On February 9, 2005, Health Canada suspended the marketing of Adderall XR (Shire), a mixture of amphetamine salts used to treat attention-deficit hyperactivity disorder (ADHD) (Med Lett Drugs Ther 1994; 36:109). The immediate-release form of Adderall was never marketed in Canada. The withdrawal was based on 20 reports internationally of sudden death in patients taking the drug. These deaths, 14 of them in children, were not linked to overdose or abuse. The FDA decided that the number of sudden deaths was no greater than expected among the large number of people taking the drug, but because 5 of the children who died had structural heart defects, added a warning against using the drug in such patients. There is no evidence that Adderall offers any advantage over methylphenidate (Ritalin, and others) or dextroamphetamine (Dexedrine, and others), but some patients who do not respond satisfactorily to these drugs may respond to Adderall. Medical Letter consultants see no need to discontinue Adderall in patients who are taking it and doing well. For patients with a heart defect or a family history of sudden unexpected cardiovascular death, methylphenidate might be a better choice.

Methylphenidate is now available in a new extended-release formulation (Metadate CD - Celltech) for treatment of attention deficit/hyperactivity disorder (ADHD). The new product, which is a Schedule II controlled substance, is being advertised directly to consumers.