1st day of vyvanse ADHD meds

[summerlake]

We have just finished our first day of ADHD medication and it was a ROUGH one. I would sincerely appreciate support or advice.

I have a thread i created earlier that explained our sitzuation, Dd was recently diagnosed with adhd inattentive and dyslexia. The only problem we have really, and it is becoming a really big problem at school, is that she can't read well. Her fluency is terrible. The dr. Recommended treating the ADHD to see if we can take that off the table as an issue. Dr. Wanted me to give her one dose today before she went to school on it.

DD took the lowest dose of vyvanse 20mg at about 9am. We were We were prepared for loss of appetite and jittery-ness. We fed her a high protein breakfast and as soon as it kicked in she complained of dizziness and nausea. She was pretty out of it for about 2 hours after.

She then got really driven and focused and was cleaning and organizing everything. But here's the really big thing: she read...amazingly well. She read so quickly and fluently, I was in tears. She read two books and it seemed so easy for her.

Then she had about three hours of come down. And it was AWFUL. She is emotional to begin with, but this was really hardc to see. She was just crying off and on the whole time.

So, is the choice I have to give her medication that causes her so much turmoil and emotional grief or to have her be unable to read. It is not okay, the way that she felt today.

Will it get better. Should we fight through two weeks of this to see if the mess are a fit or should we know right away that it's a mess?

Has anyone tried water titration to reduce the dose of ADHD meds?

[LynnS6]

Ok, bear in mind that I know very little about ADHD.

It seems to me that you had 2 things you learned from your medication trial:

1. Your daughter was helped by the med in that it helped her focus (maybe a bit too much) and made her reading much more fluent.

2. She had some pretty bad side effects.

I think that a call to her doctor tomorrow would be in order. The good news is that an ADHD med worked (and from what I know, if one works, there's likely to be another one that works). The bad news is it may or may not be the right one. I don't know how long the side effects are supposed to last, or how extreme they are.

Don't try to titrate the meds yourself. Ask your doctor. Give her a smaller dose, or skip it. But I wouldn't mess with the composition.

[Emmeline II]

I am familiar with Vyvanse as my son and myself take it. First, 9am is late to be taking such a long acting medication; it can potentially be effective for 12+ hours. On school days my ds takes it at 6am and on the weekends I give it to him by 7:30 at the latest. It does take time for the body to adjust to the medication; I would say the "hard" adjustment was about two weeks (where I noticed the medication "switch" on and off. I found that consuming a little caffeine (black tea) help the evening transition. With this med you also need to make sure you drink a good amount of water and eat regularly. I'd also avoid giving her anything with a good amount of vitamin C in the morning (like vitamins) and the product insert warns against consuming "urinary acid products" (like some juices), as it can interfere with the absorption of the medication.

My son initially had a little nausea and dizziness for a short time in the morning for the first couple of weeks but that went away; he has been on this medication for over a year now.  He did a trial of Intuitiv (non-stimulant for ADHD) for preexisting tics which did not go well as it not only caused ADHD symptoms but also insomnia, and we stopped the trial after 3 days--so ADHD medication affects everyone differently.

Stimulants can worsen anxiety, so if she was already dealing with that the medication can amplify it. I would probably give the medication at least three days but if the rebound stays the same I wouldn't do the whole two weeks.  Though medications normally have adjustment periods and/or can be tweeked to work, sometimes the side effects or rebound are not worth the results. You and your dd have to live with with the results, not the doctor, so you may have to just say "no" if the doctor wants to continue with a medication and you do not.
 

As a pp said, I wouldn't triate the medication on your own before talking to your doctor. Though the Vyvanse capsule can be opened, the thing that (usually) makes it such a smooth delivery medication is the little sponge inside that gradually expands to push out the medication.

Edited by Emmeline II - 3/19/12 at 7:12am

[summerlake]

I spoke with the doctor, and she just switched the prescription to adderall XR 5 mg and said to mix it in applesauce or yogurt. I'm not sure if that's supposed to ease the upset stomach and nausea that DD was experiencing or what.

DD may just be very sensitive to this type of medication. We will attempt to take the Adderall this weekend. I just can't send her off to school feeling so terrible and/or not knowing what the effects will be. We'll see how it goes. I wish they offered tablets or more flexible dosage than what they do.

