdf | archivedate = 2013-12-30 }}</ref><ref name="FDA Effects">{{cite web | title = Adderall XR Prescribing Information | url = http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021303s026lbl.pdf | pages = 4–8 | publisher = Shire US Inc | work = United States Food and Drug Administration | date = 2013-12 | accessdate = 2013-12-30 | deadurl = no | archiveurl = https://web.archive.org/web/20131230233702/http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021303s026lbl.pdf | archivedate = 2013-12-30 }}</ref><ref name="Shoptaw Kao Ling p=CD003026">{{cite journal | last=Shoptaw | first=SJ | last2=Kao | first2=U | last3=Ling | first3=W | title=Treatment for amphetamine psychosis. | journal=The Cochrane database of systematic reviews | issue=1 | date=2009-01-21 | issn=1469-493X | pmid=19160215 | doi=10.1002/14651858.CD003026.pub3 | page=CD003026 | quote=A minority of individuals who use amphetamines develop full-blown psychosis requiring care at emergency departments or psychiatric hospitals. In such cases, symptoms of amphetamine psychosis commonly include paranoid and persecutory delusions as well as auditory and visual hallucinations in the presence of extreme agitation. More common (about 18%) is for frequent amphetamine users to report psychotic symptoms that are sub-clinical and that do not require high-intensity intervention ...
About 5–15% of the users who develop an amphetamine psychosis fail to recover completely (Hofmann 1983) ...
Findings from one trial indicate use of antipsychotic medications effectively resolves symptoms of acute amphetamine psychosis.}}</ref><ref name="FDA Abuse & OD" /><ref name="FDA Effects" /><ref name="Stimulant Misuse">{{cite web | author = Greydanus D | title=Stimulant Misuse: Strategies to Manage a Growing Problem | type=Review Article | url=http://www.acha.org/prof_dev/ADHD_docs/ADHD_PDprogram_Article2.pdf | archiveurl=https://web.archive.org/web/20131103155156/http://www.acha.org/prof_dev/ADHD_docs/ADHD_PDprogram_Article2.pdf | work=American College Health Association | publisher=ACHA Professional Development Program | accessdate=2013-11-02 | archivedate=2013-11-03 | page=20}}</ref><!--Quoted from [[苯丙胺|苯丙胺#心理]]-->
因此期刊整理過去 185個研究（達一萬兩千多人），得到的研究結論是：注意力不足過動症的治療藥物並未增加嚴重副作用風險的機會。相對而言，常被忽略的是未經治療的注意力不足過動症所衍生出的嚴重風險<ref name="affecting">{{cite web | title=Cardiac evaluation of patients receiving pharmacotherapy for attention deficit hyperactivity disorder | website=UpToDate | date=2017-08-01 | url=https://www.uptodate.com/contents/cardiac-evaluation-of-patients-receiving-pharmacotherapy-for-attention-deficit-hyperactivity-disorder | access-date=2017-12-22 | quote=What is clear, however, is limiting or delaying children's access to effective treatment for ADHD could have serious implications (such as increased risk of adolescent substance use disorder, academic failure, and accidents) in patients who are not effectively treated. | deadurl=no | archiveurl=https://web.archive.org/web/20171223042839/https://www.uptodate.com/contents/cardiac-evaluation-of-patients-receiving-pharmacotherapy-for-attention-deficit-hyperactivity-disorder | archivedate=2017-12-23 }}</ref>（約高達50%）。{{noteTag|nam3=|1=[[愛思唯爾|Elsevier BV]]曾經出版一篇文獻指出，未經治療的ADHD可能在往後的人生中直接或間接衍生出以下共伴疾病（已忽略重複項目）：[[吸菸]]、[[性成癮]]（包含：從事{{tsl|en|Risky sexual behavior|高風險性愛}}、罹患[[性感染疾病]]）。間接：[[體適能]]不足、醫療費用及就醫次數增加。極間接：[[糖尿病]]、[[高血壓]]。<ref name="Nigg 2013 pp. 215–228">{{cite journal | last=Nigg | first=JT | title=Attention-deficit/hyperactivity disorder and adverse health outcomes | journal=Clinical psychology review | publisher=Elsevier BV | volume=33 | issue=2 | year=2013 | issn=0272-7358 | pmid=23298633 | pmc=4322430 | doi=10.1016/j.cpr.2012.11.005 | pages=215–228}}</ref>}}<ref name="risk of untreated ADHD">{{cite web
|url = http://www.tc-adhd.com/?p=1565
|title = 心動家族協會理事長專文：問ADHD藥物有無風險，不如問「不治療和治療的風險哪一個高」
|date = 2016-04-18
|website = 心動家族協會
|author = 陳錦宏
|access-date = 2017-01
|archive-url = https://archive.today/20170103064140/http://www.tc-adhd.com/?p=1565
|archive-date = 2017-01-03
|deadurl = yes
}}</ref>不過[[考科藍協作組織]]於2015年發表的系統性文獻回顧指出，使用中樞神經刺激劑後，像[[失眠]]、[[食慾不振]]等較不嚴重的副作用常出現在服用者身上，並衍生出長期預後的不確定因素<ref name="Storebø Ramstad Krogh Nilausen p. ">{{cite | last=Storebø | first=Ole Jakob | last2=Ramstad | first2=Erica | last3=Krogh | first3=Helle B. | last4=Nilausen | first4=Trine Danvad | last5=Skoog | first5=Maria | last6=Holmskov | first6=Mathilde | last7=Rosendal | first7=Susanne | last8=Groth | first8=Camilla | last9=Magnusson | first9=Frederik L | last10=Moreira-Maia | first10=Carlos R | last11=Gillies | first11=Donna | last12=Buch Rasmussen | first12=Kirsten | last13=Gauci | first13=Dorothy | last14=Zwi | first14=Morris | last15=Kirubakaran | first15=Richard | last16=Forsbøl | first16=Bente | last17=Simonsen | first17=Erik | last18=Gluud | first18=Christian | editor-last=Storebø | editor-first=Ole Jakob | title=Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD) | journal=The Cochrane database of systematic reviews | publisher=John Wiley & Sons, Ltd | publication-place=Chichester, UK | issue=11 | date=2015-11-25 | pmid=26599576 | doi=10.1002/14651858.cd009885.pub2 | page=| quote = Within the short follow-up periods typical of the included trials, there is some evidence that methylphenidate is associated with increased risk of non-serious adverse events, such as sleep problems and decreased appetite, but no evidence that it increases risk of serious adverse events.Better designed trials are needed to assess the benefits of methylphenidate. Given the frequency of non-serious adverse events associated with methylphenidate, the particular difficulties for blinding of participants and outcome assessors point to the advantage of large, 'nocebo tablet' controlled trials.|type = systematic review}}</ref>。

