Intuniv For ADHD: Dosing Details

Hi I am new here.  How do you wean a child off of intuniv if they are only on 1 mg?

Thanks

Maria

Dr. Parker, thanks for the great review on intuniv. I have a question about using strattera and intuniv together. I have been on strattera for 4 months and it changed my life; however, over the last few weeks, it has been messing with my memory and I would feel extremely fatigued after the strattera wore off, thus, I stopped taking strattera and was put on 2 mg of Intuniv instead. The positive effects of intuniv are subtle, but I noticed that my memory has improved while on it; however, I felt that when strattera was effective (before the side effects of poor memory recall and fatigue), it addressed my ADHD symptoms more effectively. I am thinking about asking my doctor to put me back on the strattera along with intuniv; however, I wanted to know if you think the strattera + intuniv combo would be beneficial. I know that strattera works by flooding the synaptic cleft with NE to down-regulate NE receptors producing anxiolytic effects + addressing ADHD symptoms, while intuniv works by acting as an alpha-2 agonist to decrease NE release. Moreover, strattera also increases the amount of dopamine in the pre-frontal cortex, and this is the main reason why I am interested in trying the strattera again along with intuniv to get that mild dopamine effect without using a stimulant. I would greatly appreciate it if you can provide me with more info on how these two drugs could perhaps interact synergistically.

Thanks, Jake

Hi, Doctor Parker. I started Deplin on Monday and I am noticing a weird taste in my mouth. It feels like I just ate a pepper. It lasts all day and night, basically stays in my mouth even when I try mouth wash and other things. I can't really find any information on side effects. Is this normal and will it go away?

Jen, There are, regrettably no absolute rules in the adjustment of meds - even tho in my book I suggest we should be following at least some 'Basic Rules!' Having said that: Blood pressure issues encourage the conclusion that she has a metabolic background noise anyway, even tho it's a side effect and not primary. That biomedical slowing, that likely dysregulation of excitatory neurotransmitters, specifically [most often] norepinephrine, often occurs downstream from immune dysregulations - see IgG in the Search Box here... many refs there. Without being there these are some ideas to discuss with your doc: 1. Adjust the Vyvanse to get the 10--12 hr DOE as described elsewhere here. 2. Intuniv, yes, should sharpen but isn't obviously, but seems to help would leave it unless further problems arise. If you continue to find you are chasing vapors it would be best to get some data from IgG and Neurotransmitter testing - details matter, and we can do that long distance wherever you are out of our office. cp

  Hi Dr. Parker, My daughter is 11 with adhd, she is a great kid, with a very outgoing personality and very athletic. She has been on  Adderall and we changed her to Strattera due to weight loss and anger issues. On the Strattera she has done well until she started her period and became moody with it, it was not helping her much in school. Her DR. recommended we try the Intuniv versus topping her out to the 60mg of the Strattera. I decided to try and take her off of everyhting for a month and see how she did. Attitude wise, great. School wise she has begun to fail completely. My concerns with the not overheating as she is so active and runs track. What can you tell me about these side effects and your advice on it.Intuniv is of course the side effects. The low blood pressure and fainting is a major concern for me and also

Jane, Absolutely could be - we've seen this reaction often in folks with immune system challenges - download the "Transit Time" pdf by searching here - Glutamate increases from allergies, especially milk, eggs and wheat, can throw them into a rage. cp

I just caught your other note, and edited your first comment to include that he is on 4mg, so the next steps are as described. cp

Braft, First make sure you are at the best dose of Intuniv, if you have room to increase do so, if at 4mg, then the next best thing without insurance is simple adderall IR but he will have to go to the school nurse at noon, no biggie. If he is too sensitive for that look into the generic ritalin time releases. cp

KES, Look forward to seeing you - the answers will be in the data... most often the tests that have already been run don't cover the chronic subterranean factors that we test for. Talk soon! cp

