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Intuniv for ADHD: Metabolic Challenges
Holistic Reviews At CorePsych
January 24, 2010Psychiatric Diagnosis and DSM 5: Maps to Nowhere
February 13, 2010
Metabolic Fire – p.Gordon/Flicker
Past Intuniv Posts:
This post is the fifth, with four others, documenting Intuniv Overview, Dosing Details, Drug Interactions and Addiction Indications. Please review all of these posts and the many comments [over 200] on the Overview post to see what readers are saying about Intuniv, this interesting new ADHD non-stimulant medication.
Burn Rate:
If you have been reading CorePsych Blog you will note that I have been writing about my new book, – and the good news, it's finished, and in edit at this moment – I do hope to get it out by March '10. ADHD Medication Rules: Paying Attention To The Meds For Paying Attention details an entire chapter on Burn Rate, as everyone who takes ADHD meds should absolutely master the burn rate principle.
This Specific Q & A:
– Is an example of the many Intuniv questions, challenges and positive remarks in these several posts:
Question About 8 yo Boy, Picky Eater and Metabolic Challenges – Consider this Odd Metabolic Syndrome
“I have just stumbled across you and [CorePsych Blog] in my research into Intuniv. My son just recently turned 8 and was diagnosed with ADHD this past spring. As I continually read about ADHD kids Luke seems wise beyond his years, is very bright when it comes to building things, or math, and picks things up quickly when he is receiving instruction one on one or in a very small group,- but he struggles in school generally. Long story short, we started with a Central Auditory Processing Disorder diagnosis when he was six.
His primary issue seemed to be language, both receptive and expressive. An exam with an audiologist confirmed a fairly significant CAPD at the time. As he progressed in school it was obvious that ADHD was also a large part of his problems as impulsivity, restlessness, inability to attend, and defiance increased as he got older. We saw a neurologist who, after an EEG, prescribed Focalin XR. This worked “like MAGIC, “- at first. [See Roving Therapeutic Window here.]
We started with 5mg and after about a month moved up to 10mg. He was able to focus, concentrate and made great strides in school. His language issues even seemed to improve. Now it seems the Focalin is either failing him or is the wrong drug. His ability to focus has tanked, he has become very impulsive (throwing things, slamming things on his desk) and is increasingly defiant (refuses to do work, follow directions). While other times he seems spaced out, and at home sometimes too compliant, and sometimes melancholy for no reason.
With age it seems his receptive language abilities are about right, and at developmental level, but his expressive abilities are still below, which of course is leading to some frustration on his part especially when he is supposed to expressing himself through writing. We were seen by the NP [I love NPs!] in the neurologist’s office today and she suggested Intuniv. From what I’m reading it sounds like it may work for Luke but she has suggested we stay on the Focalin while we start the Intuniv? Do you agree? (She mentioned d/c’ing the Focalin eventually)
Second, in one of the posts above you mentioned something about “immune dysfunction, bowel challenges and is-he-a-picky-eater”. While Luke is rarely sick, I don’t think he has a solid BM in his life (not watery, but always very, very soft) and he would live on Mac and cheese, peanut butter and jelly and chips if I’d let him. He NEVER willingly tries anything new and is indeed very picky about what he eats. As all of this is very new to me can you shed some light on what this may have to do with anything and what to do about it – or point me to the best place to read about it? We have tried adjusting his diet, etc. in the past but because he is so picky it is very difficult to do.
An Additional Metabolic Point – Headaches
One additional thing that the NP this a.m. more or less ignored – prior to starting meds Luke would wake up in the middle of the night crying and saying his head hurt. He’d be up 30 min. or more, would eventually throw up and then go back to sleep. In the morning you’d never know anything happened. This would happen about once a month from the time he was about 6. I only recall it happening once during the day at school. Once we started Focalin those incidents ceased completely. We had our first return of that 2 nights ago. Any idea what that’s all about? Initially the neurologist said it was “interesting”but had little else to say about it.”
My Answer, Abbreviated To Stay With Metabolism and Burn Rate:
My reaction to this question and many others seen on the many comments on Intuniv and Vyvanse: We must always look at the metabolic hints, the possible changes in metabolic rate before starting the meds. They are subtle but include the following:
– History of bowel issues, too soft, too hard, constipation, diarrhea, monolithic stools, too slow in transit time,
– Developmental delay issues: CAPD, speech issues, Asperger's, Autism,
– History of Fetal Alcohol exposure
– Headaches, stomach aches, tired all of the time, dark circles under the eyes, pale skin
– Picky Eater
– Not eating breakfast, waking with stomach issues and no appetite
– History of failure with many meds – including stimulants or non-stimulants [Intuniv, Strattera]
– Narrow Therapeutic Window
– History of food allergies even back to early childhood, e.g. “lactose intolerance”
– History of rashes, allergies, asthma, upper respiratory infections, ear infections
If we don't look at these issues [and more] we cannot predict what the outcome with the medications will be – and every one of these issues can significantly change the underlying metabolic patterns, the amount of neurotransmitters in the body, and the cofactors that burn the neurotransmitters effectively.
Medication management now requires a full awareness of the entire pattern including nutrition [which feeds the amino acid building blocks for neurotransmitters and cofactors], – without more careful questioning at the outset we will have predictable problems – as the burn rate will vary dramatically with all of these variables. Burn rate will effect Duration of Effectiveness [DOE] – dosage patterns and speed of titration at the onset of meds.
Then, if Burn Rate varies, we must always take the next step to measure the immune dysregulations, the neurotransmitters, and the downstream endocrine issues so often found with these upstream irregularities.
Phone Consult Availability at CorePsych…
Check out these remarks regarding how to start these reviews with a phone consult [I consult regarding these issues by phone]: See this post on Intuniv: Comment by Gina Pera on January 29, '10 2:30 PM
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78 Comments
Dr. Parker,
I had recently stumbled into your work after months of searching for answers – I had been suspecting a lot of things you read regarding burn rate, etc. I also believed our system is broken in the time spent in proper diagnosis upfront, finding the underlying issue vs the ready fire aim approach. Purchased your book and it was right on in so many areas – I now know I have thinking type ADHD.
Anyways I did the burn rate test in preparation for an appointment this week – The food passed in 6-7 hours. I have been on adderall xr 30mg 2x daily, never seemed to work very long. Switched to Vyvanse 60mg AM and 20 PM, it seems to just make me a little jittery with minimal focus. Should mention diagnosed with comorbid GAD and Chronic Depression – and dealing with a PTSD type situation as my untreated issues lead to my family abandoning me. I was curious on input on dosing for folks with fast burn rates – IR vs XRs, many doses vs 1-2 high doses, etc. I seem to hit the window, go over the top, then drop out late, then boost back in, over, and out with repeated dosing.
Thank you again for all of the phenomenal information, and taking the time to properly address issues that effect folks like us so much, yet are given so little attention.