所有用來治療注意力不足過動症的藥物只要依照醫師指示用藥，都是相當安全的。<ref name="NIDAAAS">{{cite web
|url = https://www.drugabuse.gov/publications/drugfacts/stimulant-adhd-medications-methylphenidate-amphetamines
|title = Stimulant ADHD Medications: Methylphenidate and Amphetamines
|first = National Institute on Drug
|last = Abuse
|date =
|publisher =
|deadurl = no
|archiveurl = https://web.archive.org/web/20170710220805/https://www.drugabuse.gov/publications/drugfacts/stimulant-adhd-medications-methylphenidate-amphetamines
|archivedate = 2017-07-10
}}</ref><ref name="medlineplus1"/>
<ref name="NHS">
{{cite web
|url = http://www.nhs.uk/chq/Pages/1391.aspx?CategoryID=73
|title = What is a controlled medicine (drug)? - Health questions - NHS Choices
|first = N. H. S.
|last = Choices
|date = 2016-12-12
|publisher =
|deadurl = no
|archiveurl = https://web.archive.org/web/20170503060547/http://www.nhs.uk/chq/Pages/1391.aspx?CategoryID=73
|archivedate = 2017-05-03
}}</ref>
而藥物成分為哌甲酯的中樞神經刺激劑，例如：利他能與專思達，可能導致：心悸、頭痛、胃痛、喪失食慾、失眠、因相對專注而變得冷淡（面無表情）等副作用，因此6歲以下的兒童不適宜將藥物當成第一線療法服用。（副作用產生與否因人而異）
<ref>{{cite web
|title = Methylphenidate
|url = https://medlineplus.gov/druginfo/meds/a682188.html
|website = Home of MedlinePlus → Drugs, Herbs and Supplements → Methylphenidate Methylphenidate pronounced as (meth'' il fen' i date)
|date = 2016-02-15
|access-date = 2017-02-27
|deadurl = no
|archiveurl = https://web.archive.org/web/20170704210652/https://medlineplus.gov/druginfo/meds/a682188.html
|archivedate = 2017-07-04
}}</ref>