Dr. Parker, My 9 year old son was diagnosed with Tics about two years ago and ADD this year by his pediatrician. His tics became extremely bad this past summer and after doing much reading on-line I asked that we try Intuniv since there is some indication that it might help with tics. We worked our way up to 3 mg but weaned him back off since it did not help his tics at all and 3 mg seemed to make him "sedated". It did seem to really help with ADD and mood swings! About a month ago...his temper, irritability and rages were really starting to effect our family. So I asked our Doc if we could try Intuniv again, but this time we were looking to treat his ADD not the tics. We are up to 2mg and that's were we've stopped since we know 3 mg made him too sedated. We have seen some improvement in his mood but now we are having sleep issues at night. He wakes up every night around 10:30/11 pm and has trouble falling asleep again and when he does he is constantly flopping around in bed and does not seem to fall into a "deep" sleep? The first time we tried Intuniv we gave it to him at night after dinner, but he was very sleepy during the day. This time we are giving it in the morning and he does not seem as sleepy during the day but now his teacher is reporting that he gets a little sleepy at school? I really think this might be because he does not get enough "quality" sleep at night? Do you have any suggestions as far as night/morning dosing or what might help with sleep at night? And do you know of any Docs in the Dallas area that might be able to help us sort this out? Or maybe we should schedule a phone consult with you? I would appreciate any suggestions!   Thanks, Gerald

Karl, My quick take: when you talk to your doc drop back, not up. Let Intuniv sit a bit longer before going up and take a more conservative dosage adjustment strategy as your guy sounds a bit like a "slow burner" [Type that into SEARCH for more info] cp

Laura, Sorry completely inappropriate for me to suggest specific changes on the Internet - especially with folks I haven't seen... the troops would soon be at my door and leave with my license in their hands. Won't go there on the Intuniv. On the other hand your guy has very typical findings of metabolic imbalance and it would be completely reasonable for you to consult with me long distance on the measurement of those imbalances. Type in "IgG" in my SEARCH here, read my digital *Rules* book [only 10$] and begin to look more carefully at things immune. Just doing an elimination diet doesn't fix the problem if you miss a single detail. You need all 4 wheels for the car to move down the road! cp

Heather, I can tell you much more on a long distance consult... we do them all the time. Do read my book - for 10$ it's filled with information you should absolutely have for next steps. If you don't call I can tell you with considerable certainty more if you SEARCH here for "moving therapeutic window" and "narrow therapeutic window" - with this Disqus I haven't figured out how to put the links in .... so you will have to check them out. He will be found in those comments. cp

Dr. Parker, My 6 year old, 40 lb. son is on Intuniv.  He is ADHD and moderately autistic.  We just refilled his 3mg prescription of Intuniv and he's really wired.  He was finally at normal kid energy on the last prescription.  Do you think that he needs 4mg?  I often wonder if the amount of medicine slightly varies from pill to pill or batch to batch.  The last batch was wonderful!  He was enjoyable and of course, did have his moments but it was like we got our son "back" from this condition.  He did seem a little more soporific but not terribly.  He'd take a nap and would be fine after he woke up. I or my wife will call our pediatrician tomorrow (today is Sunday) but I wonder if 4mg would be the right dosage for him. Thank you, Karl G.

Dr. Parker, I am new to your blog and want to thank you for the great information! My son is 5 1/2 yo who was given an official diagnosis of ADHD with sensory integration disorder and fine motor delay by Kennedy Krieger Institute in May. Prior to the official diagnosis we tried Concertante for a few weeks and had the angry psychotic a/e's. So then we tried Focalin for a few days but it made him a zombie. We took a break fro and decided to focus on diet we tried the cassein washout....no change. We have been dye free and HFCS free since March, along with organic meat, milk and produce. Still, no big changes in hyperactivity. So, when Intuniv received it's official indication we consulted with our pediatrician and began therapy at 1mg in May. It took the edge off his impulsive behaviors but the awful drowsiness and nighttime sleeplessness has never gone away. We tried 2nd but the daytime sleepiness was worse. We dosed it in the a.m, up until this past weekend we changed to the p.m. He just started kindergarten and has a wonderful teacher who says that he isn't focusing, agitated and still extremely sleepy all day long. We are seeing our first psychiatrist on Thursday afternoon so I am hopeful that we can start on a new soltution. In the meantime, is it o.k. To cold turkey the 1mg of Intuniv?