Mark,
Thanks for your kind remarks, much appreciated. Do connect here, it takes a village. Your participation will help others along their path of advanced understanding: http://corepsych.com/connect
RE: You problem seems, at first glance, unusual – but as you can see from my work it’s far more commonplace than expected, that’s why that Transit Time Tool is so helpful. No cost, big info: http://corepsych.com/ttt – So others can connect.
Your short [should be 12-24 hr] Transit Time result does significantly tell the tale: you, very likely [in my clinical experience more than 80%], do suffer with an immunity issue, measurable with IgG testing as seen on video link on the second page here: http://corepsych.com/tests Most of your psych woes that remain refractory to good psych care live in your biologic organism downstream from that dam, that corruption on your watershed.
In my own experience, not telling you what to do, but sharing the big picture, IR meds work far better than metabolically compromised XR meds including Vyvanse. For the near term ask your doc to work with you in the following manner:
1. Find the IR dose that burns closest to it’s expected Duration of Effectiveness – DOE: http://corepsych.com/doe e.g. Adderall IR: 4-5 hr. Then dial in the dosage frequency so that it matches your Executive Function needs through the day, being careful to watch breakfast and sleep.
2. Plan on the fact that you will likely find yourself with your medical team chasing dosage vapors in the wind until you measure and correct your underlying medical issues, whatever they are. The good news: your brain will work better and you will live longer 😉
3. Other meds [such as Intuniv, http://corepsych.com/intuniv may help, but often suffer from the same metabolic impediments.
4. Supplement and nutritional efforts will also prove futile and frustrating, as that immunity corruption, likely a food sensitivity, on the one hand interferes with absorption, and on the other sends cytokine messengers out to muck up neurotransmitter receptors.
Thanks again, – all the best,
cp
Dr. Parker,
I wanted to bump up this conversation on metabolic issues and Intuniv, as I have always had issues with your favorite topic — #2…very slow motility and chronic constipation since early childhood.
Constipation is listed as a known side-effect and you haven’t mentioned it on here yet. I have also read that ADHD and constipation are related (probably due to perseveration and not listening to body signals)…this, despite being a vegetarian, eating whole grains & vegetables, and being very conscious of my hydration.
I found a pdoc who treats kids and adults and knew about Intuniv (last psych thought it was the same as Mucinex)…so I have been on it for 4 or 5 months now. Immediately after taking I became severely constipated and had to triple my treatment efforts (prunes, prune juice, fiber bars, psyllium, etc.) Recently started on Miralax daily too. Took me months to go up from 1MG to 2 b/c of fear of worsening #2. Now I can’t go up from 2MG. I’m worried enduring this long-term could be worse for my overall physical functioning, (think Elvis) and at 2MG Intuniv isn’t having a really noticeable positive effect, except for a lessening of my chronic nightmares and night terrors. Stims were fine, though I have definitely become tolerant of Rit/Focalin, and always felt anxious on AMP. Have you heard about this problem before? Any solutions to recommend?
Stuck,
Delightful comment: hits the nail precisely on the metabolic head. Side effects from any of these ADHD meds, stimulant or not, more often than not [>80% of the time] indicates a dormant pre-existing metabolic problem, verified by your other historical evidence. You, as many, have found yourself at Intuniv’s doorstep because of those pre-existing probs w the other meds.
Misunderstood reactions to ADHD meds is the primary reason I wrote New ADHD Medication Rules. Attention to metabolic details and utilitarian corrective measures provide the answers that inevitably work everyday in my office for years [>80% of the time – the other 10% is genetic, nutritional, medical, trace element, etc].
See these YouTube videos for more answers:
ADHD Meds Tutorial – Overview: http://bit.ly/medstutorial
ADHD Meds Dosage: http://bit.ly/dosevids
ADHD Meds Problems – Mind and Gut: http://bit.ly/mindgut
ADHD Meds & Allergies – Milk and Wheat: http://bit.ly/mawimmun
ADHD Meds & Allergies – Street Immunity Answers: http://bit.ly/IorWJs
If you were in my office as a first time pt w that history I would most certainly suggest more testing to unearth the most likely metabolic culprits – IgG qualitative testing [I abore quantitative for our purposes, costly and useless] & Trace Elements [Tissue Mineral Analysis] provide good answers, depending on $ would love to see Urinary Neurotransmitter levels, covered regularly at CorePsych in the SEARCH above.
Most importantly: answers exist, you need more testing to precisely nail them down. Side effects reveal underlying pre-existing metabolic problems.
cp
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Darlene,
Could be either or both… my first take would be immunity, and we see so often folks/kids with underlying metabolic challenges related to trace element imbalances that we start measuring whenever an unpredictable variable arises. As you likely know I don’t like speculation when evidence can solve the problem by precise intervention. Having said that we see zinc insufficiency often, it’s measurable through hair analysis and an easy way to review is look for white spots in the nail beds… not always there but might be an easy flag.
cp
I’ve been writing about Intuniv now for about 2 years and if you type that word in the Search box [upper right corner there] many specific posts will come up. One of my favorites is this one:
http://www.corepsychblog.com/2010/02/intuniv-for-adhd-metabolic-challeges/ and I have one on addictions and intuniv as well easily found in Search.
cp
Nisey,
Actually this is one that we see far too often in our offices… refractory response to well intentioned and otherwise-indicated Intuniv.
See this post on the Glutamate connection with Intuniv and links to many other posts on Intuniv matters: http://www.corepsychblog.com/2010/08/intuniv-answers-adhd-neurotransmitters-glutamate-matters/
Bottom line: once anyone understands that the issue involves different neurophysiology – different neurotransmitter challenges – then the reactions become more transparent.
I haven’t seen seizures with glutamate, but I have on many occasions seen a paradoxical deterioration [Intuniv should have, from a tenex experience model, reduced the tics] with more tics and more ODD, more aggravation/anger/impulsivity. This unpredictable outcome arises, with good evidence from multiple neurotransmitter measures in our offices, an already elevated glutamate based upon, far too commonly, immune challenges *that caused the original stimulant meds not to work in the first place.*
Immune challenges [casein, gluten and eggs are my New Jersey Trifecta in that order, of most to least frequent, in our offices] elevate NE and DA so those neurotransmitters are already out the roof, then come along with Vyvanse, Strattera, Concerta, it doesn’t matter, they are all out the roof on those neurotransmitters before the meds thus causing the profound ADHD symptoms.
Then add on another DA, NE or Glutamate chicken catcher [psych med] with already too many chickens in that synaptic hen house, and you have a clear case of chicken profusion, chicken overload with subsequent tics, and, yes, neurological happenings such as rage outbursts, restlessness, inability to sleep, psychotic thinking etc, [tho I have not seen seizures, as indicated].
These finding fall under the broad rubric of common sense – too much is simply too much. One has to move swiftly to correct the underlying imbalances, as we do every single day at CorePsych, and then the chicken catchers do work more predictably.
