The other nonstimulant medication recommended by the American Academy of Pediatrics (2001) as a second-line treatment for ADHD is bupro-prion (BUP). Marketed under the brand names Wellbutrin and Zyban, buproprion is classified as an antidepressant, but its chemical structure is quite different from that of most other medications in this class. BUP acts on the noradrenergic system and indirectly on the dopaminergic system. Controlled studies have found BUP to be effective for treating ADHD in children (two trials) and adults (two trials). One open-label study found BUP useful for treating patients with ADHD and comorbid bipolar disorder. Wilens and colleagues (2002) suggested that treatment with BUP for ADHD patients should be initiated at 37.5 mg and increased every three or four days up to a maximum of 300 mg daily in younger children and 450 mg daily in older children or adults. Adverse effects may include excessive activation, irritability, insomnia, and (rarely) seizures.
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