Intuniv for ADHD: Avoid Drug Interactions

I appreciate your raising this question, and have seen no reports or specific concern raised about this issue. As I see it with these alpha 2 agonists the problem is dosage and side effects. Any meds must be titrated carefully and these are, of course antihypertensive meds with the potential for unpredictable hypotensive symptoms/side effects. cp

Amy, When you have that kind of problem i simply stop throwing meds at the person and know the metabolic variables are the problem. She needs a more careful eval, several things could be going on, the good news is that there are no drug interactions between Intuniv and Vyvanse - but you can't get it right because of the IgG very likely. Download Transit time; Do the corn thing, and get the IgG tested, those will likely improve the possibilities. cp

Any thoughts on Intuniv plus fish oil? My son seems to be extra annoying and busy when he takes both. We have had great improvements on the Intuniv though!

J White - Yes, one can gain wt on Intuniv, and one can also have a problem with comorbid depression, apathy and indifference with either Concerta or Intuniv. Two quick points to discuss with your doc to see what he/she says - consider a trial of Intuniv at night, perhaps at the next dose up to see if you can get a mix of soporific effect and correction of the ADHD. Secondly go over with your guy the possibility of cognitive depression - a Clint Eastwood apathy that needs medical attention... and this other thot comes to mind: trial of Vyvanse low dose with Intuniv for a more rounded ADHD response if that is the predominant comorbid picture. This is one of those with too many unknowns to give a clear rec for your docs consideration - but these are some trial thots. cp

Dr. Parker, My son who is 11 and in 6th grade was on Concerta for 4 years and it helped him greatly in school and socially. He did have sleep issues and weight gain was a big issue. In June I took him of mess and then started 1 mg of Intuniv and a month later 2 mg. He had some bed wetting at first and that went away. I give it to him in the am before school. He is doing well in school and wants to stay on Intuniv because he likes eating and is more himself. He is tired in the afternoons and has some issue concentrating in the afternoons to study or do activities. Some difficulty with sustained attention completing math assignments and tests but he is a very good student. On the weekends he gets very grumpy and does not want to spend much time on homework and projects. Today he told me he has been waking around 4 am every day sometimes going back to sleep. I am not sure if the intuniv is wearing off and he is underdosed or if this is just a side effect. This may explain the grumpiness and attention issues. He has also gained 18 pounds sine June (64lbs to 82 lbs which is now an average weight). I also wonder if there are weight gain concerns for kids on Intuniv.? Seems the opposite of my old concerns on Concerta. Julie

Lisa, The fact that he has been on meds since pre-school is often a big sign of immune dysregulation. Added to the history of multiple med trials I would jump on searching for the data on immune system dysregulation with IgG... qualitative not quantitative. If your doc doesn't agree we can get it done long distance, no prob. cp

Melissa, Yours is a prime example of a moving therapeutic window based upon metabolic variables. Highly likely you won't find a consistent dose as his metabolic changes keep the window moving. Do a Transit Time, look at immune dysfunction, check out the IgG and tighten up on those details first - the predictability arrives! cp

Dr. Parker,  My son is 11 and has ADHD. He has been on some sort of meds since he was 3 and in preschool. Currently, and for the last few years he has been taking concerta, 54 mg and clonidine and risperdal at night. Will Intuniv help him during the day along with the concerta? He occasionally takes a ritalin bump during the day, but he forgets to go to the nurse to get it, and he still has problems focusing in at class. Thanks, Lisa Teach4lisa!@aol.com

My son has been on Intuniv for over a year and half now.  We started out at 1mg, quickly titrated to 2mg.  This was good for a few months, but slowly his aggitation creeped back in.  I always suspected anxiety as the culprit for his irritable behavior.  We then gave hm 3mg and that mde him not himself...saying things ghe shouldn't, behaving oddly, more impulsive, sleeping a lot.  So we bumped him back to a dose of 2mg and a half of 1mg for a desired dose of 2.5mg.  BINGO!  So this lasted another 3 months and we were back to the aggiation creeping back in.  This happened until now, at 3.5mg, he again is presentling with this aggiation.  When he starts a new dose, he does beautifully for some time, but then bam!  We finally got an additional diagnosis of Anxiety along with his ADHD.  I always suspecyed this.  We stared him on 2mg of liquid suspension Lexapro.  It has only been 2 days and we notice a dramatic difference in his behavior.  I worry about this medication (Lexapro) as he is only 7 1/2 and 55 pounds.  Is Lexapro ok to use in such a young child?  What should I look out for in terms of behavior changes?  How long before we know this med is right for him? Thanks for this great question and answer forum!  You have helped me in the past.  I look forward to your reply. :) Melissa