Most often we see: unpredictable, surprise responses to meds => absolutely requires more investigation of the neurotransmitter array, and, in my humble opinion, will be the standard of care with any informed professional in the next 5 yrs – the public is fed up with rolling the dice with ADHD children and adults.
cp
Dr. Parker
My child was diagnosed at 5 with ADHD by here pediatrician. She originally started on adderall and stopped thereafter due to psychotic fits when it wore off. After a couple of tries with that to no avail, we switched to Ritalin. Ritalin worked OK but we always had to watch our time for when it wore off, “Cinderella would turn into a pumpkin”. Our term for uncontrolled behavior, often started off as overly excited and wind up as a huge tantrum. Eventually this pediatrician convinced us to go to focalin as he said Ritalin was being “phased out”. Not sure if that ever happened as I still hear a lot about it. In any case we moved on to Focalin and subsequently Focalin XR. This worked for a while, but eventually became where the long acting Focalin wasn’t lasting but 5 hours. I missed a side note; She has violent outbursts with anything amphetamine based when it wears off, but methylphenidate (Concerta) and dexmethylphenidate (Focalin) seem to have been OK. 3 years ago (She’s 13 now), we decided that the pediatrician was just taking “pot shots” and decided to find a Psychiatrist. The psychiatrist branded her “ADHD with major mood disorder” (precursor to bipolar). She started on depakote, and then abilify and had been on concerta steadily increasing with age. She was diagnosed bipolar due to unpredictable, although frequently after the pills wore off, episodes of anger. She runs out the door screaming, runs around parking lots, and acts psychotically. Until know we assumed bipolar, but are beginning to think her issues may be medication related. She takes 10mg abilify, 1000 mg depakote, and 72 mg of concerta. Melatonin for a number of years but gave it up as it quit working. She is 4’-8” and 65 pounds, and her doctor really doesn’t want anymore meds. Can’t blame her from a toxicology standpoint, but she can’t focus at school and when the meds wear off she is mean, nasty and downright hateful. Mostly aimed at her mother, but she seems lazy, wont get out of bed, doesn’t care how she looks. I have an appointment with her doctor next week but I am at a loss. She’s in therapy, but it doesn’t work. After her episodes she seems sorry, but 15 minutes later will be back at it. Very manipulative. I’m sure I’ve missed some things but would like to get an opinion. Most say she’s just being an adolescent, but I’m thinking not.
Cinder,
Whenever I see these reports, in my office or coming in from Timbuktu, I am determined to chase down the overlooked details that are quite likely creating the instability. If you look at the Services>Neuroscience page on the nav bar there is much info there on IgG, transit time, metabolic challenge etc that often contribute to these kinds of confusing and unpredictable reactions to meds.
I disagree that an untoward reaction to meds = “bipolar” – much more historical evidence needs to be taken into account. These details are covered in the bipolar chapter in my book which, even tho I am selling it, I strongly suggest you review. For 10 bucks it’s a steal, far less than the copay on a med check – and yes we do consults by Skype and phone, just can’t write for meds unless they come to the office here in Va Beach.
Much more info out there, keep digging, if we can help give me a call… we can chat for 15 min to shop me up if you wish, just call Sarah at Services.
cp
Absolutely, Darrius.
With this Disqus software missed this comment, now 4 mo out! Adults need the additional awareness on the blood pressure side and need to use considerable caution, coordinating with other docs if taking meds for BP. It can help with BP, but don’t need that unwanted synergy with other meds. For mild BP problems and ADHD, not on BP meds… perfect.
c[
can adults take intuniv for adhd
I think I’d posted a question or two before on a different page, but here goes:
1) I’m confused about bms and the frequency with which they “should” occur. I’ve read conflicting information from what I judged to be reputable sources. Does it vary for each person? Is once a day healthy? I’ve heard from 3x a week to 3x day…?
2) Why, if a person is eating lots of natural fiber and drinking more than 64 oz of h2o a day would there be difficulties? How can that be remedied? Does even more water need to be consumed to go along with the extra fiber intake? I’d also read many things about not waiting/postponing, but what about that in between part…?
3) Nutritionally speaking, obviously a balance between whole grains, vegetables, fruits, and protein/dairy is needed – with emphasis on the first 3 overall, but protein especially in the am. Aside from the “pyramid” are there other recommendations? Is what the pyramid suggests even the best recommendation? What if your proportions are ok, but you just don’t eat that much?
4) What types of effects can be seen with the efficacy of adhd meds due to these things? (I understand if this question is simply too general! But I don’t know how else to put it).
Thank you
jm,
1) Absolutely does vary from person to person, from metabolic rate to metabolic rate, from breakfast to breakfast from transit time to transit time – that’s exactly the entire point of my book on the challenges with ADHD meds.
2) Measure IgG for the details of the cause of transit time problems.
3) The details on this question fill many books – common sense applies, protein is more important than most appreciate for neurotransmitter balance.
4) Without a balance in the neurotransmitters, the immune system and the hormone system mental health problems are inevitable, and psych meds simply will not work predictably.
cp
Dr. Parker,
A few questions. (maybe quick, maybe not!)
#1. How can a patient know if there are metabolic issues, and if such issues are significant enough to effect medication? Even if they are significant enough to effect the medication, what can be done as far as the meds?
I’ve read quite a bit (including your links and your book on meds) and so many of the symptoms are things we all experience from time to time. I certainly don’t view them as a problem for myself.
#2. My nutrition:
I don’t eat a lot, but I do balance between fruits, veggies, protein, complex carbs, dairy, fiber. Not eating a lot is not new for me; in the past I would often forget to eat until I came down with a headache or was very tired — then I knew I needed to eat (or drink water). I’ve never had any notable food sensitivities. I’ve always been confident that I don’t get all the nutrients I need (since very few of us do!) And once upon a time I did take a multivitamin, but haven’t in a very long time.
In the last 4 months I’ve lost about 15-20 pounds, though that wasn’t a goal and I was towards the higher end of average, but not overweight. That was/is due though (I believe) to lifestyle and dietary changes = drinking a lot more water (now close or sometimes more to the recommended 64 oz) , exercise went from 1-2x/wk to 5+ days/wk; eating breakfast regularly; and eliminating all juice, reducing sugar in foods or the frequency of sweets, eliminating most processed foods, and flour (except for true whole wheat flour). My goal was to be healthier in general.
My question (for #2): Can you recommend a good multivitamin for young women (ages 25-30)? I know Omega 3s are important, can you recommend a good supplement for that? Can you also recommend a good protein powder? (I’ve done some looking, but just don’t know what to choose!)
#3. If a patient switches from one med to another, though still in the same class of stimulants, can much difference be expected? If deciding to switch back to the first one after a trial period of the other, does one need to start again at the low dose?
Is there any credence to drug holidays or need to have nothing (as far as the medicines) in the system for a few days before starting something new? What about the “build up” of stimulants in your system? That never made sense to me because even the long acting ones are in and out, supposedly, within 24 hrs. Can you explain that? Is the talk about build up more for the patient to know really how it affects them rather than an actual build up?
