Attention-deficit/hyperactivity disorder (ADHD) is a disruptive behavior disorder that occurs in 5-7% of school-age children and has also been estimated to occur in about 4% of adults. ADHD is characterized by a persistent pattern of frequent, severe inattention and/or hyperactivity/impulsivity that starts before the age of 7, is present in 2 or more settings (such as home and school), causes significant impairment in function, and is not caused by another mental disorder. The drugs approved for treatment of ADHD by the FDA are listed in this article. Except for atomoxetine, they are all stimulants and are classified as controlled substances by the US Drug Enforcement Administration (DEA).

On February 9, 2005, Health Canada suspended the marketing of Adderall XR (Shire), a mixture of amphetamine salts used to treat attention-deficit hyperactivity disorder (ADHD) (Med Lett Drugs Ther 1994; 36:109). The immediate-release form of Adderall was never marketed in Canada. The withdrawal was based on 20 reports internationally of sudden death in patients taking the drug. These deaths, 14 of them in children, were not linked to overdose or abuse. The FDA decided that the number of sudden deaths was no greater than expected among the large number of people taking the drug, but because 5 of the children who died had structural heart defects, added a warning against using the drug in such patients. There is no evidence that Adderall offers any advantage over methylphenidate (Ritalin, and others) or dextroamphetamine (Dexedrine, and others), but some patients who do not respond satisfactorily to these drugs may respond to Adderall. Medical Letter consultants see no need to discontinue Adderall in patients who are taking it and doing well. For patients with a heart defect or a family history of sudden unexpected cardiovascular death, methylphenidate might be a better choice.

Atomoxetine (Strattera - Lilly), a nonstimulant drug that is not a controlled substance, was approved by the FDA in early 2003 for the treatment of attention deficit hyperactivity disorder (ADHD). At that time, The Medical Letter concluded that it was unclear whether atomoxetine was as effective as stimulants such as methylphenidate (Concerta, and others) (Medical Letter 2003; 45:11). Since then, the drug has been heavily advertised directly to the public for use in both children and adults.

With the 2004 Olympics only weeks away, performance-enhancing drugs will once again be receiving a great deal of attention. The US Anti-Doping Agency has published a list of drugs banned in Olympic sports (www.usantidoping.org) that includes, at least for some sports, all but 2 of the drugs reviewed here.

Summer heat waves cause thousands of cases of heat-related illness in the US each year and hundreds of heat-related deaths, especially among the elderly. This review describes the contributing factors, clinical signs, and ways to prevent and treat heat injury.

Atomoxetine (Strattera - Lilly) is the first non-stimulant drug to be approved by the FDA for treatment of attention deficit hyperactivity disorder (ADHD). Unlike other drugs approved for use in ADHD, it is not a controlled substance and is approved for use in adults as well as children. Older non-stimulant drugs that have been used to treat ADHD, although not FDA-approved, include the alpha₂-agonist clonidine (Catapres, and others) and the tricyclic antidepressant desipramine (Norpramin, and others) (Medical Letter 1996; 38:109).

Testing for drug use has become increasingly common, not only in health care, but also in drug rehabilitation, in the military, at the workplace, after accidents and in the criminal justice system. Performance-enhancing drugs such as anabolic steroids, growth hormone (Genotropin, and others) and erythropoietin (Procrit, Epogen) are not discussed here.

Acute toxic reactions to drugs of abuse continue to be important problems. Some patients may have mixed intoxications with complex combinations of signs and symptoms.

Methylphenidate is now available in a new extended-release formulation (Metadate CD - Celltech) for treatment of attention deficit/hyperactivity disorder (ADHD). The new product, which is a Schedule II controlled substance, is being advertised directly to consumers.

Modafinil (Provigil), a benzhydryl sulfinylacetamide non-amphetamine stimulant that has been used in Europe since 1995, has now been approved by the FDA for treatment of excessive daytime sleepiness associated with narcolepsy.

Acute toxic reactions to drugs of abuse continue to be important problems. Since the last Medical Letter article on this subject (volume 32, page 92, 1990), new reactions and new approaches to treating them have been reported.

Summer heat waves cause thousands of cases of heat-related illness in the USA each year and hundreds of heat-related deaths, especially among the elderly. A few principles may be helpful in preventing and treating heat injury.