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Discussion Starter · #1 ·
DSD switched to a new pdoc today. Of course, the first thing he wants to do is switch her meds up. She is BP/ADHD and has been taking 400mg of Seroquel and 54mg of Concerta daily. Since starting these meds in combination, we have seen wonderful improvements in her behavior. This has been so for about 2yrs.

Now, this pdoc is saying that Concerta is old news and has many more side effects (that we have not experienced) than Vyvanse and wants to switch her over to it. She will start with 30mg tomorrow, 40mg on Sunday, and finally settling at 50mg on Monday and there after. He is also sending her for a routine EKG tomorrow to double check her heart for any ill effects of the Concerta.

He is also concerned about her and depression. Which I am not really surprised about since I have been saying this for a while. She will be starting with a new therapist for those issues. He may also want to include Wellbutrin in her meds eventually.

So, my question is about the Vyvanse. I have never heard of this drug and I am pretty versed in my med knowlege for this. Apparently, it is new and has very little side effects. He says we will notice a difference in her by Monday. I am just not certain what I should be looking for with it exactly since the Concerta seemed to be doing its job. kwim So what info does anyone have on this med they can share with me?
 

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I don't know too much about it, except that it is an amphetamine and it also can enhance mood (act like an antidepressant). Also the company that manufactures this (Shire) is heavily heavily pushing the drug, and have even stated that they intend through aggressive marketing to gain 50% of all ADHD meds prescribed. Its way too soon to know if this is any kind of miracle drug and it sounds like your doctor has been seriously influenced by Shire's marketing techniques if he wants to prescribe this drug when Concerta is working just fine. I don't think Concerta, if my memory serves me right, is an amphetamine but it is a CNS stimulator. I wonder if this new medication is pretty addictive compared to Concerta. But if you trust this doctor and you feel he knows what he is doing, I guess the possible mood enhancement component might be good for her.

Edited to add: I just saw that she was also bipolar. If that diagnosis is correct, I'd be really hesitant to use something like Vyvanse. Usually ADHD meds really increase bipolar symptoms. But I wouldn't have ever suggested trying Concerta, and that helped, so maybe she'd be okay.
 

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Yes, we have been through the stimulant issues with her when she was only on Adderall XR and only dx'ed as ADHD. It made her manic. Once they stopped the adderall and started the seroquel, we saw night and day results. The pdoc added in the concerta over time, and it worked well for her. As long as the BP is being managed, adding a stimulant should not cause issues. Concerta is also classified as a stimulant, but it is not amphetamine based like Vyvanse is.

From what I am reading, Adderall is losing their patent soon. They are really pushing Vyvanse now because its patent is good until 2024. So, the marketing of this med is not surprising. Also, there is a lower chance for drug abuse with this as opposed to other stimulants because it is not supposed to give that great high. So, there is little street value. I assume that makes the gov't happy.
 

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Oh and FWIW, it does bother me that the pdoc wanted to change her meds since they are managing things very well. It seems to be standard protocol when you change pdocs, though. There was no choice on changing, though, because DSD's mom's insurance changed and dropped her other dr.

I was not at this appt (for the first time ever) because the ex and I aren't on great terms right now. Had I been there, I would have mentioned how I feel about switching meds. Unfortunately, DH and her mother are not as well versed on the disorders and treatment and pretty much trust what the dr said. I have been the one doing 99% of the reseach and have been informing DH through the years. I just have to go off their decisions right now. I just wanted some more info to know what to look for with DSD since I will be the one dealing with her during this med change. kwim
 

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That is scary - if she's doing well on Concerta, I would want to keep her on it. Especially since the alternative is an amphetamine.
But then again, I HATE amphetamines, so I might be a tad biased. I hope everything goes smoothly for you.
 

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Discussion Starter · #8 ·
Quote:

Originally Posted by elisent View Post
I believe vyvanse is made by the same company as adderall.
Yep, I think you are right since all the patent issues is making them push this one now.