I’m in the beginning stages of this medicine thing and though I’m skeptical about all of it (the label – which is useless, the diagnosis, and the meds), I’ve accepted it on one level and am willing to make the necessary efforts. But I also want to make smart decisions and continue to do everything I can outside of taking meds.
Thanks for your help!
Anon,
1. Metabolic issues are subtle: Look for atypical reactions to low doses as the first obvious marker. The second most frequent: changes in Transit Time.
2. The Multivitamin I rec is here, bioavailable and comprehensive, choose the one that’s right for you. I like this Omega 3, but I drink it as a liquid, it’s a guy thing.
3. Several Protein Powders depending on your taste – they have several here this one is Vanilla, – just search for your flavor.
4. Different stimulants often definitely have different effects as outlined carefully in Rules – the details are there. Stimulant holidays are not recommended – but if metabolic issues prevail with side effects, holidays solve the problem until the metabolic issues are corrected. Meds don’t often ‘build up’ on their own. Building up is another sign of metabolic issues, often with liver metabolism slowing. Keep your eye on the DOE! Longer than expected DOE = metabolic slowing.
Best to you in your next steps, these should keep building your healthy foundation.
cp
Thanks so much for your recommendations. Very helpful!
There was one question you missed, and that was: If deciding to switch back to a previous stimulant after a trial period of a different one in the same class, does one need to start all over again at the low dose?
anon,
Generally speaking: Yes. Even AMP such as Vyvanse and Adderall just can’t be predictable dose per suspected new dose. Best to always start low, but often can go up faster as your ability to discern the DOE improves once you see it clearly.
cp
we have recently started our 5 year old son on intuniv,per doc orders,within that time the doc has cut his vyvanse from 50 to 30mg,and has cut the rispedal completly [1mg in morn and 1 mg at night} been 2 weeks now and as we approached the 3mg dose,we have noticed him developing tics,cant sleep,unable to sit still at all.moves his mouth and tounge.. school has called to ask us about problem,kinda like uncontrolled movements… before the intuniv he took vyvanse 50mg in morn and the resperdal 1mg in morn and 1mg at night and we had a few problems,was not to bad and now we are sereing problems at home and school ? any ideas
Shawn,
Many ideas, but that’s all they are without an abundance of more questions. I have seen, quite paradoxically, an increase in tics with some kids taking Intuniv. I suspect they are secondary to the glutamate elevation, an increase in excitatory neurotransmitters on an already vulnerable metabolic platform.
cp
My 10 year old son has been taking Intuniv for 3 months now. He is on 3 mg. He is in the 7% with the rapid weight gain (from a size 10 pant to a 14 husky) with little height increase. Our concern is will the weight gain level off, or will this be a continuing problem. The Intuniv has been a God-send for us and we don’t want to take him off of it. Also, we have added Concerta back in (18mg) and have been seeing yelling, screaming, mouth noises, aggression and defiance. He also takes .05 mg of Clonodine.
Thanks,
Pam
Pam,
Regrettably that question is a hard one to predict – my guess is that it likely won’t diminish without correcting the parallel neurotransmitter challenges. The more I use neurotransmitter testing the more I rely on it for any child that simply doesn’t come around in a predictable way. As you may recall: Intuniv significantly enhances glutamate neurotransmission, and the Concerta is predominantly dopaminergic. I would carefully review any contributory metabolic problems as therein resides the real answer to your question.
cp
Hello
My son Dylan was diagnosised with ADHD/ODD about 1 year ago. We have been up and down with serveral medications starting with a chewable Ritalin short lasting and moving thru Concerta 18 mg with Ritalin 10 mg given in afternoon to Concerta 27 mg to Focolin XR 1 dose in AM and 1 again at 11:30 am. When we started the Focolin he stopped sleeping. He would be awake for hrs in the middle of the night. They suggested having his tonsils and adnoids removed. That worked a little he now wakes at least 1 time a night sometimes more. We decided to go back to the Concerta I felt it worked best for him and he slept better on it. It works well for him most of the day. He is on 36 mgs given in the morning and he also takes Clonodine 1mg at night. It is almost like a switch goes off in his body at 6:00 pm. He is still very impulsive during the day, but at 6:00 pm it is a different child. He will hit, kick, bite, clean the table off with one swipe of his arm. He is sooo strong my husband, who is a pretty big guy, has a hard time controlling him. We are afraid to hurt him while we are restraining him from hurting himself or someone else. He is so hyper that time of the night I am afraid he will injure his self. So we took him to a child phyciatrist and had him evaluated. He agreed with the diagnosis of ADHD/ODD and wants us to try the Intuniv. He said when we start to give him the concerta in the a.m. and the Intuniv that night, then the next day just the Intuniv at night. He told me the Intuniv takes a good 2 weeks to start to work in his system so we would be dealing with the same behaviors ee delt with before he was ever medicated, which is too horible to discribe. Put it this way he was expelled from his daycare cause he choked a child, that was the icing on the cake that they had been dealing with for like 6 months, so of course I couldn’t blame them. So now I am having anxiety cause I will be alone with him for most of the day. My husband is working 14 hr shifts right now and I don’t have any family support. We do have wraparound services for him so I will have a TSS for 10hrs a week. That will help a little. I have been reading the different posts on this website and I have not seen anyone that has been thrilled with the Intuniv. Some say that it works for a little while and then stops or the side effects are terrible. Now I am worried, do I want to even try it at all. The doc says most of my sons evening issues and sleep issues are caused by the stimulants, which does make sense, but will this med work better? Should I be giving him the Concerta with it until his body adjust to the Intuniv? What if he doesn’t want to go to sleep at night, can I give him the Clonodine? Is it ok to just stop the Clonodine cold turkey? Some people stated that there children were over tired. Is that when they give the med in the a.m. We are supposed to give it in the p.m., but what time in the p.m. is good and how do I find that out? I just have alot of questions now and I will call the doc in the a.m. hopefully I can get an answer I am supposed to start the Intuniv tomorrow night. Can you shed any light on my concerns? Am I just to paranoid? My son is such a sweet little boy but look out when his medicine is not right he can be down right EVIL!!! Help!
Angel,
Sorry to hear about your difficulties, and yes, almost all of these pressing questions need to be run back to your doc, as there are simply too many variables to just give you an arm chair shot over the Internet.
Having said that – remember these general points: People write in here because they are having big problems, and the problems are quite advanced, refractory to the usual medication programs immediately available. CorePsych Blog is an effort on my part to shed a bit of light on even the most challenging cases – saying, in essence, there are many more things you can do if the basics aren’t working. See these CorePsych Blog Intuniv summaries and the recommendations in these comments for more on the subject of similarly challenged kids.
In my office and the offices of the docs I speak with we have had considerable success with Intuniv – but the point you may be aligned correctly with is the fact that more challenged kids often do need a more comprehensive workup. There are many kids out there like yours who do need a deeper, more biomedical view of their condition – more specific evidence.
