If you’re one of a growing number of women who’ve been diagnosed with ADHD as an adult, or if you’re a mom to a kid with ADHD, you probably perked up when you saw recent headlines that the FDA approved a new medication to treat ADHD in kids and adults alike. The med (brand name Simtriyo) is a daily extended-release capsule that contains an active ingredient called centanafadine. It’s the first norepinephrine, dopamine, serotonin reuptake inhibitor (NDSRI) to treat ADHD and is approved for use in adults and children 6 years and older (as long as they weigh at least 44 pounds).
Scary Mommy spoke with a pediatric psychiatrist and ADHD expert to ask parents’ pressing questions about the new, headline-making drug.
How is centanafadine different from the ADHD meds that are currently available?
When it comes to treating ADHD, there are two types of medications available: stimulants and non-stimulants. The stimulant medications come in two different classes: methylphenidate-based medications (like Ritalin or Concerta) and amphetamine-based medications (think Adderall and Vyvanse).
Then, there are non-stimulant medications, which are typically used when stimulant medications cause unwanted side effects, according to the American Academy of Pediatrics.
“Those are the alpha agonists — guanfacine and clonidine. Then there are the norepinephrine reuptake inhibitors. Those are atomoxetine, also known as Strattera, and Viloxazine, also known as Qelbree, and those work on norepinephrine,” says Dr. Michael A. Volkert, a psychiatrist with the Center for Management of ADHD at Children’s Hospital of Philadelphia.
“What makes this different is the mechanism. This medication works on norepinephrine, dopamine, and serotonin. It inhibits the re-uptake of all three of those. The serotonergic reuptake inhibition is unique to this particular medication,” he explains.
This chemical makeup technically makes centanafadine a “stimulant with non-stimulant characteristics,” according to its developers. In his practice, Volkert said he would think about it and use it like a non-stimulant.
Does centanafadine work better than other ADHD medications?
Specifically, will it work better than stimulants? “If that question was posed to me, the answer would be probably not, based on the data that is available now,” Volkert says.
“Stimulants are currently the recommended first-line option by the American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics. Stimulants are very effective; they provide a noticeable difference in symptom relief. Non-stimulants as a class are less effective for ADHD symptoms.”
Non-stimulants are typically prescribed when the side effects of stimulants are problematic to the patient, Volkert says. For example, stimulants can cause appetite suppression; children with ADHD are sometimes very selective eaters, and suppressing their appetite any further could cause weight concerns, he explains.
So, who is centanafadine right for?
What matters most to parents is whether this drug might be right for their child, or better in some way than what they currently take.
This medication is still so new that it’s hard to say. Clinical trials to get FDA approval usually have “squeaky clean” patient populations, Volkert says, meaning they typically only have ADHD and none of the common comorbid diagnoses, like eating disorders, substance abuse disorders, or tic disorders. So, that data doesn’t necessarily represent every person with ADHD.
Centanafadine is a drug that acts like a non-stimulant, so starting out, physicians will probably recommend it for people who may have struggled with the side effects of stimulants.
“When you compare this medication to stimulant medications — and this data is sort of extrapolated; they have not been studied directly against each other in the same patient population — it causes less appetite suppression, less insomnia, less jitteriness, and less dry mouth. Versus other non-stimulants like atomoxetine specifically, less nausea, less fatigue, and less somnolence. Versus viloxazine, another non-stimulant, less fatigue, insomnia, nausea, and constipation,” says Volkert.
Centanafadine could be a good first medication to try in specific cases, he adds.
“It really depends on the patient, what side effects we are trying to avoid, and what comorbidities exist. For example, it will be a non-controlled medication; it likely does not have abuse potential for people with substance use disorders. It is likely going to be more safe in very underweight patients who cannot tolerate the appetite suppression sometimes associated with stimulant medications. The stimulants do have some growth-related concerns for slowing growth velocity. This new medication may not have that, but we don’t have the data on that yet.”
What about that black box warning?
If you read a news article about Simtriyo, you likely know it carries a black box warning that it can cause suicidal ideation, especially within the first few months of treatment. This is obviously a terrifying possibility for parents considering the drug to treat their child’s ADHD.
This is where having a discussion with your child’s medical provider is really going to matter; there’s a lot of nuance here, Volkert says. Anxiety and depression are two of the most common disorders that co-occur with ADHD in kids, according to the CDC, and typically “stem from challenges brought on by ADHD symptoms.” Managing the condition may take precedence.
“Untreated mental health conditions also carry a risk of suicidal ideation. When the suicidal ideation occurs due to medications, stopping the medications stops the suicidal ideation,” says Volkert.
It’s also important to be clear about what suicidal ideation means. “Suicidal ideation is not going to make somebody who’s not suicidal think that suicide is now the answer. It is more of an intrusive, unwanted thought of suicide that is then reported to parents and then the medication is stopped.”
When will Simtriyo be available?
“FDA-approved” and “available to consumers” are two different things. It’ll likely be months before the medication is able to be prescribed, Volkert says. Even then, it may be difficult to get.
“It’s not available yet in pharmacies; it’s not even stocked yet. The other thing is, it will likely require prior authorization because when medications are new, they’re not available in the generic; they’re available in the brand-name only. Being a brand new medication, I’m guessing it’s going to be expensive. Insurance companies are going to want a prior authorization, and the prior authorization generally asks you if you’ve tried other medications first. And if you have not, they might refuse it and say, ‘Try these other medications first, which are generic,’” he says.
With all that in mind, it’s hard to say when this medication might be available as a first-line treatment. For now, the guidance remains unchanged: stimulants are still considered the most effective medication for ADHD, the kind that’s most likely to “move the needle” on symptoms, Volkert says. But if you or your child have tried stimulants with mixed results, it’s still worth bringing up this new option with your medical provider.
source https://www.scarymommy.com/lifestyle/new-fda-approved-adhd-medication-simtriyo
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