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注意力不足過動症的藥物治療：修订间差异

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2019年1月28日 (一) 12:34的版本

注意力不足過動症的藥物治療指的是以藥物來治療注意力不足過動症。

      參見：ADHD的治療藥物、藥品一覽表、注意力不足過動症多重治療模式研究§藥物治療

2011年，全美「有ADHD診斷的兒童與青少年（4-17歲）且被診斷數年後至少仍符合ADHD診斷最低標準的患者」之用藥比例。 [1][2][註 1]

  正在接受藥物治療者（69.3%）
  沒有正在接受藥物治療者（30.7%）

2016年，全台灣「有ADHD的兒童與青少年（4-17歲）」之用藥比例。 [3][4][5][6][7]

  正在接受藥物治療者（4.8%）
  沒有正在接受藥物治療者（95.2%）

藥物可以減少「過動—衝動」、分心等核心症狀，提升孩子的自制力，讓他們有足夠的能力追尋自己的夢想。另外一方面，藥物是治療腦部先天性功能缺陷。在醫療用途上，ADHD藥物的副作用均輕微，副作用透過調整藥物配方（停藥、減少劑量、加入Clonidine等緩心悸藥物）即可改善。在醫學與藥學（藥理學、藥劑學）知識的把關下，中樞神經刺激劑等藥物都是安全的。[references 1] [references 2]

ADHD有時可能出現忘記吃藥的情形[註 2]，且短效藥物在血漿內的濃度變化很快，故不易維持穩定的療效，所以中長效型的藥物，對於患者來說是較為適合的。[23][24] 除此之外，中樞神經刺激劑的劑量如果不足，會導致「治療ADHD的療效打折」或「藥效只出現一下下（later loss of effectiveness）」[25]。中樞神經刺激劑的劑量不足的情況曾經發生在成人及青少年患者身上且未來也有可能發生，因為美國食品藥物管理局批准的劑量主要是適用於學齡兒童。為此，有些臨床醫師選擇改以體重或臨床療效（英语：clinical judgement）作為處方藥物的劑量的基準。[26][27][28][29]

「中樞神經刺激劑」[註 3]被列為第三級別『管制藥品』的原因在於避免民眾尚未經醫師處方就錯誤地使用[16][30]。

管制藥品雖具有醫療用途，但也可能因不當流用、濫用後而導致成癮，為了使管制藥品不致於淪為非法毒品，台灣的《管制藥品管理條例》規定，醫師必須領有管制藥品使用執照，才能開立第1~3級管制藥品專用處方箋；而藥師也必須依「管制藥品專用處方箋」才可調劑此類藥品；除此之外，患者領藥時，必須出具身分證明，並在專用處方箋上簽名，確保用藥安全[31]。而患者領藥後應依據醫師開立的管制藥品處方箋，遵循醫囑，正確地服用[31]。如果管制藥品不是由醫師診斷、開立，甚至來路不明，民眾切勿服用，以免無法改善病情，還可能上癮或造成更嚴重的傷害[31]。

雖然個案可能常看似已興奮過頭，且治療藥物被歸納為興奮劑類[註 4]，但是興奮劑類藥物確實有幫助患者們保持平靜的效果。[32][16] 每個人或多或少都會有分心、過動或衝動等症狀，但這些症狀在ADHD患者上會更為頻繁的出現、症狀的嚴重度更高且影響生活、學業、工作等。一個現象是否達到疾病等級，必須考量到頻率及程度。[33]

有些家長或孩童會以為使用藥物即可解決相關問題，因此對於藥物過度依賴，卻忽略需配合藥物使用的時期，讓孩子學習與接受指導，建立起人際互動、行為管理等技巧。這也讓孩子有機會可以不靠藥物自我管理。[34][35]

一般來說，以藥物治療ADHD的效果相當顯著。 [36] [37] 使用此類藥品的患者，長期治療的預後，幾乎都可以改善其注意力不集中、衝動與人際衝突的症狀；而且患者的社會性互動及人際關係乃至閱讀能力（英语：reading comprehension）也都會有改善。[36][38] 文獻另指出，針對ADHD的個人化醫療可能包含較新的ADHD藥物配方、組合。[39]醫師藉由藥劑量滴定（英语：Dosing）協助病人找到對病人來說最適合、最有效的藥物劑量（英语：Dose (biochemistry)）[40]，而不同的ADHD子類型所適用的最小有效劑量（英语：Effective_dose_(pharmacology)）可能不同[41]。

近年來，多項國際大型研究表明適當的注意力不足過動症藥物治療可以減少未來意外傷害、交通事故的機會、降低頭部外傷的風險並且減少物質使用和濫用的機率。[42] [43] [44] [45] [46] [47] [48] [49][50][51][52]

PloS One期刊中一篇文獻指出，對臨床醫師而言，應向患者及家屬傳達「持續藥物治療對於減少身體傷害有其重要性」。研究發現，相較於從未接受藥物治療的患者，接受藥物治療超過180天的ADHD族群，其骨折風險顯著較低，低了將近23%。有接受藥物治療，但總期間不超過180天的患者，其骨折風險與未接受藥物的族群比較起來並無明顯差異，凸顯了藥物治療持續時間的影響。[43]

台灣兒童青少年精神醫學會指出：「治療ADHD核心症狀時，藥物是絕對不能忽略的治療選項。[42]」台灣兒童青少年精神醫學會理事長高淑芬另指出，對於18歲後才獲得第一次ADHD診斷的患者，台灣健保僅給付短效利他能，但患者若認為有使用其他藥物需求，應勇於跟醫生討論，不要因而忌諱就醫。[53][54]

ADHD藥物治療能減少ADHD患者（無論是否被診斷出來）身體受傷的發生率[55]

中樞神經刺激劑

参见：苯丙胺 § 醫療

中樞神經刺激劑藥物是治療ADHD的藥物選擇之一。[56][57] 中樞神經刺激劑至少能在14個月內，改善部分ADHD的症狀。[58][59][60]