隨著時間推進與各方的努力，中樞神經刺激劑的相關副作用{{NoteTag|name=adverse effect|1=「常見副作用」的定義為：在臨床試驗中，實驗組中至少5%的人出現此症狀，且在實驗組中出現此反應的比例為安慰組的兩倍。}}{{NoteTag|name=less common side effects|1=「較少見的副作用」的定義為：在臨床試驗中，實驗組中至少2%的人出現此症狀，且在實驗組中出現此反應的比例多於安慰組。}}已可藉由包括但不限於劑量調整、服藥時間、飯前飯後服用、服藥頻率等服藥模式之改變以及改變藥物組合等方式獲得相當程度的減少。<ref name="NIDAAAS" />
<ref name="Science_daily">{{cite web
|url = https://www.sciencedaily.com/releases/2016/08/160801093232.htm
|title = Combining medications could offer better results for ADHD patients
|archive-url = https://web.archive.org/web/20170102050323/https://www.sciencedaily.com/releases/2016/08/160801093232.htm
|archive-date = 2017-01-02
|date = 2016-08-01
|website = Science News
|publisher = Elsevier
|access-date = 2017-01
|quote = "Three studies to be published in the August 2016 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) report that combining two standard medications could lead to greater clinical improvements for children with attention-deficit/hyperactivity disorder (ADHD) than either ADHD therapy alone.", August, 2016
|deadurl = no
}}</ref>
<ref>{{cite book
|title = Adults with ADHD
|publisher = NATIONAL LIBRARY OF MEDICINE at the NATIONAL INSTITUTES OF HEALTH
|series = MedlinePlus the Magazine
|volume = 9
|ISSN = 1937-4712
|date = 2014
|location = 8600 Rockville Pike • Bethesda, MD 20894, United States of America
|pages = 19
|language = en-us
|url = https://medlineplus.gov/magazine/issues/spring14/articles/spring14pg19.html
|deadurl = no
|archiveurl = https://web.archive.org/web/20170715030133/https://medlineplus.gov/magazine/issues/spring14/articles/spring14pg19.html
|archivedate = 2017-07-15
}}</ref>
<ref>{{cite web
|url = https://medlineplus.gov/ency/article/001551.htm
|title = Attention deficit hyperactivity disorder
|date = 2016-05-25
|website = Home → Medical Encyclopedia → Attention deficit hyperactivity disorder
|publisher = NATIONAL LIBRARY OF MEDICINE at the NATIONAL INSTITUTES OF HEALTH
|access-date = 2017-02-27
|deadurl = no
|archiveurl = https://web.archive.org/web/20170126193043/https://medlineplus.gov/ency/article/001551.htm
|archivedate = 2017-01-26
}}</ref>
<ref>
{{cite web
|url = http://www.ninds.nih.gov/disorders/adhd/adhd.htm
|title = All Disorders
|website = National Institute of Neurological Disorders and Stroke
|access-date = February twenty seventh, 2017
|quote =
|deadurl = no
|archiveurl = https://web.archive.org/web/20161202230225/http://www.ninds.nih.gov/disorders/adhd/adhd.htm
|archivedate = 2016-12-02
}}</ref>