Janet, Sorry to be so late getting back, busy with a relaunch of my book, will be on Amazon and Nook etc, so behind the scenes has been a big summer hectic. Prozac, as you know from reading here, is simply not the best choice with Intuniv simply because of the 3A4 interaction. Just pick another antidepressant, for $ sake would rec your doc try Celexa - it's safe, more clean on drug interactions, has miles of child and adolescent use, and will keep that Intuniv from accumulating... very likely what is going on. One can never of course be sure out here on the Internet without an exam, but that is a common interaction, not frequently appreciated, that's why I wrote about it. cp

Dr. Parker My son is 10 years old and has Asperger Syndrome.  He has been on many meds, one of those being prozac.  He has been on this drug since he was around 5.  He is now taking 6mg of Intunive and 30mg of prozac.  Then at night he takes .3 Clonidine and 4 1/2mg of melatonin to fall alseep.  His behavior started getting worse again this summer.  He will for no reason become so irritable and just start screaming at us over everything.  It is like a switch flips in him at 2:00 or so every day.  His OCD has become worse than ever and he is performing morning and evening rituals with lights and fans being turned on and off.  It is as if he doesn't hear us anymore sometimes.  I took him back to the neurologist who we love and he wants to increase the prozac again.  After reading your blog and information from other parents, I am really confused.  My son has to have meds to function at school but I don't want him doped up and cause more problems.  We sent our doc your link to look at but have not heard back yet.  What would be your recommendations?  We live in a small town in Kentucky and it is SOOO hard to find someone like you who is so knowledgeable about meds and interactions.  Our doc has been great in trying to help my son but as a parent I am constantly searching for ways to help him.  What would you do?  Thanks 

Dr.Parker, I think this was what I was looking for when I asked you about a sudden death interaction between Intuniv and Concerta. You wrote up above: "Another Oversight Over at Intuniv Interactions at Drugs.com they simply aren’t looking at the CYP 450 challenges, and are waiting for someone to report these predictable interactions noted here. On a more positive note I do suggest going over there to look at the methylphenidate [Ritalin family] products as they appear to be interacting with Intuniv for some other unexplained reasons. Adderall, Vyvanse and the amphetamines appear clean and not interactive. So I clicked on the Link and it said this: http://www.drugs.com/drug-interactions/concerta-with-intuniv-1606-976-1219-13992.html "According to the manufacturer, serious adverse events have been reported during concomitant use of methylphenidate with clonidine. The mechanism of interaction, if any, is unknown, and a causal relationship has not been established. The use of clonidine, with or without methylphenidate, has been associated with rare cases of SUDDEN DEATH and cardiotoxicity including sinus bradycardia and heart block." But it is saying Clonidine, maybe I am not reading this right, could you help me understand this? You can click on the link above to read the whole thing. My son has been on this combo for 5 days now. Thanks, Denise

I am just finding your website and the fact that prozac may not be a good mix with vyvanse. I have been on prozac 60mg for years and my doc just put me on 60mg vyvanse. I've been on both for about two weeks now and feel fine so far,...but should I be doing something else?

Your blog was helpful. I am a child psychiatrist who tries to keep track of these cytochrome P450 interactions (which I don't believe existed when I was in medical school over forty years ago.) Still, I am told that with a few important exceptions, like say using depakote and lamictal together, often you can adjust one of the doses and do just fine with, say, fluoxetine and guanfacine. Still, it is better to be safe, and Lexapro would be a good option if one really feels they need to add another medicine to the intuniv. Keep up the good work!

Can you link me to the pdf of the package insert for intuniv that shows and explains why it should not be taken with prozac? I can't seem to locate it...I had found the guide for adderall and vyvanse, but not for intuniv or prozac. One of my students with Aspergers (mild) is currently taking the two medicines, (don't know about timing though) and I would like to be able to give the parents the necessary information to know and understand that this is not a good combination. The child (9 yrs) falls asleep regularly at school, the time varies, and the family does not have much of a structure routine at home. So whether it's a result of poor scheduling or side effects, I'm not sure -- but either way, I would just like to be able to pass this information on to them. I did follow the links in your post above, but was unable to locate the information in the way it needs to be presented. Thank you, Julia

My son is 7 and currently taking 20 mg of Fluoxetine, 4 mg Intuniv, and 10 mg of Abilify. Overall his mood is more stable, the anxiety is much better, and he is able to focus better. However, we are experiencing tiredness and periods of extreme irritability followed by days of rages. During these periods his impulsiveness is increased - verbally and physically. We are working with a team we trust, however, I welcome your opinion on the current drug interactions, levels, and behaviors? Thank you.