Thank you for the input! I'm pretty uncomfortable with all this, and I appreciate being able to bounce this off of you ladies.

[queencarr]

My son takes a liquid ADHD med called Procentra. It is a short acting stimulant so he has to have a dose mid day. But, because it is a liquid, we can more close control the dosing, down to the ml, and tweak it better. He takes 1 tsp (5mg) in the morning and 1/2 tsp after nap. That way he has more control during the school day. He also takes intuniv, a non stimulant 24 hr med but he takes 2 1/2 doses 12 hours apart. This combination smoothed out the bumps for us.

[ALittleBitCrunchy]

My son started on Vyvanse. It wasn't quite enough for the school day, though, and we bumped the dose a bit. He had stomach aches for 3 hours after taking it each day after that so we switched to Daytrana. It's been really good for him. I believe that ADHD treatment is (unfortunately) a trial and error test. In fact, the doctor only gave us 10 day prescriptions in the beginning so we could give each one a try and not have issues with insurance if it didn't work and we changed but wanted to fill another 30 days just a week after filling another one. He's been on meds for seven months and I'm amazed at the changes he's had. His handwriting improved, his reading level increased, his homework time cut in half, his spelling improved...and not just small changes...I feel like he's gained two years academically. The school wanted to retain him last year and now he's on honor roll every nine weeks. It was hard to work through the adjustments and figure out the right meds and doses but it was so worth it. I'd suggest you call your doctor and talk it over. There are other choices and other amounts and you might get good info on time of day and ways to take it.

Good luck!

[SpottedFoxx]

I just went off the vynase going back to adderal. Yes, it's a more gradual up and down but I just like the adderal better.  My son is on vynase and I may be taking him off because I don't like the mood swings he's getting.

I do agree that 9 is waaaay too late to give the meds.  

[kbins]

the reason the pediatrician said mix with applesauce or yogurt because some kids can't swallow the capsule whole. If the little beads inside are chewed/crushed, the extended release is destroyed.

My oldest DS takes Adderall XR and we had to open the capsule/sprinkle for months before he could safely swallow the capsules. (We practiced with empty ones for awhile).

Regarding the medication trials: Some kids have a more complex chemistry and the meds won't work as they do typically. My oldest son has had terrific results with Adderall XR. My second son who is more medically complex (PDD-NOS asthma, allergies and ADHD) has been through eight or so meds trying to find one that alleviates the ADHD symptoms. The pediatrician may not be the right prescriber if you go through a couple of medications with no luck. A psychiatrist may have more experience and knowledge about potential options and side effects. My oldest is managed by a pediatrican, but my second son is seen by a psychiatrist.

[SpottedFoxx]

Actually Vyvanse is one of the meds that does not have beads inside but rather powder.  In fact, you can put it in some water and pull it up into a medical oral syringe and have the child drink it but if you don't get every last drop - you can lose out on the meds.  

[summerlake]

Thanks! She did fine swallowing the capsule of vyvanse, it was just not a good time on it. She was dizzy/nauseous all day, she got EXTREMELY speedy and racy for a few hours and then had some angry and violent outbursts and cried for 3 hours straight. She was all the way off of it by 8pm though.  I keep reading that we should try 3 days of the meds to get a good read, but I couldn't bring myself to have her go through that again, there has to be a med that is easier on her. 

I also read that the dose of Adderall XR that the Dr. prescribed (5mg) is equal in some way to the dose of vyvanse that she tried (20mg). So I'm wary going into this weekend trying the Adderall. I'm not sure if there will be too much of a difference. Have people found that some stimulants cause a frantic speediness and emotional crash while others can have a smoother effect?  

[kbins]

I was responding to the OP's comment that the pediatrician changed the med to Adderall and recommended it be taken with applesauce. Adderall XR is beads.

We saw significantly different side effects with the Focalin XR versus the Adderall XR for my older son. He had a huge emotional crash most afternoons on the Focalin (sobbing, sadness he NEVER had before) and nothing like it at all on the Adderall.

You won't necessarily see the same effects on a new medicine even though it is also a stimulant. Our psychiatrist tell s us that the extended release mechanism particularly acts differently on meds, and that alone may impact side effects.

Keep an open mind, but definitely watch her. I have learned to only ever introduce meds on a weekend or over a holiday break, because I know my kid better than the teachers and I can identify issues sooner.

