Intuniv Answers: ADHD & Addiction Indication

by Dr Charles Parker on December 15, 2009 · 11 comments

68481352 24a8657d88 m22 Intuniv Answers: ADHD & Addiction Indication

Intuniv For ADHD & Substance Abuse
As we move down the early ADHD road of experience with Intuniv some interesting additional likely indications appear. Remember: Intuniv is not a stimulant, not a controlled substance, not abusable, and is approved by the FDA for ADHD.

The indication suggested in this post is not FDA approved, but simply makes street sense. This Intuniv comment/question regarding addiction indications recently arrived in this CorePsych Blog comments:

Question
I have a 19 yr old son, he’s still trying to finding the right medication [for ADHD], period. Doctors don’t want to put him on a stimulant because of his age and possible addiction. He has tried Strattera, that didn’t seem to work well [my observation, repeatedly], he seemed to be moody.

We are trying Intuniv tomorrow, at first because of his age I wasn’t sure, age says from 6 to 17, but I am trusting the doctors, are there any studys of young adults who have taken it, I know its new. I am also going to start a protein shake of 8oz of coffee and 20g of protein powder with it, so hopefully it will work.

My Reply
You are on the right path. Intuniv is clearly indicated with folks who have some measure of medical concern about abuse… it just isn’t abusable, period. A likely indication, not mentioned in this post, are those in recovery from substance abuse, e.g. medical professionals in programs who suffer with ADHD and are standing before licensing boards, and pilots?

As you point out adults don’t have a specifically approved indication through the FDA, but the safety with children does encourage an Intuniv intervention if any abuse concern does exist. Older adults on antihypertensive meds, with blood pressure problems or any specific cardiac conditions need a medical review – in spite of the fact that in the ‘flexible-dose’ titration study [customized for the person based upon symptom resolution, rather than the 2 'forced-dose' titration studies] the hypotensive side effect was nearly the level of placebo.

On the other hand, it is my frequent concern that still too few docs understand the diminished abuse potential of Vyvanse, documented throughout CorePsych Blog posts and elsewhere, including this abuse study from Shire. Yes, Vyvanse is an amphetamine, but is the only full-on stimulant with peer reviewed studies in the package insert regarding diminished abuse potential. Nothing is perfect, but anecdotally Vyvanse has proven useful with its prodrug release for use with recovering individuals with ADHD.

Stay with the protein, well done, and very likely you will have a positive outcome. It’s never to late to treat ADHD, and with more treatment options Intuniv might prove quite helpful for these other indications. Always remember that substance abuse folks frequently show diminished neurotransmitter biomarkers, and often prove refractory to psychotropic medications of any sort.
cp

Related articles by Zemanta
Intuniv Answers: ADHD & Addiction Indication

Digitally available now at Nook, Kindle, Barnes and Noble.
ADHD Medication Rules – PDF For Your Desktop  
ADHD Medication Rules | Paying Attention To The Meds For Paying Attention – Kindle Version


Tagged as: Abuse potential, addiction, Attention-deficit hyperactivity disorder, Controlled substance, Drug abuse, Food and Drug Administration, Guanfacine, Intuniv, intuniv drug, Intuniv for ADHD, Lisdexamfetamine, Medicine, Stimulant, Stimulant medications, substance abuse, Tenex, tenex adhd, Vyvanse

  • Lyd

    My son can’t swallow pills. Is there another way to give the medication?

  • Mora

    My 7 year old son tried Ritalin and Dexedrine. Both caused him increased agitation and irritability.
    My doctor next prescribed Propanolol, which actually helped with anger and hyperactivity. It did not, of course, assist with any focus issues. Rather than continue to do trials with different meds, we decided to wait a year.

    So, this year, we went off propanolol & began intuniv. at 1 and 2 mg, it seemed akin to propanolol. we are now at 4 mg – and he is complaining of being bored all the time. the level of boredom is actually causing signs of depression. we first noticed this at approx 3 mg intake….though it has become more clear now. is it the medication causing?

    we were considering putting him back down to 2 mg, and then trying some adderall with that……

    my spouse also thinks maybe we should just go back to propanolol, although I had heard longterm use could increase risk for diabetes…and type I runs in our family…

    what would you suggest?