Day 1- she is on 30mg working up to 50mg by Monday. She has said that she doesn't like this as much as the concerta because she is feeling like she has no energy. I explained that she is on a much lower dose than she is used to on the concerta. I told her to hold her judgement until she is on the full dose Monday.
 

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I was at an apt yesterday and the dr. prescribed Vyvanse for a kiddo much like yours who has ADHD and BPD. And she was having increased irritibility. Which I personally think has more to do with life problems, relationships in the family and anxiety about going back to school, than drugs, but what do I know? If I knew anything about pharmacology I'd be pushing drugs. LOL I'm a therapist it's my job to think that it takes more than drugs or I'd be out of biz. So we shall see. She ended up on another mood-stabilizing drug. GRRR. He's a psychiatrist so he does what they do...tweaks the meds.

I know a lot of kids are getting changed to it and that some of the kids got Trapper Keepers from the doctors as a gift from the pharmacuetical co. I thought that was pretty clever as a mom of a kid with ADHD.

I am wondering about the dual dx with Bipolar and ADHD and I do see a lot of those kids get agitated on the stimulants and then get higher and higher doses of the mood stabilizer drugs. I think we have a problem splitting mania and hyperactivity as professionals and I think the BPD kid might get the short end of the stick because ADHD is more common in kids so they go the stimulant route first which is not what kids with MANIA need.

My son is on Concerta and I thought that that was one of the non-stimulant meds. OR that's what I remember the dr. telling me. I hope I'm not wrong.
We have an apt next week with a new psychiatrist and I guess we'll know if this is the new "IN" drug if they tell us how awful Concerta is. I was never a fan of Adderall-and for awhile they kept trying to push that or Strattera. A lots of the kids I worked with had ill effects on the Adderall so my ds never had that. I am going to be more skeptical of the drug if the Adderall ppl are they really are the makers of Vyvance.
We have to do something though cuz from what I can tell the Concerta isn't really helping ds pay attention but he is a lot less hyperactive. His school performance sucks though so I'm sure they are going to adjust the meds.
 

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Discussion Starter · #10 ·
From what I understand, Concerta is still a stimulant just not amphetamine based like Adderall and Vyvanse. Strattera is the only non-stimulant med for ADHD.

I am really hoping we do not see the same issues with the Vyvanse that we saw with the Adderall. However, DSD was not being managed for BP when she was on that. We DEFINITELY saw the agitation issues with her then. It was terrible. We switched drs and the pdoc when her dr would not entertain that she could be BP despite an intense family history of it with family members that have been institutionalized with it. The new pdoc was the one that heard our concerns and medicated for BP. Adding the stimulant in at that point has not been an issue for us.

I do hear you, though, about drs continually upping the BP meds to counteract the agitation. I know for us, we have really tried to big picture DSD's issues whenever she is having more trouble. Typically, it is just what you are saying about her life being a bit out of sorts and causing problems for her. That is how we are feeling about the depression side. She comes from a divorced home and has two completely seperate homes/families she is having to negotiate her way through. That is why we are going the therapy route for the depression issues before we medicate. kwim
 

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my son was on Adderall rx for his add, they took him off that and gave him vyvance. he wound up in the ER with heart palpitations pulse over 245 and palms blue he is going to be starting Concerta tomorrow I hope it works
was very scary!
 

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Vyvanse made my bp/adhd/tourettes ds psychotic (like all the other stim drugs they tried before settling on Tenex.) Clonodine and Strattera have been added to the med stew and the Tenex was discontinued (no particular reason, since it seemed to be doing a decent job- but you know the drill- new pdocs, new tweaking).

I would've fought it but thought we'd give it a shot- he's grumpy and sleepy at odd times, but the mania has chilled a hair. I am so stressed and busy with SSI (mine & his) & a SO who has had major brain surgery in the last few weeks, I'll work with them on further tweaking later (homeschooling does have its advantages; I don't have to give a flying rat turd what the bureaucrats in the district think of his odd sleeping habits while adjusting; he can just take a nap when he chooses!)
 
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