Dr. Parker, Thanks for all the info, I've been reading through all these posts.  Where can I find someone who will try some of these things in Minnesota?  My 10yo son has Tourette's, ocd, generalized anxiety, and Adhd - though bordline on the attention, he is definately hyperactive and impulsive.  We started chlonidine 2.5 years ago to help with tics and were amazed when his teacher reported less impulsivity in class.  Unfortunately it made him so sleepy that we couldn't increase the dosage as necessary, so it eventually became less effective for that, but still helped with tics.  Last year our son asked his doc if there was something else he could take to help with school as he was always "being bad".  We started him on Strattera and seemed to help at first, then he became paranoid when we increased, cried all the time and said he was scared.  We reduced it back down and continued 1 month at the lowest dose, the crying stopped, but defiant incidences at school increased 400%!  Off it he went.  He also had started having an issue when he became worried about something and suddenly couldn't talk.  This started before Straterra, continued while on it and got so bad after it, that he was spending 1 hour in the pm and am unable to talk because he was worried about school.  Dr told us it was anxiety problem called selective mutism, with atypical presentation, as it was happening in anticipation of something.  He started taking Celexa, and the episodes completely disappeared.  Still was having trouble in school, so we tried Concerta, again seemed to help at first, cranky in the evening, and AM was near impossible, as he was so hyper.  Then one day he forgot to take it, school called and I had to pick him up, they said he was literally climbing the walls, running around and hiding.  He jumped out of the car when we got home and starting running down the street.  Off it he went.  Dr started him on Tenex, he currently takes 1 mg AM 1 mg 5:30pm.  Two months now and much better results.  We are trying Intuniv tomorrow, but I'm worried about switching. My son has been tested for allergies and food sensitivity, I don't know if it is the kind you are talking about, but they took blood and sent it away, it was called "delayed sensitivity" I think.  He was not found to be sensitive to anything they tested.  But he does have allergies.  What is this histamine level thing you keep talking about?  Could his allergies be a reason these medications haven't been working? We planned on starting the Intuniv in the AM, is this the best time? Thanks for your help. Heather

Dr.Parker, First...thank you so much for this blog!  It is beyond helpful and informative.  Quick question regarding how soon is too soon to assess that Intuniv might not be the right drug.  My 9 year old just started Intuniv 5 days ago for ADHD-Combined Inattentive/Hyperactive.  He was on Daytrana for 2 years successfully till anxiety and tics made us stop. He gained 7 pounds and 1 1/2" in height in the 3 months off Daytrana and we are thrilled.  We have been on Intuniv for 5 days with dosing at 1/2 milligram (days 1-2) and 1 milligram (days 3-4).  We have already seen an increase in hyperactivity, tics, and he has tingling under his fingernails.  He's had no sleep issues, tiredness, or dizziness.  I just want to get your take on my assumption that maybe his glutamate levels were already normal/high and this just isn't the right drug for him.  OR...do I wait it out to see the drug reach it's full potential and how long do I give it to make a correct assessment?  Any input would be greatly appreciated.

g, If no BP problems tenex would be a good choice, the half life is only about 6-8 hr, so you might need to take it AM and Noon, starting with your NP approval of course at .5 2x/day. Ensure is a protein drink with significant protein, try that for breakfast. Get more serious about absolutely staying off of milk and wheat, and if that doesn't do it try off eggs - the Trifecta in allergens. Hang in there, cp

Kev, Those two are completely kosher together, excellent choice, just commented elsewhere on the blog on a similar question. With Downs or *any* developmental delay issues I always find, yes always find, improvement, no cure asserted, with neurotransmitter testing to balance those biomedical challenges. See the Testing Options page, your psych would probably like that info, tho likely would be suspicious as we all are of things we don't know. cp cp