UpToDate指出，使用者於中斷使用中樞神經刺激劑後恢復使用之，可能需要重新從較低的劑量開始逐步增加至理想劑量。<ref name="UpToDate edginess and drug holidays">{{cite web | title=Pharmacotherapy-for-Adult-Attention-Deficit-Hyperactivity-Disorder | website=UpToDate | url=https://www.uptodate.com/contents/pharmacotherapy-for-adult-attention-deficit-hyperactivity-disorder | access-date=2018-02-26 | quote=Progressive titration, as tolerated, to an optimally effective dose is an important means of minimizing side effects. Re-titration may be necessary after drug holidays. | deadurl=no | archiveurl=https://web.archive.org/web/20180227034338/https://www.uptodate.com/contents/pharmacotherapy-for-adult-attention-deficit-hyperactivity-disorder | archivedate=2018-02-27 }}</ref><ref name="Castells Cunill Capellà 2013 pp. 347–356">{{cite journal | last=Castells | first=Xavier | last2=Cunill | first2=Ruth | last3=Capellà | first3=Dolors | title=Treatment discontinuation with methylphenidate in adults with attention deficit hyperactivity disorder: a meta-analysis of randomized clinical trials | journal=European journal of clinical pharmacology | publisher=Springer Nature | volume=69 | issue=3 | date=2012-09-16 | year=2013 | issn=0031-6970 | pmid=22983311 | doi=10.1007/s00228-012-1390-7 | pages=347–356}}</ref>

{{For2|更多中樞神經刺激劑和其藥物<!--：派醋甲酯、[[安非他命]]-->|[[中樞神經刺激劑]]、[[哌甲酯]]、和[[安非他命]]尤其[[安非他命|安非他命#醫療]]乙節}}

{| style="margin: 0 auto;" | [[File:Ritalin LA exterior、outward appearance、藥罐外觀.jpg|left|thumb|upright=0.55|[[利他能]]LA（Ritalin LA）藥罐外觀]]
| [[File:Dextroamphetamine.jpg|center|thumb|upright=0.8|[[右旋安非他命]]]]
| [[File:Lilly Strattera 60mg Capsule.jpg|center|thumb|upright=0.9|禮來公司[[思銳]]60毫克膠囊（Lilly Strattera 60mg Capsule）]]
| [[File:Strattera atomoxetin.jpg|center|thumb|upright=1.3|思銳（Strattera）外盒]]
|}
===第一線中樞神經刺激劑===
===第一線中樞神經刺激劑===
{| class="wikitable sortable"
{| class="wikitable sortable"
第95行： 第314行：
}}</ref>
}}</ref>


=== 第一線非中樞神經刺激劑 ===
==== 第一線非中樞神經刺激劑 ====
{| class="wikitable"
{| class="wikitable"
|+ 思銳（Strattera）仿單上的建議劑量<ref name="Strattera label">{{cite web|url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=309de576-c318-404a-bc15-660c2b1876fb|title=DailyMed - STRATTERA- atomoxetine hydrochloride capsule STRATTERA- atomoxetine hydrochloride|author=|date=June 2015|publisher=Eli Lilly|website=DailyMed.com|deadurl=no|archiveurl=https://web.archive.org/web/20170902005439/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=309de576-c318-404a-bc15-660c2b1876fb|archivedate=2017-09-02}}</ref>
|+ 思銳（Strattera）仿單上的建議劑量<ref name="Strattera label">{{cite web|url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=309de576-c318-404a-bc15-660c2b1876fb|title=DailyMed - STRATTERA- atomoxetine hydrochloride capsule STRATTERA- atomoxetine hydrochloride|author=|date=June 2015|publisher=Eli Lilly|website=DailyMed.com|deadurl=no|archiveurl=https://web.archive.org/web/20170902005439/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=309de576-c318-404a-bc15-660c2b1876fb|archivedate=2017-09-02}}</ref>

2018年7月6日 (五) 13:12的版本

维基百科中的醫學内容仅供参考，並不能視作專業意見。如需獲取醫療幫助或意見，请咨询专业人士。詳見醫學聲明。

注意力不足過動症的治療是指在注意力不足過動症（ADHD）治療上，以醫學實證為基礎，已確認有一定程度治療效果的治療方式。美國兒科學會針對病患的年齡不同，有建議不同的治療方式。若是四歲至五歲的兒童，學會會建議有實證基礎，且由家長或／和老師監督的行為治療，只有在有中度到重度，持續性的功能紊亂時，才加上哌甲酯的藥物治療。若是六歲至十一歲的兒童，會建議使用藥物以及行為治療，而根據實證，興奮劑有比其他藥物要明顯的效果。若是十二歲至十八歲的患者，藥物治療需取得患者的同意，最好配合行為治療。不過此年齡層行為治療的效果只有C級而已[1]。

