ADD / ADHD Medication

Sorry about the lack of activity on Myomancy. A combination of factors has left me with no time to work on Myomancy. Things should improve soon. Amongst other things, Myomancy will be moving to new server allowing me some exciting new features and fix a few problems.



ADD / ADHD, ADD / ADHD Medication, Medication

Mindhacks has an interesting post on how Ritalin prescriptions increase when parents divorce.

Drug companies and some charities have invested a lot in selling the idea that ADHD is a purely neurological disorder and that the child’s family life has little to do with it.

This study suggests that this isn’t the case, and that the child’s environment and relationships, in combination with possible genetic and neurological differences, have a significant effect on their behaviour.

Child Ritalin use doubles after divorce

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Medication

Vyvanse is the new ADHD medication from Shire PLC, the makers of Adderall XR. It marks a significant change in the range of medication available as it uses a different type of stimulant than other medications, it a has long duration and it is especially formulated to prevent substance abuse.

How Vyvanse Works

The active substance in Vyvanse is lisdexamfetamine and is chemically very close to Dexedrine Spansules, a stimulant occasionally prescribed for ADHD. The advantage of lisdexamfetamine over methylphenidate (used in Ritalin and Concerta) is that it has a long lasting effect. Taken in the in the morning, the peak effectiveness last one to four hours but had a notable effect on symptoms for 12 hours.

Traditional ADHD medications have been easy to abuse and this has led to dependency problems. Vyvanse is a prodrug, a substance that is inert until it is digested. This mimics how the body creates useful chemical and vitamins from our food. As Vyvanse only acts as a stimulant once it is broken down by the stomach you cannot get a high from grinding it up and snorting it. Swallowing higher than prescribed doses (150mg compared to the recommend max of 70mg) will still produce a high indistinguishable from that produced by a comparable dose of Ritalin.

Vyvanse: Four Times More Side Effects

Because Vyvanse is new it has only been used by those adults and children who took part in the drug’s trials. In total, less than 1000 people. With such a small sample (compared to the millions who will end up taking the drug) there is very little first hand knowledge of the drugs effects. With each of the other major drugs, Ritalin, Adderall etc, different people can have very different reactions to the drugs. Someone who is fine on one drug may have numerous side effects from a chemically very similar drug. The body and brain are very complex chemical systems and stimulants are a very crude tool.

Currently we only have the Vyvanse prescribing information to go on as a guide to its effects but one things is very noticeable. In trials 10% of users stopped taking the drug due to adverse effects (i.e. side effects). This is much higher than Adderall where only 2.4% of participants were effected. In the Adderall trials more people stopped using the placebo than the real drug but for Vyvanse only 1% of placebo users dropped out. The new drug has a side effect rate 10 times higher than the base line and four times high than Adderall.

Vyvanse And The $1.5 Billion Goal

Shire PLC are introducing this new drug as a replacement for Adderall XR whose patent is running out. They hope to capture 50% of the market share with the drug and as the market is worth $3 billion, a 50% share will generate a lot of money. Expect to see a lot of advertising aimed at parents, not doctors, when Vyvanse is launched in July. In theory Vyvanse is a lot cheaper to make than competing drugs as its chemical formula is its key rather than the complex release mechanisms used by others drugs. However I expect that Vyvanse will retail at about the same as the other ADHD medications at about $130 – $150 for a months dose.

ADD / ADHD, ADD / ADHD Medication, Medication

Vyvanse, a new ADHD medication has just got approval from the Drug Enforcement Agency (DEA) who classified it as a schedule II controlled substance, the same class as Ritalin, Concerta and many street drugs. This is the final step before Shire PLC can launch the drug commercially. Shire also Adderall, and Adderall XR.

The new drug has been formulated to provide both the long-lasting effects of Adderall XR and to minimise the potential for abuse. ADHD medication are strong stimulants and can be open to abuse both by those it prescribed to and by those who acquire it illegally.

Shire Press Release: VYVANSE™ Receives Final DEA Schedule Classification, Clearing Way For Launch Of First Prodrug Stimulant For ADHD Treatment

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Medication

What you need to know about ADHD Medications – their effects, costs, side effects and alternatives

What ADHD Medications are Available?