Dear Dr. Parker, Please forgive me dumping my life story here but I have nowhere else to turn.  I'm on SSDI with Medicare, and I'm sure you know that they don't cover anything unless you're hit by a bus.  My primary care is a nurse practitioner at a low income clinic, and she has no idea about meds.  I get to see a psychiatrist once a year for med reviews, and that's it.  I can't afford to do any fancy testing, although I'm sure I probably need it.  I have a fairly complicated medical profile, hopefully you can make some sense out of it. My current diagnosis is Bipolar Depression (slow cycling), Generalized Anxiety Disorder, ADD, Chronic Fatigue Syndrome, Fibromyalgia, Delayed Sleep Phase Disorder and Migraines.  I'm 46 years old, height/weight proportionate - but I have to work on it. In the morning I take Zoloft 100mg, 250mg Depakote and 30mg Buspar. At night I take Zoloft 100mg, 250mg Depakote, and 1.5mg Lunesta Right now, my ADD is completely untreated, and my disorganization is making my anxiety really bad, which then triggers migraines.  I am highly distractable, irritable, and prone to wanting to kill people /jk.  Trying to stay on track all day is exhausting, and then I go into CFS mode.  I'm pretty sure I have no adrenals left at all.  I'm a train wreck!  Another big problem for me, is that I have NO appetite, ever.  I have to force myself to eat when my blood sugar gets low.  Just the idea of eating in the morning is enough to make me feel nauseated.  I have always hated breakfast, even as a child.  It usually takes me several hours to work myself up to wanting to eat anything at all.  I eat as little dairy and wheat as possible, and try to focus on lean protein, fresh fruits and veggies.  I don't eat packaged junk foods at all, and I try to get some moderate exercise like walking the dogs or gardening. I can't take stimulants because I have a transient heart murmur, anxiety, and mania. I really want to try Intuniv, but I don't have $500 a month to spare.  Tenex is only $5.00 a month at the big chain drugstores.  I am very compliant with my meds, to taking one every so many hours is not a problem with me.  So my questions are, do you see any contraindications with my current meds?  Considering my sleep cycle disorder, do you think that I should take the Tenex in the morning or evening?  How can I get past my intense dislike of eating when I first get up?  Is there something I might be overlooking that I should research? (Preferably that isn't expensive.) Thank you so much for your time and concern! g

My 11 yr old daughter (75 lbs) has been diagnosed with the following:  Down's Syndrome, ADHD, and Sensory Processing Disorder.  My wife and I accept her disabilities, our main concern has been to find some med combination to make her disposition happy or at least pleasant.  She is very irritable, often growling rather than speaking.  Currently, we are trying 3 mg or Intuniv and 15 mg of Celexa.  Do you see any interactions between the two?  Also, do you have any suggestions, our Child Psychiatrist is very open to suggestions.

As you know it would be inappropriate to formally suggest your next steps, but I can tell you from a number of discussions with colleagues and clients that night dosing is not at all contraindicated, and, as you point out, it's likely that the initial response will improve over time. cp

My daughter is 6 1/2, weighs 44lbs. She has been Dx w/ ADHD and ODD. She has tried many stimulants and i didnt like the anger and irritabilty she had when she was taking those. She used to take clonidine QHS to help her sleep, they have just started her on Intuniv and the first days she took it, she slept all day and was very lethargic, with this being said, I want to give it a try but will it still be useful if we give it to her at night instead of in the am? Thank You

Carolined, Only piece you need covered better is the PM drop, and a small amt of stimulant on the immediate release side of things should cover family time! Good to hear from you- cp

My son is diagnosed PDD-NOS, which hyperactive characteristics.  His doctor does not give him a true ADHD diagnosis, but he has been taking ADHD meds successfully since Kindergarten (he is not in 4th grade) and they have helped him immensely.  He is currently on Concerta 36mg.  He started 2 1/2 years ago on 18 mg and we quickly raised him to 36.  He has been very successful on this medication.  However in January his para was complaining that his focus had completely fallen off and his behavior was a problem.  After discussion with his doctor we raised him to 54 mg.  It was awful.  The poor kid was a zombie, so we dropped him back down.  He had lost his whole personality on the higher dose.  He went back to being the happy kid he was, but there were changes so as it turns out we do need to make a switch.  Concerta used to inhibit his appetite and now he eats like a horse...that's just one example.  And he definitely cannot focus the way he used to.  Sometimes we even wonder if he is overfocused because he will concentrate on one thing and it completely stops him from doing anything else.  For instance, he’ll write his name and get stuck on the second letter.  We have a med check tonight and his doctor told us to research Intuniv.  I’ve read some very good things about it, and I love that it is not a stimulant or controlled substance.  I’ve also read, though not on your blog, that some children wake up in the middle of the night frightened and out of sorts and cannot go back to sleep. Our doctor wants to try to introduce Intuniv in addition to the Concerta.  I’m not sure whether he wants to keep the 36 mg dose of Concerta or lower that when the Intuniv is introduced.  I’ve read a few items saying that the balance of the stimulant and non-stimulant has been successful. What are your thoughts?