一些家長和老師回報哌甲酯似乎能改善ADHD的症狀。[59][58][61] 中樞神經刺激劑似乎也能降低ADHD遭遇意外事故傷害的風險。[62]核磁共振成像學研究表明長期以安非他命或哌甲酯能降低ADHD患者腦部中的結構和功能的異常。[63][64][65] 一篇2018年的系統性回顧發現以哌甲酯治療兒童、以安非他命治療成人能帶給他們最大的短期療效。[66] 中樞神經刺激劑必須定期暫停使用或降低藥劑量以評估ADHD患者是否還需要繼續用藥、即便ADHD患者仍需要繼續用藥，定期暫停使用或降低藥劑量的作法能降低患者可能身高發展延遲和腦部神經開始習慣藥劑量（耐受性）的風險。[67][68] 長期以「遠高於治療用劑量」的中樞神經刺激劑治療ADHD，可能會導致成癮和物質依賴。[69][70] 然而，若ADHD未被妥善治療，患者在往後容易出現物質濫用和行為問題（conduct disorders）的風險。[69] 使用中樞神經刺激劑治療ADHD，至少能不同程度的降低這些風險。[71][72][69]

治療注意力不足過動症的第一线药物为中樞神經刺激劑（又名為中樞神經興奮劑，簡稱為兴奋剂），其中包括[73]：

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[註 5] 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
  • 短效型：4-5小時[77]
  • 長效型：10-12小時[77]
  • 短效型：30-60分鐘[77]
  • 長效型：60-90分鐘或更短[77]
Desoxyn 甲基苯丙胺 N/A N/A
Tyvense 甲磺酸赖氨酸安非他命 12小時 2 小時
Dexedrine 右旋安非他命
  • 立即釋放型：3-7小時
  • 長效型：12小時
  • 立即釋放型：0.5-1.5小時
  • 長效型：1.5-2小時
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
專思達/專注達 哌甲酯 長：12小時左右 約服用後30分鐘

[54] [82] [83] [84] [85]

  • 必須避免於藥物作用期間攝取乙醇和醇，因為這兩種物質很可能會導致血漿中的methylphenidate濃度急速升高[74]。

利他能[85]、利長能[82]、專思達[84]、安保美喜錠[86] ，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。[87][88][89]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[90][sources 1][sources 2][sources 3][sources 4][sources 5][sources 6]。

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歲的使用者之每日建議 最大劑量上限為72毫克[127][128]。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療效落差。[129][130]

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[131]。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。[54][132][133]

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。[134]

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。[44][135][136][137]

中樞神經刺激劑即便正確依照藥物動力學及藥效動力學知識下使用，仍強烈 建議用藥者應定期追蹤自己的體重、心跳與血壓等[註 6][138][139][140]，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[140][141]（中樞神經刺激劑可能產生的副作用有：食慾降低、雷诺氏综合征、心跳與血壓上升等；高血壓可能不會被人覺察到，然而血壓長期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[142][143]；食欲降低也可能讓服藥者在空腹的時候卻不覺得餓，使得其三餐未定時定量，再者，中樞神經刺激劑本身會刺激胃酸分泌，多重因素交織，長期下來，容易引起腸道不適（英语：Abdominal_distension）或胃潰瘍[144]）。[145][138][146][147][148][149][150][151][152][153]

患者第一次用藥前必須先進行全面的心血管功能檢查，以確保患者沒有重度的先天性心臟病或存有任何嚴重的心血管問題。[138][138][154]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[155][156][157][158][159]。

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、基礎代謝率增加[註 7]、體重下降、頭痛、抖動、抽动综合症、尿液滯留[註 8]等[160][161][162][163][164][註 9][165] [166][167]；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。[138][168][169][170][168][169][171] 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，常被家長忽略的是，限制或延遲患有ADHD的兒童及早接受有效的治療可能導致往後出現的嚴重後果，例如顯著 增加孩子在其青少年時期衍生物質濫用、中途輟學、學業挫敗（academic failure）、意外事故等風險[50]（陳錦宏醫師指出，發生意外及藥物成癮或酒精成癮的風險約達到50%）[7]。[註 10][173]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[174]。

所有用來治療注意力不足過動症的藥物只要依照醫師基於藥物動力學及藥效動力學所做成的醫囑用藥，都是相當安全的。[44][135] [175] 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） [176]

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 11][註 12]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。[44] [177] [178] [179] [180] [181][182][183]

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。[184][185]

近年來美國正值可受孕期的女性（15-44歲）服用中樞神經刺激劑治療成人注意力不足過動症的人數大幅增加，截至2015年此類女性已佔全美國女性的4%[186]。然而研究初步發現，胎兒在子宮接觸到哌甲酯，有相對控制組來說，較高的風險在出生後帶有先天性心臟病，而安非他命則無此風險。[75]因此當醫生處方哌甲酯給孕婦（包含不知自己已經懷孕的女性）前，應該權衡此舉對患者的利弊得失。[75]

食物可能延遲Adderal XR的生效時間並增加安非他命在血漿中的最高濃度；Concerta 則無此特性[187]。

  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 建議劑量範圍
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 13]
18-65歲 18 或 36 毫克/每天 18 - 72 毫克/每天 （藥物臨床試驗（英语：clinical studies）中記載的安全（英语：Therapeutic_index#Maximum_tolerated_dose）且有效的劑量範圍（英语：Effective_dose_(pharmacology)）為：36 - 108 毫克/每天 [188]）

[189] 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)。[189]
  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。）[190]

至今為止的「藥劑量最佳化（Dose-optimization）」的成人組臨床試驗揭示：成分為methylphenidate的藥品，無論為短效或長效，每日最高的上限劑量總和為120毫克（120 mg / day）[123][124][125][126]。

