NRNP 6665 Week 3: Assignment 1 – Off-label prescribing – Attention deficit hyperactivity disorder (ADHD)
Attention deficit hyperactivity disorder (ADHD)
Introduction
ADHD is an incurable mental health issue. Regardless, some standard treatments and interventions involve using medications purposely to relieve symptoms and education approaches to better the patients’ livelihoods and, more so, growth. According to Titheradge et al. (2022), the use of medication among children and adolescents with ADHD is received with controversies as, to some extent, the medications are not used. Some of the reasons for this stand include the challenges of balancing the benefits, perceived risks, and side effects of these medications (Titheradge et al., 2022). Due to the need for pharmacological interventions, off-label drug use (OLDU) is considered an alternative medication for the treatment of ADHD.
Recommended Treatments
One of the recommended on-label drugs in the treatment of ADHD among children is methylphenidate (Nanda et al., 2023). However, the drug is widely discouraged by children due to the extent of its side effects, which include sleep disorders and loss of appetite; significant reasons why off-label treatments and other non-pharmacological approaches are considered. For the off-label interventions, one of the critical drugs that can be used is Bupropion. This is a norepinephrine-dopamine reuptake inhibitor sold under the brand name Wellbutrin. From a different dimension, Bupropion is used in the cessation of smoking but can also act as an antidepressant, hence preferred for the treatment of ADHD (Clark et al., 2023). For non-pharmacological approaches, research guidelines by the US Department of Health and Human Services support increased exercise for at least one hour daily, as this helps improve cognitive functionality and overall wellness (Shrestha et al., 2020). Also, it is usually advised to use a form of behavioral therapy, or CBT, in addition to ADHD drugs. Children and adolescents can benefit from this type of treatment by way of making the shift from tight monitoring to more operational autonomy. Psychoeducational therapies that focus on improving abilities such as preparing, arranging, and restructuring the mind make up most of it. In sessions pertaining to communicating, managing irritation, and changing the kid’s conduct, parents and other relatives may also participate.
ORDER PLAGIARISM-FREE WORK HERE
Risk Assessment
There are several elements considered when comparing the use of off-label and on-label medications, especially among children. First and foremost is the nature and extent of side effects. According to Nanda et al. (2023), methylphenidate is a highly effective medication that is known to increase brain activity controlling behavior, hence effective in treating ADHD. Regardless of this effectiveness and efficiency, the side effects are mainly intolerable among children as it is associated with sleep disorders and poor appetite, which, when taken for the long term, may predispose the child to risks of malnutrition and deficiencies and, consequently, growth issues. On the other hand, the off-line medication bupropion is considered not only an effective medication but also generally tolerable among children and adolescents. This means some of its side effects, including weight loss and constipation, insomnia, and nausea, are lesser than methylphenidate and hence highly preferable (Lee et al., 2022).
ADHD Clinical Practice Guidelines
According to the American Academy of Family Physicians (AAFP), the treatment guidelines for ADHD among children require that children between 4 and 6 years be treated with parent training and behavioral management and behavioral classroom education programs, if available, as the first line of treatment (AAFP, 2020). However, if the approaches fail to work, then guidelines require that the medical practitioners prescribe methylphenidate. For children above six years and adolescents, requirements entail prescribing medication only upon the patient’s approval, depending on their tolerance of the drug’s side effects (AAFP, 2020). In other words, the guideline recommends the consideration of the drugs with the least and, at the same time, highly tolerable side effects. In this evaluation, the off-line drugs and, in this case, Bupropion is one of these drugs with ascertained effectiveness and tolerable side effects. For this reason, researchers highly support the use of effective, efficient, and safe drugs in the treatment of diseases such as DHD, regardless of whether it is off-label or on-label NRNP 6665 Week 3: Assignment 1 – Off-label prescribing – Attention deficit hyperactivity disorder (ADHD).
Conclusion
The use of OLDU in treating various diseases is a joint event, as ascertained by researchers. Though effective, some of these drugs have yet to be approved by the FDA for several logical and valid reasons, including the time-consuming process required to ascertain and approve the drugs, cost issues, and the complex process of filing for supplemental drug application. Meaning that not all off-label drugs are unsafe for disease management. For this case, for instance, the use of off-line medication, Bupropion, in the treatment of ADHD among children and adolescents is ascertained to be an effective and safer option compared to the on-label approach to the same using methylphenidate. In a nutshell, the choice of a drug for prescription in a medical and clinical setting is evaluated with consideration to not only effectiveness and efficiency but, more so, safety aspects and tolerability of the drug’s side effects.
References
AAFP. (2020). clinical practice guideline: ADHD in children and adolescents. aafp.org. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/ADHD.html
Clark, A., Tate, B., Urban, B., Schroeder, R., Gennuso, S., Ahmadzadeh, S., … & Kaye, A. D. (2023). Bupropion Mediated Effects on Depression, Attention Deficit Hyperactivity Disorder, and Smoking Cessation. Health Psychology Research, 11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317506/
Lee, S. Y., Wang, L. J., Yang, Y. H., & Hsu, C. W. (2022). The comparative effectiveness of antidepressants for youths with major depressive disorder: a nationwide population-based study in Taiwan. Therapeutic Advances in Chronic Disease, 13, 20406223221098114. https://journals.sagepub.com/doi/10.1177/20406223221098114?icid=int.sj-abstract.similar-articles.1
Nanda, A., Janga, L. S. N., Sambe, H. G., Yasir, M., Man, R. K., Gogikar, A., & Mohammed, L. (2023). Adverse Effects of Stimulant Interventions for Attention Deficit Hyperactivity Disorder (ADHD): A Comprehensive Systematic Review. Cureus, 15(9). doi: 10.7759/cureus.45995
Shrestha, M., Lautenschleger, J., & Soares, N. (2020). Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review. Translational pediatrics, 9(Suppl 1), S114. https://tp.amegroups.org/article/view/32479/html#:~:text=Physiological%20interventions%20are%20regular%20physical,activity%20every%20day%20(43).
Titheradge, D., Godfrey, J., Eke, H., Price, A., Ford, T., & Janssens, A. (2022). Why young people stop taking their attention deficit hyperactivity disorder medication: a thematic analysis of interviews with young people. Child: Care, Health and Development, 48(5), 724-735. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9545018/ NRNP 6665 Week 3: Assignment 1 – Off-label prescribing – Attention deficit hyperactivity disorder (ADHD)