There are several ideas that do come to mind with your son for further inquiry and thought:
1. Don’t use Clonidine with Intuniv, talk to your doc about his suggested options.
2. AM or PM dosing doesn’t make a difference – either way works best for different folks. We have seen both the AM and PM dose help with sleep.
3. Anytime in the PM, – sometime after supper would be acceptable.
4. You are not just paranoid, it is highly likely that your son has a different problem – Questions to answer: what is his BM frequency, does he have a touchy stomach, is he a picky eater, does he look pale with dark circles under his eyes, did he have GI problems as a baby, did someone say he was ‘lactose intolerant,’ does he have any other medical challenges?
5. The good news: with current laboratory testing there are many more roads to travel, don’t give up the inquiry – his neurotransmitters are significantly off, I would speculate without some of these answers that he is suffering with an immunity of some kind – food would be a good first guess, and going gluten/casein free [see this CorePsych Blog post from 3 years ago] as an experiment might prove of interest.
Best wishes, he is fixable –
cp
my grandson , Elijah, 6 yrs.old is on his second week of the trail period of intuniv…we started on the 2ml today and he fell asleep within hours of taking it plus he is complaining of right leg cramps…he has been on concerta , too much wt loss and not sleeping and heart racing…I read on here where kids keep being sleepy even after two weeks into this drug…does that sideffect inprove??? he seems ok but falling asleep in class with not work when school starts..has anyone else complained of leg cramps??
Teresa,
If sleepy in the second week on the 2 mg I suggest to talk with your doc about dropping the dose back to 1 mg if he continues with the sleepiness.
Not appreciated as it should be, but in my new book on ADHD meds, breakfast is a detail that must be accomplished. If he’s hurrying with Pop-Tarts or just carbs [like waffles] often they contribute to the problems of side effects, and a protein breakfast is the way to go.
cp
I called Elijahs doctor today and we are going to drop his dose back down to one but if it he continues to sleep too much we are going drug free for the summer.we as a family of a very happy little guy cannot stand seeing him struggle on thses adhd drugs…thanks for your input about the carbs…He not a big meat person but I;m going shopping and I have a low carb book…I have him on the pedi- sure drinks for his wt.loss …maybe they are too high in carbs …he has been on ADHD drugs since he was 4 now 6 with no behavior problems and we dont want to keep pushing thses drugs till he gets addicted or agressive…
Teresa,
On the right track girl, take a look at this CorePsych posting if you haven’t seen it – will make breakfast and protein choices easier.
cp
Dr. Parker,
My 12 year old son was diagnosed with ADD 3 years ago and took Vyvanse for 2 years with good results except that he developed tics (or rather they worsened with the medication). We had him reevaluated this school year and was told that he had anxiety not ADD and was put on 10mg of Prozac. The Prozac did nothing for him except make him seem very dull. Needless to say, we had him evaluated a third time and recieved a diagnosis of ADD coupled with a nonverbal learning disability. My doctor wants to take him off of the Prozac (which I totally agree with) and have him take Intuniv. Should I be concerned about getting the Prozac out of his system before he begins Intuniv? Do you think Intuniv is a safe medication? I’m worried about side effects.
Marci,
Totally agree with your doc on Prozac, it’s a ‘managed care Paleolithic drug’ with multiple drug interactions and an emphasis on economy, – and yes, interacts inappropriately with Intuniv through CYP 3A4.
Prozac does take some time to clear, however I wouldn’t concern myself with waiting too long as that particular pipeline [3A4] seems to take longer to accumulate the substrate [like Intuniv]. Four days should cover it, it’s up, of course, to your doc.
cp
My seven and a half year old son, diagnosed with ADD, was on Concerta for about 3 months. It really helped him in school. We were dealing with his lose of appetite, difficulty sleeping and irritability but immediately stopped when he developed a tic. He is now on Intuniv (2mg) and he is quite tired and constipated. I don’t see the same positive results as I did with Concerta and am thinking of stopping. He is 66 pounds and am wondering if I should go to 3mg but am nervous the side effects will worsen. His doctor says I should try it but does not tell me what most 66 pound children are on and see results.
Lisa,
Not to worry about weight -do stay focused on side effects. Most important for this presentation, if I am reading between the lines correctly: Breakfast! Protein Breakfast! Constipation could be resolved by more fiber [please don’t tell my you are doing only pancakes or pop tarts!] – the carbs can slow him down, Intuniv usually does not create GI issues.
cp
Dr. Parker,
I have a 9 year old daughter who has been diagnosised with ADHD, PDD, and eplipsey. We have tried Prozac, Abilify, Lamictal, trileptal and Risperdal. Her behaviors, attentiveness, etc was the best on Risperdone. However, her body didn’t like it. It spiked her LFT’s and her glucose levels. Currently she takes Clonidine for sleep (doesn’t really work as she doesn’t sleep through the night). She’s averaging 2-3 years behind. We have finally gotten her into a great school that is desgined for PDD /ASD students. She’s doing better, but we are considering medications. What suggestions might you have for medications. We are looking into Intuniv, but we are concerned about any medication for ADHD and possible seizures. Our Neurologist suggested the Intuniv or Depakote. I am a nurse and know about the Black Box on Depakote and the concerns for puberty and increased depression.
Any input would be helpful.
Thank you,
Jennifer Clarke
Jennifer,
Intuniv could be considered by your medical team, but the complicated presentations like your girl’s just need a more complete neuroscience workup for improved evidence.
cp
Dr. Parker,
I came across your website while researching Prozac and Intuniv. My 12 year old son, who has Asperger’s, ADHD and Anxiety Disorder, is currenlty taking both medications. We have tried Ritalin, Focalin XR, Strattera, Risperdal, Zoloft and other supplements like Melatonin and 5-HTP over the past 5 years with limited (and sometimes no) success. My son seems to be very sensitive to medicine and has side effects with relatively small doses. He is currently on 3 mg of Intuniv and has been bumped up over the last week to 20 mg of Prozac. When he was first put on Intuniv, I read your information about how Prozac should not be used with it and mentioned it to my doctor. At the time, he was on only on 2 ML per day (liquid dose) and I was told that it was such a small dose that I didn’t need to worry about the interaction with the Intuniv. Well, now that his Prozac has been increased, He is horribly constipated, but has also had a couple of bouts of diarrhea and vomiting. His stomach hurts a lot. He’s been falling asleep in the afternoons sometimes. He’s also complained of numbness in his legs. The Intuniv has not helped with sleeping, as he still wakes up in the middle of the night, almost every night. He has not had gastro problems before this, even though I know it’s common with kids on the spectrum. I guess my question to you would be, do you think this is caused by the Intuniv, the Prozac, or a combination of both? I think it’s time to wean him off the Prozac and I’ll be going to his doctor on Thursday to discuss this. I don’t think the side effects for him are worth it and it doesn’t seem to be helping him right now anyway. Any additional insights are appreciated! Thank you!