非中樞神經刺激劑

數種非中樞神經刺激劑，例如：阿托莫西汀、可樂定、安非他酮和胍法辛，可與中樞神經刺激劑一起使用，也可以作為中樞神經刺激劑的替代方案。[56][60][191] 當前並無高品質的文獻比較過這些藥物的優劣，然而這些非中樞神經刺激劑藥物之間的副作用似乎大同小異。[192] 中樞神經刺激劑似乎能改善用藥者的學業表現，阿托莫西汀則否。[193] 阿托莫西汀，受惠於自身對於用藥者的成癮性或依賴性較低的屬性，所以適用於使用於那些有極高可能把中樞神經刺激劑用於娛樂用途或因為衝動而大量用藥使得中樞神經刺激劑的劑量遠高於醫療用劑量的患者。[71] 當前有些許證據表明這些藥物能改善患者的社交行為能力。[192] 截至2015年6月 (2015-06)，ADHD藥物的長期療效尚未被完全評定。[72][194]

禮來公司（Eli Lilly）的思銳（Strattera），有效成份為阿托莫西汀[195]，與中樞神經刺激劑同樣為治療ADHD的第一線藥物。思銳為非中樞神經刺激藥物（非興奮劑），且歸類於選擇性正腎上腺素再回收抑制劑。思銳有六種劑量型，分別為：18MG、25MG、40MG、60MG、80MG和100MG。[195] 「對於年齡小於18歲且體重小於70公斤」的使用者來說「總計每天服用劑量的上限為每公斤1.4 毫克（mg/day）」；對於「年齡大於或等於18歲或年齡小於18歲且體重大於70公斤」的使用者來說「總計每天服用劑量的上限為每天100毫克（mg/day）」。[196]

思銳的副作用相較於中樞神經刺激劑來得輕微許多。思銳主要的副作用有：疲倦、口乾（唾液分泌減少）等[195]。（副作用產生與否因人而異）[195]患者如果對中樞神經刺激劑沒有反應、反應不佳或過敏，可考慮使用阿托莫西汀。患者可向醫生詢問，共同制定一個漸進的劑量法。

思銳的藥效可以持續24小時[197]。思銳從第一天服用開始約需持續服用28至56天（4週到8週）才會完全生效。[198][199] 然而患者或患者周遭的人在這期間便可能逐漸感受到藥效 [200] [201][202][203]。服用者建議定期追蹤監測心律、血壓、肝功能（英语：liver function）[204]，患者第一次用藥前建議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嚴重的心血管問題[204]。

縱然阿托莫西汀與中樞神經刺激劑同樣為治療ADHD的第一線藥物，然而其對特定症狀改善的程度可能與中樞神經刺激劑不同（兩類藥物各有其長處）。阿托莫西汀在改善「過動-衝動」的症狀上，略優於派甲酯；派甲酯則在改善「分心」的症狀上，略優於阿托莫西汀。[205][206] [207] [208] [209]

而阿托莫西汀與哌甲酯併服的處方尚未經美國食品藥物管理局核可，但醫師會視個案的情況（如共病、預後等）以開仿單標示外使用的方式處方之。[210][211][212][213]在臨床試驗中，並未發現兩者併服後產生加乘的心血管副作用。換言之，兩者併服之心血管作用，與單獨服用哌甲酯所產生的心血管作用相同。[214][215]

可樂定與胍法新（英语：guanfacine）皆為非中樞神經刺激劑、α2腎上腺素受體（英语：alpha-2 adrenergic receptor）刺激劑/促進劑/活化劑 的一員；與哌甲酯併用或單獨服用都有顯著療效，其中兩藥物併服：可樂定或胍法新與哌甲酯或安非他命合併使用的療效優於單獨服用任意一者。[註 14] [177] [216] [217] [218] [219] [220]

請注意：

  1. 美國食品藥物管理局已證明數起曾因為併服：可樂定、胍法新、哌甲酯或安非他命而致命的個案群與四种药物本身並無關聯。[221]
  2. 《美國兒童青少年精神醫學會期刊（英语：Journal of the American Academy of Child and Adolescent Psychiatry）》所刊登之論文，「可樂定或胍法新與哌甲酯或安非他命合併使用的療效優於單獨服用任意一者」的結論是立基於使用「長效可樂定或胍法新」作為臨床實驗過程中的試驗物。[177][216][218][219]
藥品學名 藥物類別（屬性） 作用時間 備註
阿托莫西汀 （思銳）[註 15] 選擇性正腎上腺素再回收抑制劑、非中樞神經刺激劑（非興奮劑） 5.2小時 [203][223][224][225]
  • 美國食品藥物管理局已經批准用於治療兒童、青少年及成人患者[35]。
可樂定 [註 16] alpha 2 腎上腺素受體刺激劑/促進劑/激動劑/激活劑/活化劑、非中樞神經刺激劑（非興奮劑） 2-4 小時 [227][228][229][230][231]
胍法新（英语：guanfacine） alpha 2 腎上腺素受體刺激劑/促進劑/激動劑/激活劑/活化劑、非中樞神經刺激劑（非興奮劑） 4-8 小時[227][234]
  • 已經可在中國大陸取得。[235]

選擇性血清素再回收抑制劑、選擇性血清素及正腎上腺素再回收抑制劑（SSNRI, Selective Serotonin and Norepinephrine Reuptake Inhibitor）等俗稱抗憂鬱劑的介入可能對於某些個案病情的改善亦有幫助。[236] [237][238]

安非他酮（國際非專利藥品名稱：Bupropion[註 17]）是菸鹼拮抗劑和較微弱的去甲腎上腺素-多巴胺再吸收抑制劑：一种主要作为抗抑郁药和戒烟药使用的药物、也可用作治療注意力不足過動症的第二線藥品與中樞神經刺激劑合併使用，或作為中樞神經刺激劑的替代方案。[56] [239] [240] [241] [242]