有許多的兴奋剂及非兴奋剂用在ADHD的治療上。最常見的兴奋剂有哌甲酯（利他能、專思達）、混合安非他命鹽類（阿得拉尔、Mydayis）、右旋安非他命（Dexedrine）及甲磺酸赖氨酸安非他命（Vyvanse）。特別用來治療ADHD的非兴奋剂藥物有阿托莫西汀（Strattera）、胍法辛（Intuniv）及可乐定（Kapvay）。其他仿單標示外使用的藥物有安非他酮（Wellbutrin）、三环类抗抑郁药、5-羟色胺和去甲肾上腺素再摄取抑制剂或是单胺氧化酶抑制剂[2][3][4]。而共病的存在也會讓正確的診斷及治療更加複雜、費時，以及花費金錢。因此會建議同時評估並治療可能的共病病症[5]。

有許多治療ADHD的心理治療及行為改正（英语：behavior modification）方式，包括心理治療以及工作記憶訓練（英语：working memory training）。若其家庭及學校也配合使用父母管理訓練及教室管理（英语：classroom management）的作法，對ADHD兒童的行為是有幫助的[6]。也有專門的ADHD教練提供一些像是时间管理及組織等生活機能上的服務，並且提供策略。已證實自我控制的訓練課程在這領域效果不大。

到2006年為止，有關ADHD藥物潛在不良反應的資料仍有不足[7]，很少研究有探討在治療超過四個月之後，治療的安全性以及效果[8]，也沒有針對治療超過二年的案例所進行的随机对照试验[9][10]。

非藥物治療

参见：注意力不足過動症 § 治疗

認知行為治療

著重在「常在成人患者身上觀察到的執行功能缺失」的認知行為治療，主要協助患者治療以下問題[11][12]：

  • 難以持續掌握任務和活動、難以對任務或活動抱持恆心。
  • 拖延。
  • 有分辨事情緩急輕重的困難。
  • 缺乏管理能力。
  • 做短期和長期計畫的能力不及格。[13]

家中的行為治療

参见：父母管理訓練
*治療師會定期與家庭成員會晤以觀察進度並提供持續的支持（左對話框）。
  • 在會晤中，家長現場實習從治療師那學來的技巧（右對話框）。
  • 即便療程結束，家庭成員仍能持續感受到行為的改善以及壓力的減輕（下方橫幅）。[14]
家長能在行為治療中學到的三種核心能力
家長能在行為治療中學到三種核心能力：正向溝通、正向激勵/強化（英语：Reinforcement#Positive_reinforcement）、結構與一致的紀律/規範/規則[14]

在行为治疗期间，治療師會定期與家庭成員會晤以觀察進度並提供持續的支持。在會晤中，家長現場實習從治療師那學來的技巧，即便療程結束，家庭成員仍能持續感受到行為的改善以及壓力的減輕。[14]家長能在父母教育訓練中學到三種核心能力：正向溝通、正向激勵/強化（英语：Reinforcement#Positive_reinforcement）、結構與一致的紀律/規範/規則[14]。

  • 用「愛」來溝通
  • 傾聽與陪伴[15]

正念療法

2018年4月出爐的最新文獻顯示，「認知行為治療+藥物治療+正念療法」的策略比「認知行為治療+藥物治療」帶給患者更大的進步，因此有成為未來正式治療策略的潛力。[16] 然而單獨就「認知行為治療」和「正念療法」相比，未服藥且單獨接受「認知行為治療」或「正念療法」的ADHD患者經過訓練後，並未發現「認知行為治療」和「正念療法」的療效有何差異。[17] 有鑑於前述不一致的實驗結果，正念療法尚需更多研究來證明其有效性。