Michele, I stay away from Prozac with any of the drugs for ADHD for the following reasons: http://www.corepsychblog.com/2009/12/intuniv-for-adhd-avoid-drug-interactions/ Everyone is different on Intuniv, some do better at bed some in the AM... likely the Prozac is backing it up, giving your team a cloudy picture based upon the interaction with the Prozac blocking 3A4... and making it almost impossible to regulate. If he was on stimulants with the Prozac that is the specific reason they didn't work - reactions based on 2D6 interactions - this from a post almost 3 years ago: http://www.corepsychblog.com/2008/12/add-adhd-medications-amphetamines-2d6-drug-interaction-update/ I completely agree with your view of the "playing with it" concept - nuff said. cp

How exactly does Intuniv work? I know most ADHD drugs increase nor-epinephrine levels in the brain but this one decreases nor-epinephrine levels. What exactly is the physiology behind the drug?

can intuniv be used for adults adhd?

Hi Dr. Parker, I am writing to ask what the difference between Tenex and Intuniv is in terms of the side effects. My son has Aspergers and Tourettes with a possibility of ADD. The doctor put him on intuniv but we had to ween off the meds due to paranoia and "zombie-like" behavior. The doctor is now suggesting Tenex. I am so confused.

I'm sorry. I don't have it anymore. Unfortunately I threw it away thinking I would never let me daughter be zombie like again. I'm thinking it was 18 mg a day...I think??? However, it was the extended release, one pill a day and she is 11 years old, 63 pounds. So, I basically was asking is it possible to give her a lower dose of Intuniv to help her focus and help her mood but NOT make her so sleepy all the time? Her doctor said that was the lowest dose but from what I read I got a little confused. I wouldn't mind giving a pill to her multiple times a day I just want it to work for her. ODD is her biggest challenge and secondly focus. Our lives are turned upside down everyday with her mood and inability to cooperate. She is 11 years old and can not walk into the other room and complete any task ie, brush teeth, take a shower. We try everyday but end up either waiting a long time for her to wonder around to complete anything or we help her through it. You say black and she says white. She continually says, "I hate you, stupid" etc... because of her own frustrations with trying to get through life. She also started this new tic where she rubs her hands on objects to feel them and says it makes her feel calmer. So, she is constantly running her hands on the table in front of her or feeling the paper in front of her or running her hands up and down the length of her hair brush. We have tried the Fiengold diet and for a short time while we were really sticking to it I saw her calmer with all the ODD stuff. But due to lack of cooperation from her father and her extreme disapointment of "missing out" on all the food she can't have we compromise weekly on the diet. She is so intelligent and full of talent in art and music. Her art and music teachers say she really has a gift. I am filling you in on details hoping that you can see the big picture to guide us in the right direction. I've really been encouraged by all your other posts to help the other families on this blog. Thank you!

We tried Intuniv for one month on our 11 year old daughter. She weighs 63 pounds and was diagnosed with ADHD, ODD & OCD by the Melmed Center. After one month of Intuniv, we took her off and switched her to ritalin 5 mg am & 5 mg @ noon. She was simply too tired all the time on Intuniv. I do believe the Intuniv helped her control her mood but because she looked "zombie" like all the time it was hard to see that as a success in controlling her mood. I would love to try this type of medicine again to help with her ODD. BUT...want to know if there is a smaller dose available than the once a day pill she was taking (thinking it would help her not be as tired if the dosage was smaller)???? She literally took naps and went to bed early on Intuniv. Now she has trouble falling asleep sometimes with taking the ritalin.