There are three main ADHD Medications: Ritalin (the original ADHD medication), Adderall and Concerta. Each has its own advantages. Ritalin is the oldest, the simplest chemical formulation, and the cheapest because it can be purchased as a generic medicine. Made up of methylphenidate, it is taken two or three times a day. Having been used since the 1960s as medication for ADHD its effectiveness is well documented.

Concerta like Ritalin uses methylphenidate as its active ingredient. Unlike Ritalin and other ADHD medications at the time, it was specially designed to provide a steady stream of medication through-out the day. Allowing parents to give their child one tablet in the morning before school and the medication will be effective all through the school day and into the evening. Concerta does this by placing the medication in a very cleverly design tablet which includes a laser drilled hole that allows the methylphenidate to slowly seep out.

Adderall is unlike the other ADHD medications because it uses a mix of different forms of stimulants. In theory this gives a smoother trip up to and down from the medication’s peak effectiveness. This avoids sudden peaks and troughs in the child’s attention span and energy levels. Adderall XR is a variant on standard Adderall designed to give a whole day’s supply in a single tablet, similar to the Concerta tablet.

With the introduction of Concerta and then Adderall XR, most users of ADHD medications switched to extended release formulas. To combat this loss of sales, Ritalin introduced two versions, Ritalin LA and Ritalin SR. For more information see Adderall XR and Slow Release ADHD Medications.

What Effect do ADHD Medications Have?

ADHD medications are stimulants and have a similar effect to caffeine, nicotine and street drugs such as cocaine and speed. They stimulate the activity of central nervous system which increases energy levels and helps maintain concentration. How exactly this helps with ADHD is unknown. On the patient information sheets of the ADHD medications you will find the drug companies explicitly saying they do not know how their drugs work.

Current ADHD medications treat the symptoms of ADHD and not the underlying causes. When testing the drugs, patients were measured by teachers and parents on various behaviour scales. Typically these reported increases in concentration, a reduction in hyperactivity and a general improvement in behavior. For a parent’s first hand account on the effects of medication see this video: Lil’ Renetto… talking about ADHD… and making videos….

Side-Effects of ADHD Medication

No medicine is free of side effect and ADHD medications are no different. As they are stimulants their effects are very similar to drinking too much coffee. The most the common side effect is insomnia with loss of appetite and stomach upsets being close seconds. About 20 – 30% of mediation users will have one or more side effects. These are very minor but can cause further problems and lead to the use of sleeping tablets or appetite enhancers to combat the effects of the ADHD medication.

Unfortunately there are more serious side effects. A lot less is known about these because the drug companies do not run long term trials prior to their ADHD medication getting approval from the FDA. The longest trial run by a drug company is four weeks. This is for a tablet that is routinely used for months and years at a time.

Others have researched the long term impact of ADHD medications and found some worrying effects. Up to 9% of users over a 27 month period developed facial tics. Children with who took the medications for more then 12 months were found to grow 2cm less than their non-drug using peers. There is also concern that the constant stimulation of the central nervous system will train or acclimatize it high levels of stimulation. This may impact in adulthood and result in great use of illegal drug such as cocaine and other high risk behavior.

For more infromation on ADHD medication side effects, see: Adderall Side Effects; Concerta Side Effects; Ritalin Side Effects; and Ritalin and Cocaine Addiction.

The Cost of ADHD Medications

If your insurance or health care system doesn’t cover you for the price of your ADHD medications, treatment can get very expensive. For a month’s supply, the price of the drugs range from $26 for a generic versions of Ritalin up to $150 for Concerta and Adderal XR. The prices of the timed release versions of the drugs (Adderall XR, Ritalin LA or Ritalin-SR) are about twice the price of the normal versions. The reason for this is simple. The standard versions can be made by generic drug companies because the patents have run out. Where as the timed released version have several more years to run on the patent and so the drug companies can charge what they like for them.

When considering ADHD medication, its worth remembering this is a not a simple course of antibiotics. These a drugs that will be taken for months, if not years, because when you stop taking them the symptoms will return. Consequently the costs will added up, month after month, year after year.

If you are tempted by offers of cheap ADHD medication from online or foreign pharmacies then read this: Want No Prescription Adderall? – Read This Now!.

