A New Class of ADHD Medication: Targeting Three Brain Chemicals
A new medicine for attention-deficit hyperactivity disorder (ADHD) has entered the treatment toolbox: centanafadine (brand name Simtriyo), a once-a-day tablet approved in the US for adults and children aged six years and older, but not yet available in Australia.
How It Works: Slowing Neurotransmitter Reuptake
Centanafadine belongs to a new class of ADHD medicines and is the first to affect three brain chemicals: norepinephrine, dopamine, and serotonin. Traditional ADHD drugs typically target only dopamine and norepinephrine.
Brain cells use neurotransmitters to communicate. Normally, after a neurotransmitter sends its message, the brain cell takes it back up (reuptake). Centanafadine slows down this 'deletion' process, leaving more of these chemicals available for longer, helping improve attention, hyperactivity, and self-control.
Differences from Traditional Stimulants and Antidepressants
Most ADHD medications (such as dexamfetamine and methylphenidate) are stimulants that mainly increase dopamine and norepinephrine activity. Centanafadine works similarly but also affects serotonin—its unique feature. However, there is debate about whether it is a stimulant: the manufacturer calls it non-stimulant, while the US FDA classifies it as a stimulant.
Unlike common antidepressants that primarily affect serotonin, centanafadine affects reuptake of all three chemicals, with sufficient dopamine activity to address core ADHD symptoms.
Comparison with Strattera (Atomoxetine)
Strattera (atomoxetine) mainly increases norepinephrine with much less effect on dopamine and serotonin. Centanafadine's broader mechanism targets all three neurotransmitters.
Efficacy and Side Effects
Four large phase-3 clinical trials showed centanafadine improves ADHD symptoms and is generally well tolerated. However, studies compared it only with placebo, not directly with existing medications. A study in teenagers found symptom improvement within about a week, with common side effects including reduced appetite, headache, nausea, and rash.
The most common side effects include: decreased appetite, insomnia, dry mouth, and headache. The prescribing information also includes a warning about suicidal thoughts and behaviors, similar to other ADHD and depression medications.
Availability in Australia
Centanafadine has not been approved by Australia's Therapeutic Goods Administration (TGA) nor listed on the Pharmaceutical Benefits Scheme (PBS). If it passes regulatory review, it may become available through normal treatment pathways.
Future Potential: Anxiety and Depression
Because centanafadine affects serotonin, researchers are exploring whether it could help people with ADHD plus anxiety or depression. Early research shows promising results, but full findings are not yet published.
More research and real-world experience will clarify centanafadine's role in ADHD treatment. For users tracking their health metrics, Xiaoshu Health App can sync with Apple Health to monitor relevant indicators, helping you better manage your health data.