New ADHD Formulations, Patches, and Patient Trust

This episode, "New ADHD Formulations, Patches, and Patient Trust," catalogs the growing list of delivery formats and a newly approved non-stimulant reshaping how clinicians individualize adult ADHD treatment.

The panel continues talking about how far ADHD drug delivery has come, from orally disintegrating tablets and capsules to liquids and patches. One panelist explains that spreading a dose across hundreds of thousands or millions of microparticles means normal manufacturing variability barely registers clinically, unlike a capsule containing a countable number of large beads, where a small manufacturing shift can meaningfully change the dose delivered. The panel encourages providers to move beyond their five or six go-to medications when duration, onset, or tolerability problems, especially an evening crash, persist, arguing that patients can be shortchanged when providers stay unfamiliar with newer delivery mechanisms that will never trend on social media.

Transdermal patches, available in both methylphenidate and amphetamine classes, offer another layer of flexibility, since patients can remove a patch early within an approved window to shorten a dose, which the panel finds useful for slow and fast metabolizers, patients with GI issues, and college students. Several panelists note that college students often avoid carrying a labeled stimulant bottle on campus for fear of theft or harassment, making patches, prodrugs, and other non-immediate-release options less attractive targets; one recalls a patient who hid pills inside a relabeled antifungal bottle. The panel still recommends a locked, strapped-down storage box for any stimulant medication on campus.

The discussion turns to centanafadine, a newly FDA-approved triple reuptake inhibitor targeting serotonin, norepinephrine, and dopamine that blends stimulant-like and non-stimulant-like properties and has not yet reached pharmacies. The panel notes growing recognition of serotonin's role in ADHD, echoed in another non-stimulant's activity on the 5-HT2C receptor that helps address associated irritability. The panel agrees the biggest barrier to adopting these newer medications is patient trust, particularly around branded products competing against insurance-favored generics.

In "The Economic Cost of Undertreated Adult ADHD," the panel confronts a barrier that has nothing to do with pharmacology: getting patients the medication they've been prescribed.