Candi
Candi,
Gastro problems need to be assessed with IgG testing, food allergy review [LabCorp # 680230 – 96 Food sensitivity]. Prozac and Intuniv = more sedation secondary to the Intuniv going out the top of the window. I just don’t like Prozac for many drug interaction reasons, not just 3A4 but 2D6 and others – people use it because it’s approved for children, – this is when I decidedly don’t follow FDA approval, and disagree with those findings which did not control for drug interactions.
cp
Dr. Parker,
Thank you! I will look into the IgG testing. I am currently weaning him off the Prozac. Last night was rough-vomiting and diarrhea mixed with bouts of constipation. It sounds weird to have those together but it’s true. He spent 2 hours in the bathroom, struggling to go but when he did, it was watery diarrhea. He feels awful. I will be glad when this is out of his system. Thanks again for your help.
Candi
Candi,
Tough to be sick like this – just saw a TBI person with many ways to deny multiple immune dysregulations, and then on the way home talked to a guy in CA who was completely well on all supplements and meds for months, but fell apart with stress, now has watery diarrhea multiple times a day – and wonders why he is depressed??? Go figure. Really looking forward to see his results on the IgG out there.
cp
Candi,
I was shocked when I read your message..our sons sound identical. We were using stimulant meds for his ADD but he developed a throat clearing tic and kids were giving him a hard time about it. So over summer break we are trying Intuniv. We tried it once before and when we bumped up to 2mg, he was falling asleep in class. Dr said this should pass as his body gets used to it. I pray this will work. My son takes Zoloft for his anxiety/depression. He has been taking this for several years and it does help with his depression and his worry. It was nice to read your message and know there are other families going thru the same thing.
Pam
Thanks Pam,
It helps me too to be reminded we are not the only ones…we are currently weaning him off the Intuniv and have a few more days left. He is still having major problems with constipation and we’ve had to give him magnesium citrate twice now to help clean him out. Other laxatives have not helped. The nurse practioner told me it’s the same type of thing they give patients before a colonoscopy. So you can imagine how miserable he’s been. I will be glad once he’s off the Intuniv and his system gets back to normal. I hope you have better luck with it than we did. We were also told the side effects would pass as his body adjusted to the medicine but he started taking it in March and things never got better, just worse as we upped the dose. I’m still hoping someday to find the right medicine for him.
Candi
Candi and Pam,
– Seen the constipation more regularly with the primary immune dysfunction, less frequently with [secondary to] Intuniv itself. If puzzled by the response to Intuniv watch carefully for ongoing delay in transit time, as well as other immune challenges down the line, over time.
cp
Dr. Parker,
Thank you fror your response. I’ve never heard of primary immune dysfunction-are there other symptoms to look for? Other than occasional constipation (not regular at all), he’s never had GI problems, although I know a lot of spectrum kids do. Can these develop later in life? Is there anything else I should be watching for?
Thanks,
Candi
Candi,
Deep books are written on this, but suffice it to say the bowel, being the largest organ involved with immune dysfunction is the first inquiry. Lungs, upper respiratory and the respiratory tree are next, and the skin is the third. There are many other signs such as plain old exhaustion – but that discussion is far more than a few notes our here on the Internet. Take a look at this book if interested further: UltraLongevity by Mark Liponis.
cp
My son, 9, was diagnosed with Aspergers and ADHD 3 years ago. As he has grown, we have had to try different medications. For the ADHD, he wears the Daytrana patch (30 mg). For the behavior and other problems, he was taking Risperdol, then Abilify, and about a month ago switched to Intuniv (3 mg). Any oral medication that he has taken will last less than half as long as it is supposed to last. i.e. The Ritalin (long lasting – LA?) would last at most 4-6 hours.
The Intuniv was prescribed to be given at night before bed due to possible drowsiness. It worked great for about a week once it finally kicked in. Then it would seem great until about 1pm every day. At that time he would jerk and wiggle uncontrollably. Today was the first day he switched to taking the pill in the morning. His teacher sent me a note saying the wiggles are still there.
I think he either needs to increase the dosage and/or split it into 2 doses so it will stay in his system longer.
Any suggestions? After reading your blog, I think the burn rate may be a huge factor.
Thank you,
Sheila
Sheila,
With only this paucity of info I believe you are exactly correct. Your guy is significantly metabolically challenged and demonstrating atypical responses to meds with the on and off improvements. These variations are often see with the phenomenon of a Narrow Therapeutic Window, and are always metabolically driven, – even if born from genetics to metabolic. One possible exception: dosing may simply be too low on the Ritalin LA, as going up may significantly correct the DOE.
Not likely to be much help monkeying with the dosage and DOE, as with metabolic challenges you can monkey for years until the underlying metabolic challenge is addressed specifically and corrected. Do take a look at this Neuroscience page for more specific info.
cp
Dr. Parker,
I looked through the information you suggested, and I still have a few questions.
Is Intuniv also vulnerable to the rate changes of transit time or is it similar to Vyvanse?
How can I work with my doctor to find his DOE and metabolic rate?
My son is about 52 inches tall and weighs 53 pounds. As you can see, he’s a skinny thing. He is currently on 3 mg of Intuniv as a morning dosage. Have you seen Intuniv given in 2 doses (i.e. 2 mg in the am and 2 mg in the pm) or something similar to that? I will be speaking with the doctor later this week to give him an update on the changes with the morning dose.
I really appreciate your feedback. You are helping me cope with this adjustment phase and helping me look for signs I wouldn’t have looked for previously.
Sheila
Sheila,
Rate changes and transit time always effect drug metabolism… sometimes seen on the front end, – often seen after some time on the meds and with a refractory response to intervention strategies. Intuniv DOE is not easily seen – the only criteria is simply: is it working or not?
I don’t use Intuniv in 2 doses, or find it necessary – and likely would find that over time [even if you tried it at two times/day] – it would work correctly a few weeks after starting. I have seen the PM dose work better for some if they go out the top of the window with a soporific reaction during the day.
cp
Hope this helps
Dr,
My son is 11, dx with ODD & Asp. He is taking Intuniv (2mg) and having low blood pressure issues. Should we be concerned? His blood pressure is 74 over 43, with a heart rate of 50.
Thank you,
Trina
Trina,
The Intuniv package insert clearly recommends against staying with Intuniv if significant blood pressure problems arise.
As you likely know, using stimulants can prove even more beneficial clinically, but most likely won’t have hypotension associated.
Further, as this presentation is not common, I would make sure you follow up with 2 other interventions:
1. First: a medical work up with your pediatrician or pediatric cardiologist.
2. A review of neurotransmitters if this first recommendation proves inconsequential.
cp
Chuck,
For those with BP issues, using Licorice Root (I like Natures Way version) is great way to normalize it. It HAS to be the glycerized version. You have to work up gradually to get the dose right. Gee, that sounds like Window of Effectiveness!
Pat
Pat [at PatSullivan.com],
Thanks so much! No experience with Licorice Root, but will definitely chase down the info – have plenty of folks looking for a less complicated way to deal with the BP issues.