Alternatives to ADHD Medications

If you are not keen on everyday, giving your child a drug that can have serious short and long term side effects but doesn’t actually treat the problem then you need to consider the alternatives to ADHD medication. There are two problems with the alternatives to medication. Firstly, unlike the drug companies, the alternatives do not have hundreds of millions of dollars to spend marketing their products. Secondly, the alternatives take many months to have an effect. ADHD medication have an effect on the symptoms almost instantly. Tackling the underlying cause takes a lot longer.

Probably the best known and most widely available treatment is the Dore Programme of cerebellum exercises. These simple exercise are done everyday for a year or more and train up specific parts of the brain related to coordination, movement and self-control. It is an approach that has many critics but also many customers who have found them to work.

Another movement based approach is Interactive Metronome. This teaches the child a sense of rhythm, timing and control. There has been some very good research on how effective this can be as an alternative to ADHD medications.

A third movement based approach to ADHD is INPP’s primitive reflex training. Similar to Dore in some ways, this approach focuses on primitive reflexes that in normal children develop before they are 18 months. The INPP hypothesis is that in children with ADHD the reflexes are retained or not fully developed. Two books related to this are Stopping ADHD and Infinity Walk.

There are various herbal remedies that claim to be alternatives to ADHD medications. The science behind these is very weak but some people claim they work. See ADHD Natural Remedies Part 1, Part 2 and Part 3. Omega 3 fish oil supplements have also been promoted as an ADHD treatment. See ADHD and Omega Fish Oils for more information.

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Medication

Are expensive slow release medications like Concerta or Adderall XR better than traditional and cheaper stimulants?

Adderall XR and the Patent Problem

One of the problems for manufacturers of ADHD Medication such as Ritalin and Adderall is that anyone can make them. The stimulants used in them where discover 50 or more years ago and any patents on them ran out long ago. Generic version of Ritalin are very cheap to make which is why you can buy a month’s supply for about $26.

So how do the manufacturers make lots of money from an ADHD medication that anyone make? Simple, formulate it in a new way and patent the new technology. This is what Shire Pharmaceuticals did with Adderall XR and Novartis did with Ritalin LA and Ritalin-SR. These time release tablets cost two or three times as much as their generic equivalent.

What’s Different about Adderall XR?

Compared to the standard Adderall, Adderal XR contains a different mixture of stimulants that are processed at different speeds by the body. This gives Adderall XR, in theory, a longer lasting effect with a smoother trip to and from its peak effect. In addition Adderall XR contains is medication in two beads. These dissolve in the stomach at different rates, one almost immediately and the other after four hours. This allows the drug to have an effect for up to 12 hours.

With Ritalin, Novartis took a different track to Shire and Adderal XR. In addition to the standard Ritalin tablets they introduced Ritalin-SR (slow release) and Ritalin LA (long acting). The SR version is a just a normal Ritalin tablet that disolves more slowly in the stomach where as Ritalin LA is a capulet containing tiny beads of medication. These beads dissolve at different rates giving a more even release of the drug. With the Ritalin LA capulet you can sprinkle the contents on food if the child cannot swallow the pill. This may be an advantage over Adderall XR or Concerta which cannot be broken before being swallowed.

Both the Ritalin-SR and Ritalin LA have the same active ingredient, methylphenidate, as regular Ritalin tablets. The prescribed dose of the Ritalin-SR/LA should be equivalent to the total daily dose of standard Ritalin. The effect of the long acting and slow release is about eight hours compared to the 12 hours claimed for Adderall XR and Concerta.

Is Adderall XR Better Than Standard Adderall?

Standard Adderall tablets are known as instant release tablets as they are designed to take effect as quickly as possible. Whilst this is useful in situations when a quick impact is needed it does mean that additional doses will be required after a few hours. The big advantage of the slow release medication such as Adderall XR and Concerta is that they last up to twelve hours. This allows a child to be medicated before the start of the school day and for the medication to still be effective by the time child returns home at the end of the day. This avoids giving the child or the school nurse additional tablets to take at lunch time, reducing the risk of the child missing or abusing their medication.