第一線非中樞神經刺激劑

思銳（Strattera）仿單上的建議劑量[195]
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 1.4 毫克/每公斤
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 100 毫克/天
（臨床試驗的劑量範圍為60 mg/day 到 120 mg/day[243]）
  • 備註：
  1. 建議劑量與種族無關。[195]
  2. 肝腎功能不全的患者的服用劑量應低於建議劑量[195]（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。[195]
  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[196]
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  7. ^ 7.0 7.1 陳鈞凱. 【有影】從白目衝動變拿文學、美術獎 台灣醫師靠這招解除過動兒「封印」. 匯流新聞網. 2018-08-17 [2018-12-15]. （原始内容存档于2018-12-16） （中文）. 根據統計，台灣ADHD盛行率約為7.5至9%，但健保資料研究顯示，只有近2%的孩子尋求診斷，更只有1%接受完整治療。超過7成的ADHD青少年有其他合併症狀，陳錦宏說，包括5成有學習障礙、4成感到焦慮、3成發生物質濫用行為、2成有憂鬱情形，且在學業、工作、身體意外傷害、家庭關係、車禍、藥酒癮的負面影響機率全都是一般人的2到3倍，而專業治療可以降低這些意外及藥酒癮50%的風險。治療非常的重要，陳錦宏強調，因ADHD是一種腦生理功能發展延遲的問題，大腦一半區域發展速度明顯較慢，美國國家衛生研究院花了10年追蹤更發現，ADHD兒童大腦皮質發展比正常兒童慢3年，部分更會持續到青春期或成年之後。 
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    Table 9.2 Dextroamphetamine formulations of stimulant medication
    Dexedrine [Peak:2–3 h] [Duration:5–6 h] ...
    Adderall [Peak:2–3 h] [Duration:5–7 h]
    Dexedrine spansules [Peak:7–8 h] [Duration:12 h] ...
    Adderall XR [Peak:7–8 h] [Duration:12 h]
    Vyvanse [Peak:3–4 h] [Duration:12 h]     
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  34. ^ 衛生福利部精神疾病衛教叢書 注意力不足過動症，第19至20頁「反之，有些家長或孩童會以為使用藥物就像吃了「聰明藥」一切都解決了，而對於藥物過度依賴。卻忽略藥物只是提供孩子學習與接受指導的最佳時機，藉由此時建立起學習策略、人際互動、行為管理的技巧，才是孩子一生受用的能力，也有機會不靠藥物自我管理。」
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  46. ^ Chang, Zheng; Lichtenstein, Paul; Halldner, Linda; D'Onofrio, Brian; Serlachius, Eva; Fazel, Seena; Långström, Niklas; Larsson, Henrik. Stimulant ADHD medication and risk for substance abuse. Journal of Child Psychology and Psychiatry. 2014, 55 (8): 878–885. ISSN 0021-9630. doi:10.1111/jcpp.12164. Conclusions：We found no indication of increased risks of substance abuse among individuals prescribed stimulant ADHD medication; if anything, the data suggested a long-term protective effect on substance abuse. Although stimulant ADHD medication does not seem to increase the risk for substance abuse, clinicians should remain alert to the potential problem of stimulant misuse and diversion in ADHD patients. 
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  154. ^ Cardiac evaluation of patients receiving pharmacotherapy for attention deficit hyperactivity disorder. UpToDate. 2017-08-01 [2017-12-22]. （原始内容存档于2017-12-23）. Evaluation of children with ADHD prior to initiation of medication should include a comprehensive, cardiovascular (CV)-focused patient history, family history, and physical examination 
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  170. ^ Shoptaw, SJ; Kao, U; Ling, W. Treatment for amphetamine psychosis.. The Cochrane database of systematic reviews. 2009-01-21, (1): CD003026. ISSN 1469-493X. PMID 19160215. doi:10.1002/14651858.CD003026.pub3. 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.  参数|quote=值左起第492位存在換行符 (帮助)
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  173. ^ 陳錦宏. 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」. 心動家族協會. 2016-04-18 [2017-01]. （原始内容存档于2017-01-03）.  |archiveurl=和|archive-url=只需其一 (帮助); |accessdate=和|access-date=只需其一 (帮助); |archivedate=和|archive-date=只需其一 (帮助)
  174. ^ Storebø, Ole Jakob; Ramstad, Erica; Krogh, Helle B.; Nilausen, Trine Danvad; Skoog, Maria; Holmskov, Mathilde; Rosendal, Susanne; Groth, Camilla; Magnusson, Frederik L; Moreira-Maia, Carlos R; Gillies, Donna; Buch Rasmussen, Kirsten; Gauci, Dorothy; Zwi, Morris; Kirubakaran, Richard; Forsbøl, Bente; Simonsen, Erik; Gluud, Christian, Storebø, Ole Jakob , 编, Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD), The Cochrane database of systematic reviews (systematic review) (Chichester, UK: John Wiley & Sons, Ltd), 2015-11-25, (11), PMID 26599576, doi:10.1002/14651858.cd009885.pub2, 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. 
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  186. ^ Anderson, Kayla N.; Ailes, Elizabeth C.; Danielson, Melissa; Lind, Jennifer N.; Farr, Sherry L.; Broussard, Cheryl S.; Tinker, Sarah C. Attention-Deficit/Hyperactivity Disorder Medication Prescription Claims Among Privately Insured Women Aged 15–44 Years — United States, 2003–2015. MMWR. Morbidity and mortality weekly report (Centers for Disease Control MMWR Office). 2018-01-19, 67 (2): 66–70. ISSN 0149-2195. PMC 5772805 可免费查阅. PMID 29346342. doi:10.15585/mmwr.mm6702a3. 
  187. ^ Auiler, J. F.; Liu, K.; Lynch, J. M.; Gelotte, C. K. Effect of Food on Early Drug Exposure from Extended-Release Stimulants: Results from the Concerta®, Adderall XR™ Food Evaluation (CAFÉ) Study. Current medical research and opinion (Informa Healthcare). 2002, 18 (5): 311–316. ISSN 0300-7995. PMID 12240794. doi:10.1185/030079902125000840. The food effect on early drug exposure and the pharmacokinetic profiles up to 8 h after dosing of the two extended-release stimulants were directly compared using partial area (AUC(p4h), AUC(p6h) and AUC(p8h)) fed/fasted ratios. Amphetamine concentrations were markedly lower when the subjects had eaten breakfast, resulting in lower early drug exposures (p < 0.0001). By contrast, methylphenidate concentrations over the same 8 h were unaffected by breakfast, providing consistent levels of early drug exposure. Therefore, as a child's or adult's eating pattern varies, methylphenidate exposure over the first 8 h would be expected to have less day-to-day variation compared with amphetamine exposure. The osmotic-controlled OROS tablet provides a reliable and consistent delivery of methylphenidate HCI, independent of food, for patients with ADHD. 
