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Question
28 year old male presents to clinic today with chief complaint of wanting to restart ADHD medications. He is not currently taking any medications. In the past he has taken Concerta and Vyvanse for his ADHD. Vyvanse was most recently during college. It has now been 4 years since he has been on ADHD medications. He stopped them because he didn't think he would need them anymore when he finished college and he also was heavily using alcohol at the time. He has a past history of alcohol abuse (remission for 2 years) and states he did snort his ADHD medication a few times in the past (10 years ago). He wants to restart medications because he is recognizing that his ADHD symptoms are affecting his work and personal relationships. He often feels restless and can't focus on tasks. At home and work, he has difficulty completing tasks as well.
1. What would you prescribe today and why? Explain the mechanism of action and dosing recommendations.
2. What would you choose as second-line medication and why?
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