The other main selling point of Adderall XR and the other tablets is its smoother trip to and from its peak effectiveness. Stimulants that quickly achieve full effectiveness and then quickly drop off have a higher risk of abuse and addiction. Cocaine is a classic example of the quick high and quick fall. The different formulations of the drugs, compared to instant release tablets, mean that Adderall XR is harder to misuse as they are less suitable to crushing and snorting or smoking.

Does Adderall XR Do What it Claims?

Simply put, yes. Adderall XR is just as effective in treating ADHD as standard Adderall tablets and it does remain effective for up to 12 hours. This appears to be true of other extended release medications. However this must be treated with caution. Most of the research has been done by the pharmaceutical companies themselves and was scored using subjective criteria. Whether your child should use Adderall XR compared to normal Adderall or one of the other time release medications is something you and your doctor need to discuss.

Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD.
Long-Term Tolerability and Effectiveness of Once-Daily Mixed Amphetamine Salts (Adderall XR) in Children With ADHD.

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Medication

No Prescription Adderall! Buy Ritalin Online! Concerta Without Prescription! Websites and spam email are all trying to sell you cheaper, easy access to drugs. Are they safe? Are the legal? Are they cheaper?

No Prescription Adderall!

In the US, Adderall, Ritalin and Concerta are Schedule II controlled drugs. The sale of these ADHD medications is strictly regulated by the Drug Enforcement Agency. In short it is illegal to buy Ritalin, Concerta or Adderall without a prescription. It is also illegal to buy online without a prescription from foreign pharmacies as you are then importing illegal drugs.

The situation is the same in the UK where these medications are counted as Class B drugs. ADHD medication such as Adderall, Concerta and Ritalin are heavy duty stimulants and have a long history of illegal use and abuse. Governments tend to frown on easy access to such powerful drugs so whatever country you are in, offers such as ‘No Prescription Adderall’ are going to be illegal.

Buy Adderall Online!

If you have an Adderall prescription, can you legally buy online?

Maybe is the most honest answer. The regulation of drugs is carried out by large and slow moving government agencies. These bodies are not best suited for dealing with the fast moving world of the global internet and most of the relevant laws were drawn up before the internet was created. So it may be legal to buy Adderall online (with a prescription) depending where you are. However buying from a foreign country, whether you have a prescription or no prescription, Adderall, Ritalin and Concerta will be illegal. Police, customs and the post office get very upset when you import controlled drugs through the post.

In the US it is legal to buy medication online if you have a prescription and the pharmacy you are buying from is in the US and is properly licensed. When it comes to schedule II ADHD medication such as Adderall, the DEA say:

Is it Possible for my Internet Pharmacy to Fill Prescriptions for Schedule II Substances?
You may fill valid prescriptions for Schedule II substances if the patient or prescriber provides you with the signed original prescriptions prior to dispensing. Practically, it is unlikely that most patients will want to wait the time required for such a transaction.

The key words in this are ‘signed original prescriptions’. Faxing a copy of your prescription is not enouigh to buy Adderall online.

Cheap Adderall Online!

You have a prescription for Adderall and you want to buy from an online pharmacy in the US. Is it any cheaper than your local store? According to the Consumers Union, the price for a month’s supply of Adderall XR (10mg) is $144 and $130 for Concerta (18mg). Prices from September 2006.

Seaching Google for ‘Buy Adderall Online’ I quickly found Meds For Cost who are selling Adderall XR (10mg) for $109.88. It can be had for $105.80 from Trusted Online Pharmacy or for $52.80 if join their site as a member ($25 a month). After ten minutes more of searching I could not find any other sites actually claiming to sell Adderall or Concerta online.

No Prescription Adderall – A Myth

If you are looking to buy no prescription Adderall online then don’t bother. Any legitimate pharmacy in the US will require you to send an original prescription before they can supply the medication. Even if you have an Adderall prescription, this is simply too much work for the customer and the company to make it worth while.

If you are tempted to buy online from foreign companies then think twice. For starters, you will be breaking serious laws by attempting to import them into your country. Secondly, Adderall, Concerta and Ritalin are powerful and dangerous drugs. Do you really trust a company that will sell you strong medications such as Adderall with no prescription? If a company is willing to behave that irresponsibly, they are willing to do anything. Including sending you fake pills made with god-knows-what. Caveat emptor

Buying medicines over the Internet
Class A, B and C drugs
ADHD Medication: Best Buys
Consumer Report ADHD Drug Prices
National Association of Boards of Pharmacy
US Customs – Importing Drugs

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Medication

What side effects does Concerta have?

