目前治疗成人注意力缺陷/多动症的非兴奋剂药物。

IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Expert Review of Neurotherapeutics Pub Date : 2024-08-01 Epub Date: 2024-06-25 DOI:10.1080/14737175.2024.2370346
Giulio Emilio Brancati, Anna Magnesa, Donatella Acierno, Marco Carli, Ugo De Rosa, Alessandro Froli, Samuele Gemignani, Lisa Ventura, Francesco Weiss, Giulio Perugi
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引用次数: 0

摘要

导言:兴奋剂(包括哌醋甲酯和苯丙胺)是治疗成人多动症的一线药物。然而,对于对兴奋剂无反应或耐受性差的患者,通常建议使用非兴奋剂药物:作者对成人多动症的非刺激剂治疗文献进行了叙述性综述,包括针对成人样本进行的对照和观察性临床研究。阿托莫西汀已被广泛研究,并显示出治疗成人多动症的显著疗效。本文总结了与剂量、疗程、安全性以及在精神疾病合并症情况下的使用有关的问题。在其他用于治疗成人多动症的化合物中,至少含有去甲肾上腺素能或多巴胺能成分的抗抑郁药,包括三环化合物、安非他明和维洛沙嗪,都显示出明显的疗效。降压药(尤其是胍法辛)以及美金刚、美他多辛和情绪稳定剂也提供了证据,而加兰他敏、抗精神病药和大麻素则出现了负面研究结果:虽然根据临床指南,阿托西汀可作为成人多动症患者的唯一二线选择,但其他几种非兴奋剂化合物也可有效使用,以便根据合并症和多动症特征进行个性化治疗。不过,还需要进一步研究,以确定和测试针对成人多动症患者的更多个性化治疗策略。
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Current nonstimulant medications for adults with attention-deficit/hyperactivity disorder.

Introduction: Stimulants, including methylphenidate and amphetamines, are the first-line pharmacological treatment of ADHD in adults. However, in patients who do not respond or poorly tolerate stimulants, non-stimulant medications are usually recommended.

Areas covered: The authors provide a narrative review of the literature on non-stimulant treatments for adult ADHD, including controlled and observational clinical studies conducted on adult samples. Atomoxetine has been extensively studied and showed significant efficacy in treating adult ADHD. Issues related to dosing, treatment duration, safety, and use in the case of psychiatric comorbidity are summarized. Among other compounds indicated for ADHD in adults, antidepressants sharing at least a noradrenergic or dopaminergic component, including tricyclic compounds, bupropion, and viloxazine, have shown demonstratable efficacy. Evidence is also available for antihypertensives, particularly guanfacine, as well as memantine, metadoxine, and mood stabilizers, while negative findings have emerged for galantamine, antipsychotics, and cannabinoids.

Expert opinion: While according to clinical guidelines, atomoxetine may serve as the only second-line option in adults with ADHD, several other nonstimulant compounds may be effectively used in order to personalize treatment based on comorbid conditions and ADHD features. Nevertheless, further research is needed to identify and test more personalized treatment strategies for adults with ADHD.

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来源期刊
Expert Review of Neurotherapeutics
Expert Review of Neurotherapeutics Medicine-Neurology (clinical)
CiteScore
7.00
自引率
2.30%
发文量
61
审稿时长
4-8 weeks
期刊介绍: Expert Review of Neurotherapeutics (ISSN 1473-7175) provides expert reviews on the use of drugs and medicines in clinical neurology and neuropsychiatry. Coverage includes disease management, new medicines and drugs in neurology, therapeutic indications, diagnostics, medical treatment guidelines and neurological diseases such as stroke, epilepsy, Alzheimer''s and Parkinson''s. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points
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