Attentin (dexamfetamine) is a CNS stimulant agent for treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents aged 6-17 years. Attentin can be used second-line when response to methylphenidate is not sufficiently effective or has caused unacceptable adverse reactions. The indication for medicinal treatment of ADHD is made by a specialist in child and adolescent psychiatry upon which further treatment (maintenance treatment) may be decided by the general practitioner in collaboration with a child and adolescent psychiatrist (1). Pharmaceutical treatment should not be the only treatment for ADHD, but should be combined with non-pharmaceutical interventions (1).
The effect of dexamfetamine on ADHD core symptoms in children and adults has been established compared to placebo and is presumably on a par with methylphenidate. However, the evidence in support thereof is based on small studies with different measures of effectiveness. Therefore, the effect of Attentin cannot be established with certainty. The long-term effects have not been investigated thoroughly.
The most common adverse reactions are reduced appetite and sleeplessness. When prescribing Attentin, doctors should pay attention to cardiac events, growth and abuse potential as with any other centrally-acting ADHD medicinal products.
Pursuant to the Danish Medicines Authority's guideline, methylphenidate is the first-line agent for treatment of ADHD (1). Atomoxetine is preferred if there is an abuse potential.
It is IRF's overall assessment that treatment with Attentin can be attempted in children and adolescents aged 6-17 years with ADHD when methylphenidate is not sufficiently effective or has caused unacceptable adverse reactions. It has been demonstrated that patients respond differently to different centrally-acting medicinal products, and that the response rate therefore increases if more than one medicinal product are tried. Nonetheless, the IRF finds it problematic that the effect of Attentin is insufficiently demonstrated in general and in relation to other second-line products and therefore recommends that efficacy and adverse reactions be monitored closely. Furthermore, the price of Attentin is on a par with atomoxetine and higher than lisdexamfetamine.
Attentin was marketed in Denmark on 11 May 2015, replacing magistral preparations of dexamfetamine. Presently, single reimbursement may be applied for.
1. Vejledning om medikamentel behandling af børn og unge med psykiske lidelser nr. 9194 af 11/04/2013