  188. ^ CONCERTA- methylphenidate hydrochloride tablet, extended release. DailyMed. 2018-10-09 [2018-10-18]. （原始内容存档于2017-03-26）. 14.3 Adults
    Two double-blind, placebo-controlled studies were conducted in 627 adults aged 18 to 65 years. The controlled studies compared CONCERTA® administered once daily and placebo in a multicenter, parallel-group, 7-week dose-titration study (Study 5) (36 to 108 mg/day) and in a multicenter, parallel-group, 5-week, fixed-dose study (Study 6) (18, 36, and 72 mg/day).
    Study 5 demonstrated the effectiveness of CONCERTA® in the treatment of ADHD in adults aged 18 to 65 years at doses from 36 mg/day to 108 mg/day based on the change from baseline to final study visit on the Adult ADHD Investigator Rating Scale (AISRS). Of 226 patients who entered the 7-week trial, 110 were randomized to CONCERTA® and 116 were randomized to placebo. Treatment was initiated at 36 mg/day and patients continued with incremental increases of 18 mg/day (36 to 108 mg/day) based on meeting specific improvement criteria with acceptable tolerability. At the final study visit, mean change scores (LS Mean, SEM) for the investigator rating on the AISRS demonstrated that CONCERTA®was statistically significantly superior to placebo.
    Study 6 was a multicenter, double-blind, randomized, placebo-controlled, parallel-group, dose-response study (5-week duration) with 3 fixed-dose groups (18, 36, and 72 mg). Patients were randomized to receive CONCERTA® administered at doses of 18 mg (n=101), 36 mg (n=102), 72 mg/day (n=102), or placebo (n=96). All three doses of CONCERTA® were statistically significantly more effective than placebo in improving CAARS (Conners' Adult ADHD Rating Scale) total scores at double-blind end point in adult subjects with ADHD.     
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  191. ^ Childress, A. C.; Sallee, F. R. Revisiting clonidine: an innovative add-on option for attention-deficit/hyperactivity disorder. Drugs of Today (Barcelona, Spain: 1998). 2012, 48 (3): 207–217. ISSN 1699-3993. PMID 22462040. doi:10.1358/dot.2012.48.3.1750904. There are a number of non-stimulant medications, such as atomoxetine, bupropion, guanfacine, and clonidine that may be used as alternatives, or added to stimulant therapy. 
  192. ^ 192.0 192.1 McDonagh MS, Peterson K, Thakurta S, Low A. Drug Class Review: Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder. Drug Class Reviews. United States Library of Medicine. December 2011. PMID 22420008. （原始内容存档于31 August 2016）.  已忽略未知参数|df= (帮助)
  193. ^ Prasad V, Brogan E, Mulvaney C, Grainge M, Stanton W, Sayal K. How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis. European Child & Adolescent Psychiatry. April 2013, 22 (4): 203–16. PMID 23179416. doi:10.1007/s00787-012-0346-x. 
  194. ^ Hazell P. The challenges to demonstrating long-term effects of psychostimulant treatment for attention-deficit/hyperactivity disorder. Current Opinion in Psychiatry. July 2011, 24 (4): 286–90. PMID 21519262. doi:10.1097/YCO.0b013e32834742db. 
  195. ^ 195.0 195.1 195.2 195.3 195.4 195.5 195.6 195.7 DailyMed - STRATTERA- atomoxetine hydrochloride capsule STRATTERA- atomoxetine hydrochloride. DailyMed.com. Eli Lilly. 2015-06. （原始内容存档于2017-09-02）. 
  196. ^ 196.0 196.1 Label of Strattera consisting of atomoxetine. DailyMed.gov. Eli Lilly Company. 2015-06 [2017-02]. DOSAGE AND ADMINISTRATION 2.1 Acute Treatment Dosing of children and adolescents up to 70 kg body weight......No additional benefit has been demonstrated for doses higher than 1.2 mg/kg/day [see Clinical Studies (14)]. 'The total daily dose in children and adolescents should not exceed 1.4 mg/kg or 100 mg, whichever is less'. Dosing of children and adolescents over 70 kg body weight and adults......The maximum recommended total daily dose in children and adolescents over 70 kg and adults is 100 mg. 
  197. ^ Atomoxetine: Drug information. UpToDate. 2017-12-28 [2017-12-28]. （原始内容存档于2017-12-28）. Duration of action: Up to 24 hours (Jain 2017) 
  198. ^ Taylor, D; Paton, C; Shitij, K. The Maudsley prescribing guidelines in psychiatry. West Sussex: Wiley-Blackwell. 2012. ISBN 978-0-470-97948-8. 
  199. ^ Kooij, JJS. Adult ADHD Diagnostic Assessment and Treatment (PDF). Springer London. 2013. ISBN 978-1-4471-4137-2. doi:10.1007/978-1-4471-4138-9. 
  200. ^ How long for Strattera to start working? (PDF). Minnesota National Allianceof Mental Illness. [2017-02]. （原始内容 (PDF)存档于2015-12-24）. It may take 4 - 8 weeks after an effective dose is reached for atomoxetine to reach maximum effectiveness. However, improvements in some symptoms may occur sooner. 