Short Term Concerta Side Effects

The information on Concerta’s side effects come from the clinical trails undertaken during the approval process for its use an ADHD medication. It was tested on over 2100 people, some of whom were healthy adults but most were patients diagnosed with ADHD.

In a four week trial of children, the following Concerta side effect were reported. The percentages indicate the number of patients reporting side effects whilst on Concerta and those reporting side effects whilst (unknowingly) on a placebo.
Headache 14% / 10%
Abdominal pain (stomachache) 7% / 1%
Vomiting 4% / 3%
Anorexia (loss of appetite) 4% / 0%
Nervous Dizziness 2% / 0%
Insomnia 4% / 1%
Upper Respiratory Tract Infection 8% / 5%
Cough Increased 4% / 2%
Pharyngitis 4% / 3%
Sinusitis 3% / 0%

Trials on adolescents found a very similar level of Concerta side effects to the trials on children. One notably difference is that a notably increase in accident injury occurring when on medication compared to the placebo ( 6% to 3% ). This may indicate that heightened energy levels and improved concentration may cause adolescents to take part in new, higher risk activities.

Long Term Side Effects of Concerta

Unlike comparable drugs such as Ritalin or Adderall there is useful information on the long term side effects of Concerta. In two trails (one involving just children and the second a mixture of children, adolescents and adults) 6.7% of the patients discontinued using the drug because of side effects with insomnia being the leading cause.

One of the Concerta side effects reported in long term studies was facial tics. After an average of 7 months of treatment one study of 682 children found that 1% of patients developed facial tics. In a second study lasting 27 months, 9% of patients had developed tics.

In common with other stimulant medication there is a danger of patient’s abusing the drug. Patients with a history of drug or alcohol should not be prescribed Concerta. There has also been concerns that long-term use of ADHD medication in childhood may make patients more liable to legal and illegal stimulant use in adulthood.

Concerta Product Information [ PDF ]

ADD / ADHD, ADD / ADHD Medication, Medication

Ritalin may be a wonder drug to some but what are the side effects of Ritalin?

Side Effects

Because of its long history as an ADHD medication Ritalin has not gone through the same testing and approving process required by more modern drugs such as Adderall and Concerta. Unlike those drugs, a detailed breakdown of Ritalin’s side effects is not included in the labeling information. However as Ritalin is the poster-child of the ADHD medication debate it has been widely studied.

A four week study into Ritalin’s side effects in children compared to a placebo treatment found that insomnia, appetite disturbance, stomachaches, headaches and dizziness all significantly increased when using the drug.

Another study looking and the side effects of Ritalin and Dexedrine found that the ‘side effects’ reported for the medication were more frequent and more severe before the use of Ritalin started. Only in appetite problems were the Ritalin side effects worse than those reported before the medication started.

Some mental health problems can arise as a side effect of Ritalin. Hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania can be caused by Ritalin at its usual doses. In short-term trials 0.1% of patients reported mental health problems compared to 0% of patients receiving a placebo.


Contraindications are signs or symptoms that medication should not be prescribed or taken rather than specific Ritalin side effects. The most worrying of these is the potential fatal effect it can have on patients with structural heart problems. It is not clear if or how Ritalin effects these problems but there have been a handful of cases where Ritalin users with heart defects have died suddenly.

In common with most stimulants Ritalin should not be taken by patients with motor tics or with a family history or diagnosis of Tourette’s syndrome. A side effect of Ritalin is to aggravate those symptoms.

Long Term Ritalin Side Effects

Does Ritalin have any long term side effect? We don’t know. Despite Ritalin being prescribed to patients for months or years at a time. The manufacturers have never run any long-term studies to establish Ritalin’s effectiveness or safety. However some evidence of Ritalin side effects over the extended usage has been found.

One area that has been a studied is whether stunted growth is a Ritalin side effect. On average, a total of about 2 cm less growth in height and 2.7 kg less growth in weight over 3 years. It is recommend that children taking Ritalin have their height and weight monitored.