藥物治療

参见：注意力不足過動症 § 藥物治療

中樞神經刺激劑

参见：苯丙胺 § 醫療和注意力不足過動症的治療 § 第一線中樞神經刺激劑

治療注意力不足過動症的第一线药物为中樞神經兴奋剂（又名為中樞神經刺激劑），其中包括：

藥物名 藥物（主成分/有效成分）學名 作用時間 生效時間 備註
利他能（Ritalin） 哌甲酯[a] 短：3.5小時左右 約服用後30分鐘
Adderall 右旋苯丙胺和左旋苯丙胺 N/A N/A
Desoxyn 甲基苯丙胺 N/A N/A
  • 為安非他命产品
利他(長)能LA（Ritalin LA/利長能） 哌甲酯 中：8小時左右 約服用後30分鐘
  • 藥物之半衰期介於利他能與專思達之間。有10MG、20MG、30MG、40MG及60MG等劑型。
專思達/專注達 哌甲酯 長：12小時左右 約服用後30分鐘
  • 台灣譯作專思達，有18MG、27MG、36MG、54MG等數種劑量。
  • 中華民國中央健康保險署已經核定醫師可將此藥物作為十八歲以下患者的第一線處方。[18][19]
  • 中國大陸翻譯為專注達。

[20] [21] [22] [23] [24]

利他能[24]、利長能[21]、專思達[23]、安保美喜錠[25] ，所含之有效成分皆為哌甲酯，各自在藥效動力學上具有相同屬性；在藥物代謝動力學上的作用則有些微差異。[26][27][28]醫師可依患者的需求，視各種藥品之藥物動力學的特性，調整處方藥物，實現個人化醫療[29]。 常見的專思達，其12歲以下的使用者每日最大劑量上限為54毫克；13到17歲的使用者之每日最大劑量上限為72毫克[30][31]。若患者早上服用的中長效劑型藥物之藥效在傍晚開始消退，患者可視需要再服用短效劑型藥物，彌補隨著長效型藥物藥效退去後產生的空窗期。[32]

雖中樞神經刺激劑藥效約於服用後半小時左右開始，並不表示症狀會在服用後半小時就消失，如同其他疾病的治療一樣，病情的改善需要一定（段）時間的持續治療（時間長度因人而異）。藥物（包含：中樞神經刺激劑、非中樞神經刺激劑、......）會在這些患者的背後推他們一把，助他們一臂之力[33]。然而，即便如此，患者本身仍需認真努力地改變自己。藥物是注意力不足過動症整體治療的其中一環。[20][34][35]

根據世界反運動禁藥組織，中樞神經刺激劑在未事先申請醫療許可及非醫療所需的情況下服用都將被視同違規行為。[36]

部分用來治療注意力不足過動症的藥品（例如：中樞神經刺激劑）在美国食品藥物管理局划分为二级管制藥品（Schedule II，即指有滥用可能性的药品），在台灣則列為第三級管制藥品。[37][38][39][40]

中樞神經刺激劑如同多數藥物一樣，在正確使用下，造成內臟器官受損的機率非常低，但UpToDate仍強烈 建議用藥者應定期追蹤自己的體重、心跳與血壓等[41][42]，研究顯示中樞神經刺激劑造成的心血管作用與其攝取劑量多寡有關[42][43]（中樞神經刺激劑的副作用可能有：食慾降低、心跳與血壓上升等；而輕度、中度的心悸及高血壓可能不會被人覺察到，然而長期血壓超越正常範圍可能會導致許多健康問題；食慾降低可能不自覺地引起低血糖，導致心悸等副作用[44][45]）。[46][47][48][49][50][51][52][53][54][55]UpToDate指出，患者第一次用藥前必須先進行全面的心血管功能檢查，以確保患者沒有先天性心臟病或存有任何心血管問題。[56]有研究指出ADHD用藥可能會引起血管硬化，然而尚需更多研究確認，並且也要再確認此現象是否有到臨床上界定需要治療的程度[57][58]。