Hi, My son is ten and has had an qeeg and neuro testing done. He has ADD, ODD and a little ocd along with a little bit of tics. He has a casein intolerance and doesn't metabolize proteins well so we were given enzymes along with amino acids and vit B12 and magnesium suppliments to give him. That didn't improve his well being so we tried Ritalin. Wayyy to overfocused so we stoped that. I had a feeling it wasn't a good idea. He has been on Intuniv now for almost two months, we are up to 2mg a day which i recently started giving at night. He is on very skinny but eats well and is also very pale looking. He is fair skinned by nature but since he started taking intuniv he's got dark circles and has been having some side effects. The doctor said down the road we should try introducing vyannse (sp?) He is weepy at times, crying very easily, he feels dizzy and says he doesn't feel well. I notice that he just sort of seems a little lost. He said that in class yesterday he was asked to read and a word came up that he knew but he confused it and said a completely different word. Could it be lowering his cognition? He suffers from anxiety as well. My irrational concern is that he will grow up and self medicate and become addicted as there is a strong gene in my family for alcoholism. What med direction should i be going in? Stims seem to not be good for him and his emotional state is unstable meaning he cannot control his anger and frustration which also runs in the family.

My 10 yr old adhd daughter who also suffers from anxiety and oppositinal disorder has been taking intuniv and fluoxitane together. She has been on this drug treatment for 2 months and has gained 8lbs. She is hungry constantly. After having her on a stimulant for 4 years and not eating much this is a huge change. Any feedback would be appreciated. We go back to her med Doctor in Aug.

I child I take care of is 6 years old. Has Autism and ADHD. Has been taking Abilify 15ml daily for the Autism. Recently started on Intuniv. Was ordered to take 1 mg daily x 7 days, then 2 mg daily x 7 days then 3 mg q d. After taking the 1mg dose 4 days he had a episode of uncontrolled crying that escaladed to a full meltdown. Thought this was just his Autism but then after taking 2 days of of the 2mg he had a major meltdown and the doctor said to increase the intuniv to 3mg. 3rd and 4th day later he began to cry for no apparrent reason. Seems to have these crying episodes a couple of hours before he is to take his dose of Intuniv. His sleep pattern has changed also. Are these crying episode related to the Intuniv and is this something that will continue? Does he need change of med or dosage change

Good morning, my son has adhd and pretty close to a full blown odd diagnosis. He has been on concerta until end of January when we started with intuniv. at this point he is only taking 3mg. I have 17 mg of concerta to supplement the intuniv but I am very anxious about giving it to him. any thoughts? He is going to be twelve in July, and has gained about 15 pounds since we took him off stimulants. He has pushed through the extreme exhaustion but is tired a lot. I like intuniv in that he does not have the crazy rebound behavior and his impulsive behaviors are much better. His focus and attention however are not.

My son is taking Intuniv he is currently taking the 3 mg dose in the am with breakfast. he seems to fall asleep if he is sitting in the car or just sitting in a chair for a while when he is up he seems ok but as soon as he is sitting he is out.it has been about a month since he has been taking the intuniv . how long does this medication take to show improvement of the side affects and how safe is this drug ?. there is not much known about this medication. my son has a blood pressure of 100/58 is that too low for a 14 year old to have he weighs 170 and is 6' tall.

I am currently taking Paxil for anxiety and Adderall for ADD. I have already had a seizure related to serotonin syndrome and now I am ''sweating" all day after taking the Adderall. I have not had this problem before and am wondering if Paxil is the culprit and I should change meds?

Dear Dr. Parker- After our correspondence, I worked with our doc and took my son off Intuniv due to the interaction with Luvox (extreme fatigue). We need to give Luvox a chance, because his OCD is most problematic socially. He weaned off Zoloft now that the Luvox is up to 150 mg., so he's only on Luvox. However, now he's pretty hyper at school & is having trouble focusing. In your opinion, what if any stimulant meds would be good to try? He had some success a year or so ago with Adderall & then Focalin (but seemed to build a tolerance?). He has OCD/A.D.D./trichotillomania, and Tourette's which is waning (stim meds haven't caused tics when tried previously). Thanks!