Do you have Licorice Root up on your website at Jigsaw Health?
cp
Dr. Parker,
My son has been diagnosed with ADHD, OCD, ODD, Asperger’s and Turret’s. He is currebntly on Concerta XR and at night Zoloft (Sertilian 50 mg’s). His Dr’s. want to start him on Intunive and slowly ween him off of the concerta. I read in your blog that once on Intunive any night med’s should not be requiered as it is a 24 hr. acting med. Is that correct? I also understand that many medication’s can have side effects. I have looked at the diferent side effects and don’t like every thing that I have read. I relize that just because it say’s that it can have certain side efect’s doesn’t always mean that one may have them, however one that I haven’t been able to get any info on is how will intunive effect my 7 year olds physical development? He obviously hasn’t hit puberty yet and I am curiouse as to how it will either slow it down /speed it up? This is important in my husband’s and my desision as to wheather we should make this change. If there is no danger to that area of his development there is a greater chance that we may be able to change him over. Please share with me any info you might have, or send me to a site where I might be able to find out. Thank you
Christie –
1. Not necessary to go off the Concerta to try Intuniv if some improvement has occurred with Concerta.
2. Intuniv can help with sleep, doesn’t always, and, as you can see, some have used it more successfully at night due to the sedation that may occur.
3. Side effects more rare than common – with any med you best bet is informed usage, and simply to watch. Incidence of hypotension very low compared to placebo.
4. Won’t slow down development.
5. My own take with his significant complexity: He needs full IgG workup as we so often see challenges with developmentally challenged kids like this. Mentioned elsewhere [don’t have the # with me at this moment: the LabCorp or the NeuroScience testing for IgG food sensitivities]
6. With complexity be patient, as the meds prove more unpredictable than predictable.
cp
Hello Dr. Parker
I am very nervous about starting my son, 11-yr old on Intuniv. He was diagnosed with ADHD 5 yrs ago. He has underlying anxiety and PDD/AS traits-not officially diagnosed, I’ve had this brought to my attention. He’s a wonderful boy, but his nervousness and social anxiety is hurting him at school and we’ve delt with some pretty severe bullying in the past.
Concerta has been our one and only med for the entire time. We’ve been at 36mg for the majority of the time, with success overall in attention and focus, but the comments from school continue to be related to his anxiety and social struggles. He see’s the social worker, who is just wonderful. I’ve noted a decrease in his attention in the past 4-6 months-his weight is right around 70 lbs and he is 4ft-ish in height.
I did go to a child psychiatrist recently, and she was more concerned with the AS side-she did not meet him, but our overall discussion/description pointed to this-which I”ve heard before. She would like to meet him and consider starting him on a high dose of Prozac-which she tells me is the treatment of choice for AS and keep him on the Concerta 36mg. I went to my Ped about this and told him I’m not comfortable with this and this is when Intuniv came into play.
Can you give me insight into the Prozac/Concerta combo and the Intuniv/Concerta combo-apparently, we would continue the Concerta with both, until he adjusted. Prozac flat out scares me.
Thank you for allowing parents this place for questions-I’m sure you understand our apprehension and great care in medicating our kids.
V
Veronica,
As you will see from even a casual reading of these posts I am clearly not a fan of Prozac, – and the idea that it is the antidepressant treatment of choice of AS is your psychiatrists personal view, is not in the literature, and if it is, someone was not paying attention to the multiple drug interaction details. I do disagree with that opinion for the many reasons stated here at CorePsych Blog.
One quick observation and a brief story: Concerta blocks 2D6, so a person can become toxic on the interaction there, in that MPH will cause the Prozac to build up with possible disastrous results – including even suicidal regressions. [Prozac is a 2D6 substrate, and is lipophilically stored in the brain, and actually interferes with its own metabolism, as it blocks 2D6!] Many years ago co-wrote an article for Primary Psychiatry with my son, a medical student at the time, on these matters, but they didn’t get the fact that I was a doc!
See the comment on 1-1-09 post on interactions for this story: Girl from Scotland quite psychotic in behavior, toxic on Prozac and Concerta – with SPECT images to confirm significant toxicity as well. Not recommended, especially with AS.
Intuniv has no interaction with Concerta, and a recent affirmative study is out regarding that combination, – but I can’t dig it up on the Internet at this moment.
cp
Dr. Parker,
If you do come across that no-interaction study confirming concerta and Intuniv I would appreciate a copy of the link to this study. My daughter just began Intuniv to supplement the 27mg/daily dose of Concerta for ADHD diagnosis. Thanks very much!
Mike G
mjbeanie@comcast.net
Intuniv has no interaction with Concerta, and a recent affirmative study is out regarding that combination, – but I can’t dig it up on the Internet at this moment.
cp
Mike,
Sorry, don’t have the time this AM to chase that down, but would refer you to this book if you want the details.
cp
Dr. Parker,
My son is 14 and was dx at age 7 with ADHD Inattentive type. He has very slow processing speed (visual) as well. He seems much like a very intelligent Sluggish Cognitive Tempo type, but he has a superior auditory working memory. He first tried ritalin at 7 and increasingly became more depressed and flat affect over several weeks. We tried again in 7th grade with Concerta and Adderall XR but he complained after a couple of months of “feeling like he has got to move.” Was on Straterra for a year without side effects but not helping with attention and executive issues. He is now on Intuniv 3 mg and loves that he is not daydreaming for the first time in his life, but he is way too sleepy in class. He has tried caffeinated drinks and energy drinks and taking the medicine at night. Nothing has helped with the extreme sleepiness. He has tried focalin regular release, and says that even at 2.5 mg he feels racy. If he takes 5 mg of focalin, his responses become delayed with extremely flat affect (almost staring into space–scary.) He has had EEGs that noted some abnormal frontal lobe spikes, but the report stated it was nothing. Could the stimulants be causing him to have subclinical seizure activity? Are some more prone to cause this than others?
Mandy,
Some general remarks, not trying to diagnose from a distance, just pointing out several likely challenges:
1. Of course it is most reasonable to suspect any comorbid neurological disorder because he is reacting so ‘biologically,’ not psychologically. A consult with a neurologist would be useful.
2. I would expect that review, however, to prove negative, and if it does, the next step involves assessment for his very narrow Therapeutic Window. More specifics on the Narrow Therapeutic Window at this CorePsych Blog Post.
3. My very distant guess is that he has an underlying metabolic problem. I would expect a history of bowel problems from childhood, gas, touchy stomach, picky eater, constipation or diarrhea – and barring any of those would look for dark circles, exhaustion, pale skin and general lassitude – any of these can forewarn of underlying immune system issues in the gut. Extreme sleepiness could be a side effect of the Intuniv, but could very well be amplified background noise from a pre-existing condition.
4. Immune system issues slow down metabolic turn over, and narrow that window – so that a tiny bit is too little and a tiny bit more is just too much.