中樞神經刺激劑藥物可能的副作用包含口乾、失眠、急躁/急性子/靜不下來、煩躁、食慾降低、體重下降、頭痛、抖動、抽动综合症等[59][註 1][60] [61][62]；而在不超量使用中樞神經刺激劑藥物的情況下，其引發幻覺、偏執、心血管問題等嚴重副作用的機率極低，大約千分之一到萬分之一，而且發生的機率和沒有服用藥物的人沒有差異。[63][64][65][63][64][66] 因此期刊整理過去 185個研究（達一萬兩千多人），得到的研究結論是：注意力不足過動症的治療藥物並未增加嚴重副作用風險的機會。相對而言，常被忽略的是未經治療的注意力不足過動症所衍生出的嚴重風險[67]（約高達50%）。[註 2][69]不過考科藍協作組織於2015年發表的系統性文獻回顧指出，使用中樞神經刺激劑後，像失眠、食慾不振等較不嚴重的副作用常出現在服用者身上，並衍生出長期預後的不確定因素[70]。

所有用來治療注意力不足過動症的藥物只要依照醫師指示用藥，都是相當安全的。[37][38] [71] 而藥物成分為哌甲酯的中樞神經刺激劑，例如：利他能與專思達，可能導致：心悸、頭痛、胃痛、喪失食慾、失眠、因相對專注而變得冷淡（面無表情）等副作用，因此6歲以下的兒童不適宜將藥物當成第一線療法服用。（副作用產生與否因人而異） [72]

隨著時間推進與各方的努力，中樞神經刺激劑的相關副作用[註 3][註 4]已可藉由包括但不限於劑量調整、服藥時間、飯前飯後服用、服藥頻率等服藥模式之改變以及改變藥物組合等方式獲得相當程度的減少。[37] [73] [74] [75] [76]

UpToDate指出，使用者於中斷使用中樞神經刺激劑後恢復使用之，可能需要重新從較低的劑量開始逐步增加至理想劑量。[77][78]

  關於更多中樞神經刺激劑和其藥物，請見中樞神經刺激劑、哌甲酯、和安非他命尤其安非他命#醫療乙節。
右旋安非他命
禮來公司思銳60毫克膠囊（Lilly Strattera 60mg Capsule）
思銳（Strattera）外盒

第一線中樞神經刺激劑

專思達（Concerta）仿單（說明書）上的建議劑量
患者年紀 建議起始劑量 劑量範圍
6-12歲 18 毫克/每天 （mg/Kg） 18 - 54 毫克/每天 （mg/Kg）
13-17歲 18 毫克/每天 18 - 72 毫克/每天 每天每公斤不可超過2毫克。[註 5]
18-65歲 18 或 36 毫克/每天 18 - 72 毫克/每天

[79] 註解：

  1. 在專思達的藥物試驗過程中發現，13-17歲的青年試驗組中，專思達的最低有效劑量為： 每天每公斤1.4毫克 (1.4 mg/kg/day)。[79]
  2. 18歲以上的兩個成人試驗組中，發現每天18-72毫克的劑量皆可達到在統計學上具顯著意義的療效。（然而以每天36毫克以上進而達到統計學上具顯著意義的療效的臨床試驗者為大多數。）[80]

第一線非中樞神經刺激劑

思銳（Strattera）仿單上的建議劑量[81]
體重 每天服用的起始劑量 總計每天服用的目標劑量 總計每天服用劑量的安全上限
年齡小於18歲且體重小於70公斤 0.5 毫克/每公斤（mg/Kg） 1.2 毫克/每公斤（mg/Kg） 1.4 毫克/每公斤（mg/Kg）
年齡大於或等於18歲或年齡小於18歲且體重大於70公斤 40 毫克/天（mg/day） 80 毫克/天（mg/day） 100 毫克/天（mg/day）
  • 備註：
  1. 建議劑量與種族無關。[81]
  2. 肝腎功能不全的患者的服用劑量應低於建議劑量[81]（詳見：阿托莫西汀#劑量）
  3. 總計每天服用劑量的上限 = 無論分幾次服用，一天之內最多可攝取的劑量。
  4. 每天的起始劑量應服用至少三天，使身體適應後，才可開始服用每天的目標劑量。[81]
  5. 若每天目標劑量效果不符預期，則可逐漸增加劑量至每天服用劑量的上限[82]