Dr. Parker, I have been a longtime reader of your blog. I appreciate your work so much. If only there would be more doctors out there like you who continue to seek new information and research ADHD, understand how far reaching ADHD can be in learning and behaviors and dig deep with your patients to seek effective individualized treatment. That being said, I know you cannot give me your most accurate assessment via a web blog...but I'm curious what your gut instinct would be here, given the following information about my son: 9 year old boy in 3rd grade. Extremely talented in art, comedic, affectionate, advanced math skills, lags in reading skills (fluency has great improved over the years with reading intervention, but reading comprehension is improving at a slower rate), was delayed as a pre-schooler in the areas of receptive and expressive language, had speech therapy from 18 mos to 3 yrs, is somewhat socially immature compared to most of his peers but does have some close friends (tends to bond with others who seem also a bit socially immature or who are younger though) and is well liked by most everybody in his grade, was diagnosed ADHD in 2nd grade (we were not surprised - he has always had low attention span in many areas, yet could hyperfocus on things like legos - it was in 2nd grade when 'independent work' became expected that he really fell apart...teacher would find him sitting there with a blank paper), my son is a perfectionist...REALLY hard on himself - disappointed with any other grade but an A, went on 20 mg of Vyvanse in 2nd grade and it helped a little, bumped to 30 mg and it was a MIRACLE!!! His grades went to A's and everyone at school was amazed at the difference in him academically and socially. He was really plugged in for the first time. Only downside - REALLY unfocused in mornings before Vyvanse kicks in and HYPER (wasn't even diagnosed hyperactive type ADHD but seems more hyper and unfocused in the mornings now that he takes meds) PLUS he gets grumpy and moody in the PM. We have had a few episodes over the past 16 months where he has YELLED at us and one time where he even hit me! He's VERY sorry and remorseful and miserable after these episodes. Very hard on himself. I'm very afraid that just a few of these episodes and someone is going to slap an ODD or bipolar dx on him. I don't believe these things to be true. The grumbles are ONLY in pm's when meds have worn off and he is REALLY prioritized on what adults in his life think of him. He is a major rule follower at school, church, etc. Again, he's very much a perfectionist. He is still on 30 mg of Vyvanse. First half of 3rd grade went great schoolwise - still doing well socially and academically. But, last few months we've been hearing from his teacher that she feels like she's losing him, she's not sure how much he's absorbing, he sometimes seems in his own world, he's not participating in class and I have noticed the Vyvanse is not getting us through homework anymore and he's grumpier than ever after home from school. In the past 6 weeks, I have watched his grades SLIDING DOWN. Last night, he cried to me, "It's like my pill has EXPIRED, MOM!" and he also told me he thinks he is "a really bad and mean kid." I should note he has NEVER had any behavior problems at school - just attention issues. One more thing to note is that my son has been chronically constipated since he was a baby. We've had him tested before for food allergies and nothing found. We've tried removing gluten and dairy and have never seen any impact on his bowels or behavior. His pediatrician has had us do Miralax, but after reading here and other places about Magnesium we are going to try that. I also am going to get him on Omega 3 supplement, too (how much of each of these for a 9 year old boy who weighs 55 lbs?) My hubby and I are both small and were tiny kids. He eats well...though he hates that he is skinny and feels it is the Vyvanse's fault. But, he eats a big protein breakfast, eats lunch I pack (I have school let me know if he does not eat), eats snacks, has a protein shake every day at nurse's office, eats a good dinner, etc. Seems like his upcoming med check this week we need to talk about a bump up? But, then I also am reading so much positive things about Intuniv in combination with Vyvanse. Could the Vyvanse be causing his anger/moods in PM? Is it the drop-off from it? Is the morning hyperness some kind of REBOUND effect? One doc told me no way, no such thing, Vyvanse clears body in 24 hours. Just off the cuff...I won't hold you to it...would you be thinking bump the Vyvanse only, bump the Vyvanse and add Intuniv or leave the Vyvanse as is and try adding Intuniv? I know you are a very busy man. I would be SO SO SO grateful to hear back from you.

I need advice. After many trials, we have found Vyvanse to be the best treatment for our daughter. But, she is 8 and weighs only 45 lbs. We started on 20mg 1 yr ago. Then we bumped up to 30 (with clonidine 1mg at night), and finally about 6 months ago we went to 40mg Vyvanse am and 2mg clonidie at bedtime. Now, unfortunately we need to "bump" again. But due to my daughter's low weight our doctor is reluctant. So our new plan is 2mg Intunive along with the 40mg Vyvanse in the am. No clonidine at night. This is not helping at all. She is so out of control and hyper. We took a stimulant vacation over Christmas break. She was better on .5mg clonidine 3x per day than she is on Vyvanse 40mg + Intuniv 2mg. What are your thoughts on Vyvanse 50mg for 8 yr old underweight girl? I just want her to be able to help herself with impulse control and hyperactivity. She is screaming alot. Was thinking ritalin 3x a day might be our last resort. She is so smart, in the gifted program. But struggles with self esteem b/c always in trouble. Should we bump? Any other suggestions?