Gold: First, Small Mom is right about the citris. Don't mix it with the med in the a.m. Second, there is an effective strategy to deal with the tic/ADHD combination. I've been all over this recently and ended up with a great result.
Recent research inidicates that the development of tics in children with ADHD is NOT related to psychostimulents. Stimulents can "unmask" tics but it doesn't casue them. The ADHD/tic combo has been viewed as difficult to treat. New findings (from The Tourette's Syndrome Study Group, 2002) show both Ritalin and Catapres (Clonidine), especially when used together, are effective in treatment.
I encourage you to discuss Clonodine with your P-doc. The Clonidine suppresses the tics and helps with both mood and attention, and the stimulent helps with attention/impulsivity. The Clonidine is best used in patch form since it is on 24/7.
The following article was helpful for me in getting my P-doc to look into the combo and agree to its use. It is working wonders for my kids (I have two with Tourettes/ADHD). (You will need to monitor blood pressure and do an EKG before starting as a precaution since Clonidine is also used to lower blood pressure.)
http://www.ninds.nih.gov/news_and_events/news_articles/news_ article_adhd.htm
This is a repeat of my post "Onset of Tics and Concerta." I want to be sure I reach people whose children are on Focalin.
Well, after being on 10mg of Focalin XR for about 3-4 weeks, my son now has the clearing of the throat tic again. It occurs every 3 seconds or so, and I therefore have no choice but to take him off of it. Not sure what I'm going to do next. I'm really frustrated because the medicine really helps him track when he reads and spell carefully when he writes. The first day that he took the Focalin XR pill with milk for breakfast, the tic left over from the Concerta completely disappeared! So, I thought maybe he needed to drink milk with the pill. I was giving him OJ with Concerta. (I know the type of drink is not supposed to matter, but it's just my observation.) While on Focalin XR, he did develop a very quiet sniff, but I thought of it as a trade off for the benefit of Focalin. Now that he is clearing his throat, and not quietly sniffing every once in a while, I tried to think of what has recently changed. I'm sure they're just coincidences, but I wish I could figure out the trigger!
Here are the changes:
One week ago, we switched from two 5mg capsules (taken at the same time), to one 10mg capsule. (At first he was on a trial, so 5mg capsules were used to build up the dosage.)
This past weekend we didn't give him medicine for two days.
Two days ago he didn't take his every day mulitple vitamin with dinner so we gave it to him in the morning with the Focalin.
Any thoughts?
First, you're never supposed to give these meds with acids like OJ because it affects the time-release delivery. So there is a chance he was getting higher doses of whatever med all at once, which might actually exacerbate his tics.
Second, I personally don't believe giving it with milk or a vitamin or anything else (except acids) will affect whether the tics are present or not. I do think drinking it down with water or sprinkled in a bit of pudding or applesauce are the safest delivery forms. I also don't believe using 2 5mg capsules or 1 10 mg capsule will make an iota of difference. It's all the same med and dose. You should definitely consult your doc on these issues, however, because I'm not a medical professional.
Third, we have been told repeatedly by our docs that tics are not caused by stimulants, but can be exacerbated by stimulants. We have seen my son's tics come and go, on meds or off, no rhyme nor reason to them. Since your son's tics are becoming a problem, I suggest you consult a neurologist because tics are a neurological disorder. I'm sure a neurologist can help you sort all this out. BTW, there are meds available that can reduce tics.
Fourth, does your son have co-morbid anxiety? My son does, and we've been told that tics can be fueled by anxiety. My son recently started taking Zoloft for anxiety, and his tics diminished a great deal. He had to stop Zoloft because of side effects, but is now on the anti-anxiety med Buspar. We'll have to see if the tic suppression continues.
Hope this helps.
Tenex and Clonidine are similar. The transdermal patch works for my daughter because it is active 24 hours/day. We use a half patch and while it doesn't eliminate the tics, they certainly diminish in frequency and intensity. We have to move the patch around on her back and shoulder areas because the patch tends to irritate the area it is on. She doesn't seem to mind.Thanks for taking time to post. I realize that tics are not caused by stimulants, although stimulants may exacerbate tics; however, my son has never had tics before medicine (neither does anyone else in our family) and his tics disappear after a month of being off the stimulants. I guess in his case the stimulants unmask tics that haven't yet surfaced without meds. My son does not have Tourettes, anxiety, etc. He is impulsive at times and benefits from the medicine when he reads and spells. It's not a necessity for him when he reads and spells, it's just that he reads more fluently and spells and writes without sometimes leaving out letters or words.
My son tried Tenex with the Concerta to stop the tics. I know the Tenex also lowers blood pressure. This drug did not help. I guess we could investigate Clondine. Where do your children wear their Clondine patch? Why did you choose a patch rather than a pill?