Course Overview
Practical ADHD pharmacology for real-world outpatient care. This course gives primary care and outpatient clinicians a clear, usable framework for prescribing ADHD medications with confidence. We break down stimulant and non-stimulant options without unnecessary complexity, compare amphetamines and methylphenidates, and walk through how to choose, titrate, and adjust medications based on function—not just symptom checklists. You’ll learn when to use long-acting versus short-acting formulations, how to extend coverage safely, when to switch classes, and how to approach non-stimulants when stimulants aren’t appropriate. Throughout, the emphasis is on realistic expectations, shared decision-making, and helping patients use medication to build skills rather than replace them.
Not sure where to start with ADHD medication?
Try the ADHD Medication Decision Guide — a short, practical walkthrough designed to help you think more clearly about starting ADHD medication, titration, coverage, and next steps before diving into the full course.
A quick decision guide for clinicians who want a clearer starting point before committing to the full framework.
Start the ADHD Medication Decision Guide🎧
Listen on-the-go
Course owners can access the course through a private podcast feed for listening on-the-go. If you are a Full-Access CME Member or purchased this course as a one-off, check you inbox for an email from Castos, our podcast hosting service, for instructions on how to set up the private podcast feed for this course. For more detailed instructions, check out our Private Podcast page.
Learning Objectives
After participating in this activity, learners will be able to:
- Differentiate the pharmacologic mechanisms, clinical profiles, and practical similarities and differences between the two major stimulant classes used in ADHD treatment: amphetamines and methylphenidates.
- Apply a structured approach to selecting and initiating stimulant therapy for ADHD, including appropriate use of long-acting and short-acting formulations.
- Implement evidence-informed strategies for stimulant titration and dose adjustment based on duration of symptom coverage, functional response, and tolerability.
- Identify appropriate clinical scenarios for the use of non-stimulant medications in ADHD management, including atomoxetine and bupropion.
- Describe safe and effective titration strategies for commonly used non-stimulant ADHD medications.
Course Content
Listen
Unlock the full ADHD prescribing framework
Get full access to the ADHD Pharmacology audio course — streamable here or through a private podcast feed — plus downloadable clinical tools, patient handouts, and CME credit.
Join Full Access to unlock this course along with all current and future Audio Courses, or purchase this course individually.
Try the ADHD Medication Decision Guide first — a short, practical walkthrough to help you think through starting medication, titration, coverage, and next steps.
Course Chapters
- 00:00 — Introduction and Roadmap: What this course covers (and what it doesn’t), why stimulant prescribing feels more complex than it actually is, and how to think about ADHD pharmacology without memorizing endless brand names.
- 04:35 — How Stimulants Work: A practical neurobiology primer on dopamine, norepinephrine, and the prefrontal cortex — and why executive dysfunction sits at the core of ADHD symptoms.
- 07:54 — Stimulant Isomers (Quick Naming Primer): Dextro and levo-isomers explained just enough to make sense of medication names, without getting lost in pharmacology trivia.
- 08:59 — Long-Acting vs Short-Acting Stimulants: How duration, onset, convenience, and abuse risk differ between formulations — and why long-acting stimulants are usually the backbone of adult ADHD treatment.
- 13:11 — Side Effects, Contraindications, and Cardiac Considerations: Common stimulant side effects, what a “good response” should actually feel like, blood pressure and heart rate effects, and when cardiac workup or caution is warranted.
- 17:25 — Abuse and Diversion: Practical Risk Reduction: What the data actually show about misuse, diversion, and addiction risk — and how to have straightforward, preventive conversations with patients.
- 21:00 — Pregnancy: A Risk–Benefit Framework: What we know (and don’t know) about stimulant use in pregnancy, differences between amphetamines and methylphenidates, and how to approach shared decision-making.
- 23:40 — A Practical Prescribing Framework: A step-by-step algorithm for choosing an initial stimulant, starting with long-acting formulations, and deciding when to add or switch medications.
- 27:10 — Amphetamines – Core Formulations and Dosing: The key long-acting and short-acting amphetamines used in adult practice, including Vyvanse, Adderall XR, Adderall IR, and Dexedrine — with practical dosing ranges and clinical pearls.
- 34:41 — Methylphenidates – Core Formulations and Dosing: Concerta, Ritalin LA, Focalin XR, and immediate-release options — how they compare to amphetamines and when they may be preferable.
- 42:46 — Titration, Dose Adjustment, and Switching Classes: How to titrate stimulants thoughtfully, assess response based on function, use symptom scales like the ASRS, and switch classes when a medication isn’t working.
- 49:04 — Extending Coverage – Adding Short-Acting to Long-Acting: When afternoon boosters make sense, how to time them, dosing guardrails, and how to avoid insomnia and unnecessary side effects.
- 54:10 — Drug Holidays and Reassessment: The rationale for stimulant breaks, why the practice has fallen out of favor, and how to individualize decisions about medication holidays.
- 57:01 — Non-Stimulants for ADHD: When stimulants aren’t the right choice — an overview of atomoxetine, bupropion, and alpha-2 agonists, including expectations and limitations.
- 1:06:46 — Duration of Treatment and Long-Term Management: Is ADHD lifelong? How skills, comorbidities, stressors, and tolerance affect treatment over time — and how to reassess medication need longitudinally.
- 1:11:41 — Summary and Key Takeaways: A concise recap of the core framework so you can confidently manage most ADHD cases without overcomplicating stimulant prescribing.
- 1:13:30 — Outro: CME Instructions and review of PDF resources available on the website.
Clinic Resources and Patient Handouts
Prescribing Frameworks & Clinical Algorithms
Medication Reference Tables
Patient Handouts
Expectations & Understanding ADHD
Medication-Specific Handouts
Practical Management & Safety
Stimulant Isomers
Both stimulant classes contain dextro (D) and levo (L) isomers.
Clinical relevance
- D-isomer = more potent
- Some meds mix isomers (e.g., Adderall)
- Others isolate D-isomer (e.g., Dexedrine, Focalin)
Bottom line
- At therapeutic doses, isomer differences rarely matter clinically
- This section is mainly about understanding nomenclature
Long-Acting vs Short-Acting Stimulants
At appropriate doses, both are effective. The distinction is about coverage, convenience, and risk.
Short-acting
- Onset: ~30 minutes
- Duration: ~3–6 hours
- Often dosed 2–3×/day
- Higher abuse potential
- Mostly generic and inexpensive
Long-acting
- Once-daily morning dosing
- Duration: ~6–14 hours
- Better adherence
- Lower abuse/diversion risk
- Preferred first-line in adults
Key rule
- Use long-acting as foundation
- Add short-acting only to extend coverage
Unlock the full ADHD prescribing framework
Get full access to the ADHD Pharmacology audio course — streamable here or through a private podcast feed — plus downloadable clinical tools, patient handouts, and CME credit.
Join Full Access to unlock this course along with all current and future Audio Courses, or purchase this course individually.
Try the ADHD Medication Decision Guide first — a short, practical walkthrough to help you think through starting medication, titration, coverage, and next steps.