  201. ^ Frequently Asked Questions. Official website for Strattera. Strattera-Eli Lilly. 2016-09 [2017-02]. （原始内容存档于2017-01-09）. Strattera works gradually, so improvements are seen over time. When your child starts treatment with Strattera, it's important to set some small goals. Remember to be patient—some people notice small changes within 2 weeks, and by 4 to 6 weeks at target dose you should see significant improvement in your child's symptoms. 
  202. ^ Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies. Biological Psychiatry. 2003-01-15, 53 (2): 112–120 [2017-12-28]. ISSN 0006-3223. doi:10.1016/S0006-3223(02)01671-2. 
  203. ^ 203.0 203.1 atomoxetine (Rx) – Strattera. Medscape Reference. WebMD. [2013-11-10]. （原始内容存档于2013-11-10）. 
  204. ^ 204.0 204.1 Drug information for atomoxetine. UpToDate. [2018-02-26]. （原始内容存档于2017-12-28）. 
  205. ^ Chi-Yung Shang, Yi-Lei Pan, Hsiang-Yuan Lin, Lin-Wan Huang & Susan Shur-Fen Gau. An Open-Label, Randomized Trial of Methylphenidate and Atomoxetine Treatment in Children with Attention-Deficit/Hyperactivity Disorder. Journal of child and adolescent psychopharmacology. 2015-09, 25 (7): 566–573. PMID 26222447. doi:10.1089/cap.2015.0035. At week 24, mean changes in ADHD-RS-IV Inattention scores were 13.58 points (Cohen's d, -3.08) for OROS-methylphenidate and 12.65 points (Cohen's d, -3.05) for atomoxetine; and mean changes in ADHD-RS-IV Hyperactivity-Impulsivity scores were 10.16 points (Cohen's d, -1.75) for OROS-methylphenidate and 10.68 points (Cohen's d, -1.87) for atomoxetine. 
  206. ^ 衛生福利部精神疾病衛教叢書 注意力不足過動症，第22頁「atomoxetine，用在病情 較為複雜、或是無法忍受MPH副作用的患者，然而一般發現其對於專注度的改善沒有MPH明顯」
  207. ^ Myriam Harfterkamp, Jan K. Buitelaar, Ruud B. Minderaa, Gigi van de Loo-Neus, Rutger-Jan van der Gaag & Pieter J. Hoekstra. Long-term treatment with atomoxetine for attention-deficit/hyperactivity disorder symptoms in children and adolescents with autism spectrum disorder: an open-label extension study. Journal of child and adolescent psychopharmacology. 2013-04, 23 (3): 194–199. PMID 23578015. doi:10.1089/cap.2012.0012. 
  208. ^ L. Eugene Arnold, Michael G. Aman, Amelia M. Cook, Andrea N. Witwer, Kristy L. Hall, Susan Thompson & Yaser Ramadan. Atomoxetine for hyperactivity in autism spectrum disorders: placebo-controlled crossover pilot trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2006-10, 45 (10): 1196–1205. PMID 17003665. doi:10.1097/01.chi.0000231976.28719.2a. 
  209. ^ Matthew Siegel, MD.,Craig Erickson, MD., MS, Jean A. Frazier, MD., Toni Ferguson, Autism Society of America., Eric Goepfert, MD., Gagan Joshi, MD., Quentin Humberd, MD., Bryan H. King, MD., Amy Lutz, EASI Foundation: Ending Aggression and Self-Injury in the Developmentally Disabled., Louis Kraus, MD., Alice Mao, MD., Adelaide Robb, MD., Jeremy Veenstra-VanderWeele, MD, PhD., Paul Wang, MD, Autism SpeaksCarmen J. Head, MPH, CHES, Director, Research, Development, & WorkforceEve, Bender, Scientific Editor. Autism_Spectrum_Disorder_Parents_Medication_Guide (PDF). 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007: American Academy of Child and Adolescent Psychiatry. 2016: 13. （原始内容存档 (PDF)于2017-04-11） （英语）. Atomoxetine (Strattera) has also been researched in controlled studies for treatment of ADHD in children with autism, and showed some improvements,particularly for hyperactivity and impulsivity. 
  210. ^ Parent's Medication Guide: ADHD. American Psychiatric Association (Guidelines (Tertiary source)). American Psychiatric Association & American Academy of Child and Adolescent Psychiatry (AACAP). 2013-06 [2017-01]. （原始内容存档于2017-02-02）. Though not FDA-approved for combined treatment, atomoxetine (Strattera) is sometimes used in conjunction with stimulants as an off-label combination therapy.  |archiveurl=和|archive-url=只需其一 (帮助); |accessdate=和|access-date=只需其一 (帮助); |archivedate=和|archive-date=只需其一 (帮助)
  211. ^ Medical Encyclopedia → Attention deficit hyperactivity disorder. MedlinePlus.gov. 2017-01-05 [2017-01]. （原始内容存档于2017-01-26）. Medicine combined with behavioral treatment often works best. Different ADHD medicines can be used alone or combined with each other. The doctor will decide which medicine is right, based on the person's symptoms and needs. 
  212. ^ Treuer T, Gau SS, Méndez L, Montgomery W, Monk JA, Altin M; et al. A systematic review of combination therapy with stimulants and atomoxetine for attention-deficit/hyperactivity disorder, including patient characteristics, treatment strategies, effectiveness, and tolerability.. Journal of Child and Adolescent Psychopharmacology (systematic review (Secondary source)). 2013, 23 (3): 179–93. PMC 3696926 可免费查阅. PMID 23560600. doi:10.1089/cap.2012.0093. Existing evidence suggests, but does not confirm, that this drug combination may benefit some, but not all, patients who have tried several ADHD medications without success. 
  213. ^ Perugi G, Vannucchi G. The use of stimulants and atomoxetine in adults with comorbid ADHD and bipolar disorder.. Expert Opin Pharmacother. 2015, 16 (14): 2193–204. PMID 26364896. doi:10.1517/14656566.2015.1079620. Although systematic trials on the use of stimulants and ATX in ADHD-BD comorbidity in adulthood are necessary, both treatments should be considered possible options to be carefully evaluated once the patient has been stabilized. 