There is also concern that long-term use of stimulants can lead to drug dependence. This is not a specific Ritalin side effect but a problem that effects all stimulant medications. Care should be given when prescribing Ritalin to people with a history of drug or alcohol abuse. There is some evidence that suggests that extend Ritalin use can lead to problems with cocaine use in later life.


Placebo-Controlled Evaluation of Ritalin Side Effects

Side Effects of Methylphenidate and Dexamphetamine in Children With Attention Deficit Hyperactivity Disorder: A Double-blind, Crossover Trial

FDA Labeling Information

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment

Adderall, unlike its main rivals Ritalin and Concerta, does not use methylphenidate as it stimulant. Instead in uses a mixture of stimulants to treat ADHD.

The original Adderall, introduced in 1996, was an instant release tablet that combine the amphetamines dextroamphetamine and racemic . Dextroamphetamine is better known under its brand name of Dexedrine and whilst racemic form the basis of Desoxyn. In theory this combination gave Adderall a smooth effect that Ritalin, its direct rival, however there is very little evidence to support this.

Adderall XR (eXtended Release) was introduce in 2001 and directly competes with Concerta. The aim of the slow release mechanism is to have a smoother build-up and come-down effect on the patient. This is important as fast effecting stimulants with a sharp drop-off, such as cocaine, have been linked to problems with abuse and addiction.
The extended release Adderall is a different mixture active ingredients to the standard capsule using two different forms of dextroamphetamine and two different forms of levoamphetamine, more commonly known as amphetamine. This blend of different stimulants is what gives Adderall its long duration. The different chemicals are processed by the body at different rates with the levoamphetamine giving fast initial onset and the dextroamphetamine providing the longer effectiveness.

To further enhance the duration of the tablets effect, Adderall XR consists of two beads, each with about four hours supply of the active ingredients. The first bead dissolves straight away and the other after about four hours. Drinking acidic drinks such as Coke can effect the chemical balance of the stomach and increase the speed at which the second Adderall bead dissolves. Under normal circumstances Adderall reaches it peak effect at about eight hours. Eating before taking the tablet does not effect the medications onset time but does lengthen the duration of its effect.

In 2005 the Health Canada, the Canadian equivalent of the FDA, suspended the use of Adderall after the sudden death of patients using it. A few months later they allowed Adderall’s use after establishing most of the deaths where related to structural problems in the heart. Its is not clear if the medication had any role in triggering the deaths so the FDA say that Adderall should not be used by children or adults with structural heart problems. Overall, there are more reports of Adderall Side Effects and contraindications that there are with Ritalin and Concerta. If Adderall is taken with Propoxyphene (a pain killer) and MAO inhibitors (anti-depressents) the results can be fatal.

Adderall was tested in studies of 584 6 to 12 year old children diagnosed with ADD or ADHD. The study lasted three weeks and the recipients of Adderall XR were rated by teachers as being more attentive and less hyperactive than those who where just receiving the placebo treatment. A trial with 255 adults lasting four weeks also found significant improvements in those receiving Adderall XR. However there was no evidence that doses larger than 20mg a day conferred any additional benefit.

In common with other ADHD medications there is no evidence on exactly how Adderall helps children with ADHD or what long-term effect it has on the brain. The longest trial for Adderall only lasted four weeks so its effectiveness beyond that is unknown as are its long-term side effects.

Adderall and Adderall XR are produced by Shire Pharmaceuticals and in 2005 earned them $770 million in worldwide sales. That was up by more than 20% on 2004 sales figures. Overal, Adderall has about the same market share as Concerta ($900 million in 2006).

The non-active ingredients of Adderall XR are: Gelatin capsules, hydroxypropyl methylcellulose, methacrylic acid copolymer, opadry beige, sugar spheres, talc, and triethyl citrate. Gelatin capsules contain edible inks, kosher gelatin, and titanium dioxide. The 5 mg, 10 mg, and 15 mg capsules also contain FD&C Blue #2. The 20 mg, 25 mg, and 30 mg capsules also contain red iron oxide and yellow iron oxide.

Shire Annual Report 2006