Welcome to part one of my two-part series on ADHD medications in New Zealand. Stimulant medications are the most effective evidence-based treatment for ADHD, and provide some degree of symptom relief for the majority of people. This makes optimising medication the most influential factor for most people in managing ADHD symptoms. But here's the thing - as with all medications, stimulant medications don't work the same for every person, which means an individualised approach to treatment is required. There are a lot of opinions about medications on the internet, and many formulations you might read about are not even available in New Zealand. This post is a brief educational overview of the stimulant medications available in New Zealand.
The Australasian ADHD Professionals Association (AADPA) provide a detailed guide of ADHD stimulant prescribing regulations and authorities in all states of Australia and in New Zealand.
Disclaimer: I am not a medical doctor and cannot prescribe any medications nor provide special authority codes for stimulant medication. The below information is for educational purposes only and should not be taken as recommendations or specific prescription advice. My knowledge comes from my training in neurobiology and psychopharmacology as part of my psychology training, psychopharmacology textbooks, drug information sheets, research articles, and listening to webinars from ADHD expert psychiatrists and pediatricians. There are links at the bottom of this blog to information presented or approved by medical doctors.
All stimulant medications for ADHD fall into two categories: methylphenidate and amphetamine. The best-known methylphenidate medication is branded Ritalin. A commonly known amphetamine medication you might have heard of is branded Adderall and is unavailable in New Zealand. Instead, dexamphetamine and lisdexamfetamine are the amphetamine-based medications used here.
Click here to watch a psychiatrist explain how methylphenidate and dexamphetamine operate in the brain
Below is a list of the stimulant medications available in New Zealand. Each name contains a link to the Medsafe data sheet for this medication. Medsafe also offers Consumer Medication Information documents, which can be found by searching for the medication name on the Medsafe website.
Methylphenidate formulations:
Immediate release: Ritalin and Rubifen (tablets) – tablet up to 4 hours of action with quick onset and offset.
Longer release: Ritalin LA (capsule) and Rubifen SR (tablet) – 6-8 hour action. Ritalin LA is effectively two short-acting doses contained in one capsule; an immediate dose, and one that releases on average four hours later. Rubifen SR is a slower-release in tablet form.
Longest release: Concerta (and Teva is the generic) - 10-12 hours of action. Concerta works through a sophisticated capsule that involves a fast-release layer, osmosis, and a laser-drilled hole - it's pretty interesting. Teva is a pressed powder tablet.
Click here for a video that shows the sophisticated way that Concerta releases methylphenidate in the gut.
Dexamphetamine:
Immediate release: tablet up to 4 hours of action with quick onset and offset.
Sustained release: lisdexamfetamine (branded Vyvanse) has been available in New Zealand since June 2023 and can give 10-12 hours of symptom treatment. Vyvanse is a prodrug, in which its psychoactively inert formulation is converted to dextroamphetamine through the digestive process and is facilitated by enzymes, particularly in the red blood cells. Again, very interesting. As of the time of writing, it is not funded by Pharmac funded, therefore it does cost more - $100 or more a month. In the US, Vyvanse is also an FDA-approved treatment for binge eating disorder.
ADHD medication can be customised to fit the individual's needs. Stimulant medications have a short half-life, meaning they are quickly absorbed and eliminated by the body. Medications are recommended to be started at a low and increasing dose, and it can take a number of months, or longer, to get medications right. And even then, changes may be made in response to age, environmental demands, pregnancy and childbirth, menopause, or other life or health factors. Having honest conversations about treatment and side effects with a prescriber is essential for finding the right medication regimen for an individual.
By optimising treatment, the core symptoms of ADHD and associated features, like emotional dysregulation, can be greatly improved. The amount of improvement is different for each person, but it can be life-changing for some. It can take time to get things right, so it's worth not giving up if things don't go well initially, and having open communication with the prescriber.
It's important to note that there are no common serious long-term negative side effects associated with stimulant medication (see the article referenced below for more information about this), and they are not addictive when taken as prescribed: swallowed and at the prescribed dose. With proper monitoring through a prescriber, stimulant medication can be an effective and safe option for many people managing ADHD symptoms.
Here's an excellent one-hour podcast about ADHD meds and how to optimise them, presented by ADHD expert psychiatrist Dr William Dodson.
Here's an equally excellent one-hour podcast about ADHD meds in children, presented by ADHD expert developmental pediatrician Dr Walt Karniski.
Clinical psychologist Dr Thomas E. Brown discusses how to optimise and troubleshoot stimulant medication: The ADHD Medication Stopped Working! How to Troubleshoot Treatment. Note that many of the medications in this article are not available in NZ, so compare it to the medications listed in this blog post.
This article: What Are the Long-Term Effects of ADHD Medication on the Brain? may answer a few questions.
For a deep dive into how stimulant medications differ and their effects at a neurobiological level, I recommend this podcast from Dr Andrew Huberman: Adderall, Stimulants & Modafinil for ADHD: Short- & Long-Term Effects
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