  214. ^ Label of Strattera consisting of atomoxetine. DailyMed.gov (Leaflet/label (Tertiary source)). Eli Lilly Company. 2015-06 [2017-02]. 7.7 Methylphenidate\ Coadministration of methylphenidate with STRATTERA did not increase cardiovascular effects beyond those seen with methylphenidate alone. 
  215. ^ NIMH » Attention Deficit Hyperactivity Disorder. NIMH » Home. [2018-07-21]. （原始内容存档于2016-12-25）. Non-stimulants. A few other ADHD medications are non-stimulants. These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with ADHD. Doctors may prescribe a non-stimulant: when a person has bothersome side effects from stimulants; when a stimulant was not effective; or in combination with a stimulant to increase effectiveness.  |accessdate=和|access-date=只需其一 (帮助)
  216. ^ 216.0 216.1 Parent's Medication Guide: ADHD. American Psychiatric Association. American Psychiatric Association & American Academy of Child and Adolescent Psychiatry (AACAP). 2013-06 [2017-02]. （原始内容存档于2017-02-02）. Extended release guanfacine (Intuniv) and extended release clonidine (Kapvay) are approved to be added to stimulant treatment when the stimulant doesn’t fully reduce the ADHD symptoms.  |archiveurl=和|archive-url=只需其一 (帮助); |accessdate=和|access-date=只需其一 (帮助); |archivedate=和|archive-date=只需其一 (帮助)
  217. ^ Loo SK, Bilder RM, Cho AL, Sturm A, Cowen J, Walshaw P; et al. Effects of d-Methylphenidate, Guanfacine, and Their Combination on Electroencephalogram Resting State Spectral Power in Attention-Deficit/Hyperactivity Disorder.. J Am Acad Child Adolesc Psychiatry. 2016, 55 (8): 674–682.e1. PMID 27453081. doi:10.1016/j.jaac.2016.04.020. 
  218. ^ 218.0 218.1 McCracken JT, McGough JJ, Loo SK, Levitt J, Del'Homme M, Cowen J; et al. Combined Stimulant and Guanfacine Administration in Attention-Deficit/Hyperactivity Disorder: A Controlled, Comparative Study.. J Am Acad Child Adolesc Psychiatry. 2016, 55 (8): 657–666.e1. PMC 4976782 可免费查阅. PMID 27453079. doi:10.1016/j.jaac.2016.05.015. 
  219. ^ 219.0 219.1 Bilder RM, Loo SK, McGough JJ, Whelan F, Hellemann G, Sugar C; et al. Cognitive Effects of Stimulant, Guanfacine, and Combined Treatment in Child and Adolescent Attention-Deficit/Hyperactivity Disorder.. J Am Acad Child Adolesc Psychiatry. 2016, 55 (8): 667–73. PMC 4964604 可免费查阅. PMID 27453080. doi:10.1016/j.jaac.2016.05.016. 
  220. ^ Combining medications could offer better results for ADHD patients. Science News. Elsevier. 2016-08-01 [2017-01]. （原始内容存档于2017-01-02）. Summary:Three studies 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. At present, studies show that the use of several ADHD medications result in significant reductions in ADHD symptoms. However, so far there is no conclusive evidence that these standard drug treatments also improve long-term academic, social, and clinical outcomes.  |archiveurl=和|archive-url=只需其一 (帮助); |accessdate=和|access-date=只需其一 (帮助); |archivedate=和|archive-date=只需其一 (帮助)
  221. ^ Death with the concomitant use of clonidine or guanfacine and amphetamine／dextroamphetamine or dexmethylphenidate or dextroamphetamine or lisdexamfetamine or methylphenidate. (PDF). American Psychiatric Association. Department of Health and Human Services & Public Health Service & Food and Drug Administration & Center for Drug Evaluation and Research & Office of Surveillance and Epidemiology. 2010-07-06 [2017-01]. （原始内容存档 (PDF)于2017-02-15）. 
  222. ^ LABEL: STRATTERA- atomoxetine hydrochloride capsule STRATTERA- atomoxetine hydrochloride. DailyMed. 2017-03-16 [2017-24-23]. （原始内容存档于2017-09-02）. Swallow STRATTERA capsules whole with water or other liquids. 
  223. ^ John-Michael Sauer, Barbara J. Ring & Jennifer W. Witcher. Clinical pharmacokinetics of atomoxetine. Clinical pharmacokinetics. 2005, 44 (6): 571–590. PMID 15910008. doi:10.2165/00003088-200544060-00002. After single oral dose, atomoxetine reaches maximum plasma concentration within about 1-2 hours of administration. In extensive metabolisers, atomoxetine has a plasma half-life of 5.2 hours, while in poor metabolisers, atomoxetine has a plasma half-life of 21.6 hours. 
  224. ^ STRATTERA® (atomoxetine hydrochloride). TGA eBusiness Services. Eli Lilly Australia Pty. Limited. 2013-08-21 [2013-11-10]. （原始内容存档于2017-04-06）. 
  225. ^ ATOMOXETINE HYDROCHLORIDE capsule [Mylan Pharmaceuticals Inc.]. DailyMed. Mylan Pharmaceuticals Inc. 2011-10 [2013-11-10]. （原始内容存档于2013-11-10）. 
  226. ^ LABEL: CLONIDINE HYDROCHLORIDE EXTENDED-RELEASE- clonidine hydrochloride tablet, extended release. DailyMed. 2016-09-30 [2017-04-23]. （原始内容存档于2017-04-23）. 
  227. ^ 227.0 227.1 廖曉菁; 楊智超. 成人之注意力不足及過動症. National Taiwan University Hospital. [2017-04-14]. （原始内容存档于2018-01-29）. 
  228. ^ 228.0 228.1 CLONIDINE HYDROCHLORIDE - clonidine hydrochloride tablet. DailyMed. 2017-04-13. （原始内容存档于2017-04-14）. Clonidine hydrochloride USP tablets act relatively rapidly. The patient's blood pressure declines within 30 to 60 minutes after an oral dose, the maximum decrease occurring within 2 to 4 hours. 