對於治療方式的不同論點

参见：注意力不足過動症 § 治療方式的爭議

中華民國（台灣）有社會學學者從新聞媒體資料庫－聯合知識庫蒐集2001年起有關注意力不足過動症的新聞報導，並從記者的報導中，利用內容分析方法分析出「兒童的過動問題一開始就以生物醫學模式來解釋，在處遇建議上則呈現從行為治療轉向藥物治療的明確趨勢」的結論[83][84]。

美國有社會學家認為注意力不足過動症（ADHD）的治療是一個把「不常見且不被廣泛接受的行為」（deviant behavior）醫療化的例子。抱持這種想法的社會學家認為ADHD的治療是把早期不屬於醫療範疇的學生在學表現的問題給醫療化（另有一說是指這是「特教醫療化」）。[85][86]在中華民國，也有兩位學者附和這樣的論點。[87]

在美國，絕大多數的醫療人員相信ADHD是一個真實存在的「症」（genuine disorder）[86]，至少在症狀較明顯的人身上是這樣沒錯。[88][89]美國醫療人員之間的爭議主要是圍繞在那些症狀輕微的病患的診斷及治療方式[88][89][86][90][91][88][89][86]。（美國的ADHD流行率高於世界平均，詳見：注意力不足過動症 § 流行病學）

英國官方機構－英國傑出國家健康照護機構（英语：National Institute for Health and Care Excellence）在2009年發表聲明，聲明中有提及目前存在的爭議，但表示：當前的治療策略與診斷方法都是基於大量學術文獻所形成的學術界共識而得。 [92]

中華民國一位中央研究院歷史語言研究所的學者分析指出，台灣關於「西藥」的文化信念或成見在注意力不足過動症的治療方式的爭議之中，扮演著一個催化劑的角色。[93]

該學者建議精神醫學界「必須更認真思考大眾科學與衛教等議題」、全面向的介紹一個疾病以避免見樹不見林，從而化解相關爭議[93]。
除此之外，他也呼籲：強調精神疾病是生物性疾病的精神醫學與關注心理病理與心理發展的心理學、關注家庭社會病理與社會支持的社會工作專業、以及以教育矯正為職能及宗旨的教育與特教專業，彼此之間應有更緊密的合作。
他還指出「即使相信過動症的生物性本質，在目前的臨床實作上，從其症狀表現、發現認定、診斷到評估治療成效的指標，都還是以實際情境中的行為為基礎；而各種非藥物治療模式的施行，也需要多方面配合及參與。因此，在評估過動症的各種流行病學數據與藥物療效，以及要引入某種治療模式時，必然需要考慮在地的家庭、教育、社會環境與文化。」[93]

這位學者的結論是注意力在當代社會扮演的腳色日益重要[93]，並預期精神科在未來的人類社會中，將有更為多元的職能。[93]。

參考文獻

维基文库中的相关原始文献：身心障礙者權利公約
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註解

  1. ^ 又稱為「派醋甲酯」
  1. ^ See Obsessive–compulsive_spectrum#Tic_disorders（英语：Obsessive–compulsive_spectrum#Tic_disorders）
  2. ^ Elsevier BV曾經出版一篇文獻指出，未經治療的ADHD可能在往後的人生中直接或間接衍生出以下共伴疾病（已忽略重複項目）：吸菸、性成癮（包含：從事高風險性愛（英语：Risky sexual behavior）、罹患性感染疾病）。間接：體適能不足、醫療費用及就醫次數增加。極間接：糖尿病、高血壓。[68]
  3. ^ 「常見副作用」的定義為：在臨床試驗中，實驗組中至少5%的人出現此症狀，且在實驗組中出現此反應的比例為安慰組的兩倍。
  4. ^ 「較少見的副作用」的定義為：在臨床試驗中，實驗組中至少2%的人出現此症狀，且在實驗組中出現此反應的比例多於安慰組。
  5. ^ 舉例：一個三十公斤的服藥者每天不可服用超過60毫克的專思達

外部連結

检索自“https://zh.wikipedia.org/w/index.php?title=注意力不足過動症的治療&oldid=50282219”