    • http://www.CorePsychBlog.com Dr Charles Parker

      Mora,
      Beta andrenergic antagonists [propanolol/Inderal] block both epinephrine and norepinephrine receptors, and certainly can help with agitation and anger – Intuniv acts on blood pressure in a different way, by stimulating the Alpha 2 post-synaptic receptor to modify glutamate neurotransmission – helping with ADHD. Rather than continue to guess, as you will see reading the many comments here at CorePsych Blog on similar challenges – I say get the evidence first, then make the decision. Neurotransmitter testing outlined voluminously on this page will provide better info for more informed intervention strategies.
      cp

  • Janice

    I have a 19 year old son, who has done well on Strattera 120 mg daily with Ritalin 10 mg in mornings and prn for studying etc. in the afternoons. It has recently been recommended to me that he try Intuniv. My concerns for him are that the Strattera is such a high dose and long term side effects. What is your opinion regarding a change from Strattera to Intuniv with the Ritalin in addition. He does well in school but still struggles with concentration at times, his “busy” activity levels are still high, he has learned to channel it well, but still fidgits excessively. He can be impulsive, but usually medicated not as badly as without it. He getting ready to start hard Civil Engineering program in college this year and I would like to have him start with his feet on stable ground.
    janice

    • http://www.CorePsychBlog.com Dr Charles Parker

      Janice,
      For those leaving for college now is the time to jump on any changes, as once in school the whole business can quickly go into 52 Pick-Up.

      First of all, has he tried Vyvanse – it is absolutely the best for college with the long DOE. If he needs an augmentation strategy then could use the Intuniv, but honestly I wouldn’t try to do all that with only a month left before they go off to school. You might discuss with his doc a Vyvanse strategy. If that has already been tried I would not go off the Strattera, but would augment with Intuniv [no interaction there as Strattera runs up through 2D6 - not 3A4]. You might be interested in my new book ADHD Medication Rules that covers the details on all of these matters, with a discount pub date July 4-11.
      cp

  • jim

    I’m a 37 year old male that suffered severe anxiety from worry. About two months ago my doctor put me on citalopram and life is so much better. The challenge I still have is the inability to focus. Sitting at the desk and putting a concentrated effort into a project is very challenging and I love my job. The doctor put me Straterra for a month and the focus seemed to improve, but the medicine made me very warm all the time. I’ve been off the Staterra for a month and the doctor wants to put me on intuniv. I see this is really only approved for children. Should I be concerned in trying the Intuniv?

    Thanks,

    Jim

    • http://www.CorePsychBlog.com Dr Charles Parker

      Jim,
      The parent compound has been used with adults for years. It is not indicated for ADHD by the FDA simply because adult studies [now underway] have not been completed. No problem with giving it a shot.
      cp

  • annie

    hi dr. parker, i’m a sixteen (almost seventeen) year old girl and i’ve recently started up on intuniv. i’m already taking 60mg of vyvanse twice a day (once in the morning, and again at lunch time). i started taking the 3mg dose of intuniv two days ago. other than the obvious side-effects that i’ve become accustomed to, i’ve noticed that my menstral period is late compared to usual. i’m sexually active, but we always always always use protection. i’m about a week late for my period, and i’m hoping it’s due to the new medication. is there any evidence to suggest that that is the reason?

    • http://www.CorePsychBlog.com Dr Charles Parker

      Annie,
      Not likely secondary to Intuniv [alpha 2 agonists] see this reference on guanfacine and menses from the master: Stephen Stahl.

      On the other hand: amphetamines and menses with references show some changes with menses secondary to use of AMP.
      cp

      • annie

        could you put that in terms i could understand more? hah, but thank you so much!
        -annie

        • http://www.CorePsychBlog.com Dr Charles Parker

          Annie,
          A bit heavy, but just documenting that the stimulant is more likely the problem with the periods.
          -Good you are asking the questions, and important to keep clear thinking about these matters.
          cp

Previous post:

Next post: