Methylphenidate vs. amphetamine: Comparative review
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Date
2000
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Multi-Health Systems Inc.
Abstract
This article compares the two most common medications for Attention-Deficit/Hyperactivity Disorder
(ADHD), using data from controlled studies. Medline and Psychinfo searches were done for 1984-1996 with
the key words methylphenidate (MPH) and amphetamine (AMP); these were supplemented with known prior
and recent literature. Of 92 animal studies found, 15 showed clear differences between the two drugs. Ten
reports of controlled crossover ADHD clinical trials (three in the same sample) and a dozen other articles
comparing the two drugs in humans were found. MPH is a pure re-uptake inhibitor of catecholamines,
especially dopamine; AMP also releases catecholamines. Lab animals showed differential interactions with
other drugs and with behavioral paradigms. Human response profiles are noncongruent. An ADHD patient
who fails on one stimulant should try the other. Of 174 patients in the 6 clearest crossover studies, 48
responded better to AMP, 27 to MPH, and at least 72 to both, which is an 87+% overall response rate if both
are tried. All crossovers, except the one with comorbid Tourette's, showed a nonsignificant tendency for
AMP superiority in response rate. Summed data suggest suspected differences in side effects (AMP more
sleep and appetite loss and exacerbation of tics in comorbid Tourette's, MPH possibly more
depression/apathy and stomachaches) and effects on comorbid disorders (AMP better for
conduct/oppositional symptoms, MPH for Tourette's and possibly learning disorder (LD). Most of the
clinical differences are tendencies rather than statistically significant.
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Citation
L.E. Arnold, "Methylphenidate vs. amphetamine: Comparative review," Journal of Attention Disorders 3, no. 4 (2000), doi:10.1177/108705470000300403