[Emmeline II]

Originally Posted by summerlake 
I also read that the dose of Adderall XR that the Dr. prescribed (5mg) is equal in some way to the dose of vyvanse that she tried (20mg). So I'm wary going into this weekend trying the Adderall. I'm not sure if there will be too much of a difference. Have people found that some stimulants cause a frantic speediness and emotional crash while others can have a smoother effect?  

Adderall (Amphetamine-dextromphetamine) and Vyvanse (Lisdexamfetamine) are two different classes of medications. Also, as pp mentioned, extended release (XR) medications can have different results/side effects that the short acting version of the same medication, and any stimulant or non-stimulant can have different results/effects; my ds can't take Intuitiv (a non-stimulant) because it causes ADHD symptoms in him, and we stopped Concerta when an increased dose had a similar result.

Knowing whether you are getting Generic vs. Name Brand is important for evaluating an ADHD medication as it seems common enough for the generic not to work as well (though others do fine and sometimes better on generic)--I've read that the problem is likely that the generic can't reproduce the precise release mechanism. Pharmacies don't necessarily point out that you are getting generic..

http://adhd.emedtv.com/adhd/adhd-medications.html

ADHD Parent Medication Guide prepared by the American Academy of Child and Adolescent Psychiatry and American Psychiatric Association
http://www.parentsmedguide.org/ParentGuide_English.pdf

The Hows and Whys of ADHD Medication
http://www.additudemag.com/adhd/article/8673.html

A Full List of ADHD Medications

ADHD Stimulant Medications

ADHD Non-Stimulant Medications

Edited by Emmeline II - 3/23/12 at 8:09am

[puzzlepeace]

Just wanted to say it isn't just you! Hang in there.  We experienced horrible side effects with some of the meds even at the lowest doses.  It is heart wrenching to watch a child benefit so greatly from something that also causes them suffering of some sort.  We finally have sorted some of it out, partly through trial and error and partly through dc finally growing a bit physically which has helped (the meds only come in doses so small and some kids need smaller). You are smart to document what you see, the timeline helps your team figure out treatment. I wanted to mention though with any of the meds, don't cut pills or otherwise change them without first talking to the dr.  Some like Concerta can be dangerous if cut since they utilize the coating as part of the mechanism of release.

[melissa17s]

Originally Posted by Emmeline II 

Knowing whether you are getting Generic vs. Name Brand is important for evaluating an ADHD medication as it seems common enough for the generic not to work as well (though others do fine and sometimes better on generic)--I've read that the problem is likely that the generic can't reproduce the precise release mechanism. Pharmacies don't necessarily point out that you are getting generic..

Generics are the same active ingredients as brand name and required to show same levels in blood work up.  http://www.fda.gov/AboutFDA/Transparency/Basics/ucm194953.htm  I think the inactive ingredients can irritate some individuals in addition to the active, though.  It is good to always get the same brand whether or not it is generic because then there are less inconsistencies with with dosing.  http://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/ucm167991.htm

[Jen Muise]

Generic drugs do not have to go through the same rigorous testing as brand name drugs, and just because the drug occurs at the same levels in the blood does not always mean it is as bio-available.  Things like the time release mechanism and fillers can work for or against the drug; it's really not just a matter of some people being sensitive to non-medicinal factors.  This has been well documented in some cases, like when effexor switched to generic, and not so well in others.  When dealing with mental health especially, a very small change in the way the chemical works can have dramatic and unexpected results.  Altho I don't know about ADHD drugs specifically, I would advise anyone to be very careful when switching to a generic.  I thought that generics and name brands were the same thing as well, until I got switched to a generic - it took nearly a year to figure out why I was like a zombie (like to the point that we were starting to look into home care because I couldn't maintain my housekeeping and child rearing duties).  I was shocked to discover that people had documented 3x the side effects in studies of the generic I was switched to, and that it was ineffective in treating some of the illnesses the name brand was used for.  Most of the time generic vs name brand is not a big difference, but it can be catastropic when it doesn't work.

[myadhdson]

My son also had a horrible comedown on vyvanse, we tried depakote for awhile and it helped the comedown but later on created mania. He's back on just vyvanse now and I will say that 4-5 months later the comedown is less but it's still there.  He gets extremely hyper, emotional, angry, overly silly, etc.