A deep dive into the extended-release ADHD stimulant medications. Jonathan Murphy, PMHNP-BC, walks through every major option in the methylphenidate and amphetamine categories, the clinical reasoning behind choosing one over another, and the specific patient presentations that point toward each medication.

This episode covers:

• The two stimulant categories: methylphenidate and amphetamine
• OROS technology in Concerta versus micro-bead technology in newer extended-release formulations
• Why Concerta's absorption can be spotty and when to move to Ritalin LA
• The methylphenidate bead ratios: 50/50, 60/40, 70/30 and what each one does clinically
• Aptensio, Metadate, and Jornay PM as alternatives within the methylphenidate family
• Focalin (dexmethylphenidate) as the second-line methylphenidate when standard formulations don't deliver
• The amphetamine side: Adderall XR, Vyvanse, Dexedrine, and Mydayis
• Why dextroamphetamine-only options (Vyvanse) work better for some patients than mixed amphetamine salts (Adderall)
• The 25-30% of adult patients who do best on a pure dextroamphetamine
• Why "all good, no bad" is the optimization standard, not "good enough"
• The diagnostic value of medication response: if any properly trialed medication works, the diagnosis is confirmed and other options remain available
• Why FDA-recommended dosing limits are appropriate guardrails, not arbitrary restrictions

This episode references the Top 10 ADHD Stimulants video on the Focus Path YouTube channel: https://youtu.be/xJQLSCGY9Vc

This is the third episode in the sequence covering the optimization process from the book The Process: An Adult's Guide to ADHD Medication, available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T

Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog.

For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.