5. Seizure activity is possible, but very remote. More likely in the range of some of these items I am sending out here, – but this note should not obviate a complete workup for any suspected neurological impairment.
cp
Well, right on!! He has terrible immune system problems, and had his first ear infection within days of birth! Takes 4 different allergy desensitization injections. He also has difficulties with constipation. Luckily, he is a good eater though. Thanks so much. I will look more into the Narrow Therapeutic Window blog.
Mandy,
Great to hear we are getting your guy closer to dead reckoning – on the mark. Drop an offline note if we can get the testing out for you.
cp
Hi,
My name is Heather Jones and I am the assistant editor of Epsychologist.org. I am contacting you today in hopes of developing a relationship with your website; we have seen your site and think your content is great. Epsychologist.org offer a free informational resource to both the general and professional public on several issues.
I hope you show some interest in building relationship, please contact me at heather.epsychologist.org@gmail.com.
Heather,
Did drop you a note off line, look forward to seeing your team’s perspective.
cp
Just let me know when the book is ready to go, and I’ll help spread the word.
Checked out that page- which links would you suggest? I see many……
Thanx,
Terry
Terry,
Best to start from the top with the synapse, then go to the basic info “Start with this introductory webinar” and then the Cass presentation under Metametrix. What I find so interesting, having done many of these, is using the neurotransmitter testing with the meds already in place – significant improvements accrue with that new real evidence… pd for by most insurance!
And thanks so much for the book offer – will be setting up affiliates if you find it useful.
cp
Thanks, Chuck.
Couldn’t get thru the long webinar, but did watch the Cass presentation. And of course, have read a lot of your material over the past year or so.
Question: if I were to have my daughter tested and the recommendations were to make changes in diet, how does one do that successfully with young people like her, who are incredibly fussy eaters? She won’t even drink water. No joke.
Would love to be an affiliate when you’re up and running.
Terry
Terry,
Therein, as the Bard said, lies the rub. There are several good books out there on the slow conversion of picky eaters, finding the taste they like but replacing it with parallel healthy things. With the Neuroscience interventions they have several targeted amino acid products that are delivered in a liposomal delivery systems to obviate irritation of the stomach, and bypass the bowel. A few well placed sprays can change the attitude and correct underlying neurotransmitter imbalances… sounds like snake oil, but I can tell you it actually works. The liposomal product [e.g. EndoTrex] makes delivery right from the buccal mucosa thru the blood brain barrier… and home to the holographic brain.
Not to worry if you review the holographic YouTube link… just the point that if perceptions are neurochemical, we can tip- toe-in with some safe, natural interventions. It’s all good.
cp
Hi Dr. Parker,
Our 8 year old son has been on 2 mg of Intuniv for 4 weeks for ADD. We have no behavioral issues. His teacher has noticed some improvement in attention and social choices. We started him on it in the mornings and he seemed to have insomnia so he’s taking it at bed time. He’s been wetting the bed for a week now, and it’s really impacting his self-esteem. Can you suggest a dosing regime to help us work through the insomnia and the bed wetting?
He’s on other meds – 15 mg Prevacid twice a day, 10 mg Focalin, Flovent, Albuterol as needed, and frequent antibiotics. He has almost constant sinus infections and multiple learning disabilities. I’ve read about neurotransmitter testing and read many of the links off your page. I’m struggling with what our next steps should be and if neurotransmitters could be impacting his health and his learning issues. Any insight you can offer over the internet?
Thanks
Kari
Kari,
I seriously doubt that the bed wetting lives only downstream from the Intuniv. Rather, I do expect he has an immune condition that is significantly contributing [guessing from the Flovent, Albuterol, and Prevacid with respiratory and GERD likely] If you look at these Prevacid side effects [quite numerous] – you will see insomnia there. My strong recommendation is that you consider the shift from treating symptoms to digging into the food sensitivity issues likely behind the many other symptoms here.
Bed wetting, tic disorder and a variety of symptoms often attributed to the ADHD meds [stimulant or otherwise] are often associated with comorbid immune dysregulations, and/or side effects of a combo of meds, as in his case treating the tips of immunity spawned icebergs.
I seriously doubt that the Intuniv is the problem, therefore am unable to throw out a guess that will likely prove inadequate for the underlying issues… that, by the way, are very easily corrected once measured.
cp
Thanks, Dr. Parker.
Our son has a hiatal hernia and has been on Prevacid for 7+ years. Intuniv was the most recent medication added and lists bed wetting as a side effect, which is why we wondered if the newly developed bed wetting could be attributed to that new medication or the new combination of meds.
We’ve wondered about an immune problem given frequent illnesses, and found Dr. Kellerman’s webinar quite interesting. We may be in touch for a consultation.
Thanks again,
Kari
Kari,
I look at side effects as having multiple causes – yes the med may be involved, but I always think more deeply and seek evidence beyond symptoms alone. For example: just saw a very interesting guy yesterday with severe IBS most of his adult life. He is under stress, out of the Navy, and completely refractory to any psych meds in spite of chronic depression and ADHD. He has significant sexual problems with every SSRI.
I am sure we will find out that the adrenal fatigue, and hormone balance will show much lower titers of testosterone, and the SSRIs are only pushing him off the diving board that he finds himself chronically perched upon. Yes the SSRI is causal, but the background noise on the hormone dysregulation is the underlying culprit, and the IBS is the actual problem, the SSRI is the only problem easily visible.
I look forward to a possible chat.
cp
Hi,
I just got some samples of intuniv for my six year old daughter. I started her on the first week of 1mg and moved her to the 2mg on the second week. I have seen an improvement but now she is wetting the bed. Two nights in a row now she has wet the bed and she has never done this before. I dont kow what to do about it. I give her the medicine at night time. Both nights of the 2mg pills is when she has wet the bed. There was no problem of this with the 1mg.
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Chuck,
Can’t wait for your book to finally land! Congrats on finishing it.
“Kiddo” is up to 3mg Intuniv. No positive (or negative) results seen yet. Will keep you posted.
Terry
http://www.MomsWithADD.com
Author, Survival Tips for Women with AD/HD
Terry,
Thanks on the book, – now have to get it converted [pdf] and out there! On your ‘kiddo’ – complexity often means more than a silver bullet fix. Multiple intervention strategies become necessary to address the many subterranean issues. I know I’m preaching to the choir here, – just trying to add a constructive reframe!
cp
Chuck, are you self-publishing? I can hook you up with Specialty Press (Dr. Harvey Parker), if you’re interested.
Re: my kiddo- oh, I know. It’s not all about meds. But this has been a work in progress for 22 yrs. Looking now to consult with a brain injury specialist re: behaviors. Current therpist is wonderful but not when it comes to parenting tips. But she sure can untangle her inner world and help her to make sense of the outer world, too. A real complex situation, this kid!
Terry,
Yes, will self-pub the book as an eBook – available off the CorePsych site, with the expectation of a hard launch later once the readers catch on that it does have merit. Will chase down Dr Parker over at Specialty – tnx.
Do take a look at the excellent webinars on this page – just loaded a few more that will give you more options down the road with your girl.
cp