  229. ^ New Zealand Datasheet\Name of Medicine\CATAPRES®\Clonidine hydrochloride (PDF). 2012-02-24 [2017-04-13]. （原始内容存档 (PDF)于2017-04-08） （New Zealand English）. 
  230. ^ Catapres-drug/clinical-pharmacology. RxList. [2017-04-13]. （原始内容存档于2017-04-14）. 
  231. ^ CATAPRES® 100 TABLETS (PDF). ABN 52 000 452 308 78 Waterloo Road NORTH RYDE NSW 2113: Boehringer Ingelheim Pty Limited. 2016-11-07 [2014-04-14]. （原始内容存档 (PDF)于2015-02-28） （澳大利亚英语）. Pharmacokinetic Studies Absorption and distribution The pharmacokinetics of clonidine is dose-proportional in the range of 75-300 micrograms. Clonidine, the active ingredient of CATAPRES, is well absorbed from the gastrointestinal tract and undergoes a minor first pass effect. Peak plasma concentrations are reached within 1-3 hours after oral administration. The duration of action varies from 6-12 hours, the duration of action being longer in the milder hypertensives. The plasma protein binding is 30-40%. Metabolism and excretion The terminal elimination half-life of clonidine has been found to range from 9-26 hours in patients with normal renal function. With impaired enal function it has been reported to increase to 18-48 hours  参数|quote=值左起第412位存在換行符 (帮助)
  232. ^ Lowenthal, DT; Matzek, KM; MacGregor, TR. Clinical pharmacokinetics of clonidine.. Clinical Pharmacokinetics. 1988-05, 14 (5): 287–310. PMID 3293868. doi:10.2165/00003088-198814050-00002. 
  233. ^ Clonidine: MedlinePlus Drug Information. MedlinePlus. [2018-07-13]. （原始内容存档于2018-04-23）. 
  234. ^ Guanfacine: MedlinePlus Drug Information. MedlinePlus. [2018-07-13]. （原始内容存档于2018-05-27）. 
  235. ^ Guanfacine hydrochloride (Guanfacine) - Adrenergic Receptor Agonist - MCE中国. MCE中国-您身边的抑制剂大师 | 活性小分子-抑制剂-激动剂-化合物库. [2017-12-15]. （原始内容存档于2017-12-15） （中文）. 
  236. ^ Wilens TE, Spencer TJ. Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgrad Med. 2010-09, 122 (5): 97–109. PMC 3724232 可免费查阅. PMID 20861593. doi:10.3810/pgm.2010.09.2206. 
  237. ^ Niederhofer, Helmut. Duloxetine May Improve Some Symptoms of Attention-Deficit/Hyperactivity Disorder. Prim Care Companion J Clin Psychiatry. 2010-01-01, 12 (2). PMC 2910994 可免费查阅. PMID 20694126. doi:10.4088/PCC.09l00807pin –通过PubMed Central. 
  238. ^ Pharmacotherapy-for-adult-attention-deficit-hyperactivity-disorder. UpToDate. [2018-03-17]. （原始内容存档于2018-03-17）. For adults with ADHD and co-occurring generalized anxiety disorder, we suggest treatment with the combination of a stimulant and an SSRI over other medications. For adults with ADHD and co-occurring depression, we suggest first-line treatment with bupropionrather than other medications (Grade 2C). Treatment with an SSRI plus a stimulant is also a reasonable option. 
  239. ^ Dr. Ian Morton, I.K. Morton, Judith M. Hall. Concise Dictionary of Pharmacological Agents: Properties and Synonyms. Springer Science & Business Media. 1999-10-31: 57–. ISBN 978-0-7514-0499-9. （原始内容存档于2016-04-27）. 
  240. ^ Dictionary of Organic Compounds. CRC Press. : 104–. ISBN 978-0-412-54090-5. （原始内容存档于2016-04-30）. 
  241. ^ Index Nominum 2000: International Drug Directory. Taylor & Francis. 2000-01: 38–. ISBN 978-3-88763-075-1. （原始内容存档于2016-04-30）. 
  242. ^ Childress, A. C.; Sallee, F. R. Revisiting clonidine: an innovative add-on option for attention-deficit/hyperactivity disorder. Drugs of Today (Barcelona, Spain: 1998). 2012, 48 (3): 207–217. ISSN 1699-3993. PMID 22462040. doi:10.1358/dot.2012.48.3.1750904. 
  243. ^ STRATTERA- atomoxetine hydrochloride capsule STRATTERA- atomoxetine hydrochloride. DailyMed. [2018-12-16]. （原始内容存档于2017-09-02）. 14.2 ADHD studies in Adults
    The effectiveness of STRATTERA in the treatment of ADHD was established in 2 randomized, double-blind, placebo-controlled clinical studies of adult patients, age 18 and older, who met DSM-IV criteria for ADHD.
    Signs and symptoms of ADHD were evaluated using the investigator-administered Conners Adult ADHD Rating Scale Screening Version (CAARS), a 30-item scale. The primary effectiveness measure was the 18-item Total ADHD Symptom score (the sum of the inattentive and hyperactivity/impulsivity subscales from the CAARS) evaluated by a comparison of mean change from baseline to endpoint using an intent-to-treat analysis.
    In 2 identical, 10-week, randomized, double-blind, placebo-controlled acute treatment studies (Study 5, N=280; Study 6, N=256), patients received either STRATTERA or placebo. STRATTERA was administered as a divided dose in the early morning and late afternoon/early evening and titrated according to clinical response in a range of 60 to 120 mg/day. The mean final dose of STRATTERA for both studies was approximately 95 mg/day. In both studies, ADHD symptoms were statistically significantly improved on STRATTERA, as measured on the ADHD Symptom score from the CAARS scale. Examination of population subsets based on gender and age (<42 and ≥42) did not reveal any differential responsiveness on the basis of these subgroupings. There was not sufficient exposure of ethnic groups other than Caucasian to allow exploration of differences in these subgroups.     


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