Optimising ADHD pharmacotherapy across the lifespan

Case scenario

You are working in a community pharmacy when Sam, a 19-year-old university student, presents with a new prescription for lisdexamfetamine following a recent diagnosis of ADHD. Sam is concerned about long-term stimulant use and asks how quickly the medicine should work, whether it can be taken only on study days, and what to expect if it is stopped in the future.

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a common, lifelong neurodevelopmental condition characterised by persistent patterns of inattention, hyperactivity and impulsivity which are incongruent with a person’s age and result in functional impairment across multiple settings. Although historically viewed as a childhood disorder, it is now well recognised that ADHD frequently persists into adulthood, with significant impacts on education, employment, relationships and overall health.^1-3

Pharmacological treatment is highly effective for reducing core ADHD symptoms and improving daily functioning. Robust evidence from randomised trials and meta-analyses demonstrates clinically meaningful benefits across children, adolescents and adults when medicines are appropriately prescribed and monitored.^1,2 At the same time, ADHD pharmacotherapy is an area of ongoing public debate and clinical uncertainty, with concerns commonly raised about long-term safety, cardiovascular and psychiatric risks, misuse and diversion, and use in pregnancy.^1-3

Learning outcomes After reading this article, pharmacists should be able to: Describe the clinical features of attention-deficit/hyperactivity disorder (ADHD) Outline pharmacological and non-pharmacological management options for ADHD Identify key monitoring, counsellin