You mention that she seems to sleep better when you leave the patch on longer. Some people fall asleep better with meds in thier system. Talk to the doctor about leaving the patch on until bed and see if the calming effect of the med helps (this might allow you to stay on the current med). Another parent here reported using nasonex (steriod like nasal spray for allergies) on the skin at the doctor's sugestion, before adding the patch (another thing to discuss with your doctor).
If you need to move to a different med, guanfacine (Tenex) might be a candidate since your primary concerns are hyperactivity, impulsivity and sleeping. This is a blood pressure med that is used off-label for ADHD and Shire has completed studies to ask the FDA for marketing approval to use a long acting form for ADHD. Here is some info:
http://www.peacehealth.org/kbase/topic/detail/drug/hw164961/ detail.htm
http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=109&ST ORY=/www/story/08-24-2006/0004421422&EDATE =
vickie39024.402349537Thanks Vickie- Those are good suggestions. I even have some nasonex at home. I'll talk to her dr. about it.My daughter takes guanfacine (generic for Tenex) 1mg, 3x a day (morning, after school and before bed) and Concerta in the morning. Alone, the guanfacine controlled hyperactivity, calmed her, helped her sleep, reduced impulsivity, reduced defiance (with other things we put into place), but was not enough for focus at school. However, it helps with homework as the concerta is wearing off. The doctor has said that we can increase to 2mg, 3x a day if we want. We use the combo because she was losing weight on the concerta and not getting enough benefit (hyper and impulsive in the afternoon and not getting homework done). So rather than increase the concerta (making weight issues worse), the psychiatrist added the guanfacine. I would have preferred a single med, but I am happy with my daughter's response to the current treatment. She is getting As and Bs at school (she failed last year), she is happy and doing better with friends, her relationship with me is wonderful, and with her dad is improving weekly (he always seems one step behind).
Dose changes (up or down) need to be made by 1/2 mg increments, to avoid blood pressure problems. When shire gets approval (8 months or so) for their guanfacine med, there will be a long acting form to get away from the 3x a day issue.
Hi: My 8 year old dd was dx with ADHD 3 years ago in Kindergarten. She has mostly the hyperactive/impulsive type. She is sweet, eventempered and smart but SOOO hyper and doesn't have much self control. She has been on Adderall XR for the past 3 years with great success. We began at Adderall XR 10mg which worked great at first but every 6 months or so we've had to increase her dose by 5mg just to maintain the same effectiveness. So she began at 10mg and over the course of the 3 years she has gradually gone up to 30mg. Well, now in 3rd grade the 30mg isn't working so great anymore. Her psychiatrist doesn't want to increase her dosage from 30mg. He says her brain is used to the adderall and we need to switch med groups.We had tryed concerta without much luck so she has now been on Daytrana 30mg patch for 2 weeks. She also has to take a 5mg focalin tablet in the morning because the patch takes forever to kick in. The patch overall seems to work pretty well. It definitely lasts a long time and gives pretty good control once it kicks in, but it is such a hassel to put on and I am always worried that it is going to come off at school which would be a disaster for her. Her unmedicated behavior at this point is major rebound. Our dr. suggested storing the patch in the refrigerator which does help the backing come off easier. The red spots on her hips are starting to become a problem. They seems to be getting worse and I am having a hard time finding a spot to put the patch. I have been using hydrocortisone cream on them at night which helps a bit. The biggest problem though is that she cannot get to sleep at night no matter what time I take the patch off. It's actually a little better the longer I leave the patch on. Adderall actually helps her sleep but the ritalin products seem to really keep her up. SO I don't know if we will be able to continue the patch for all the various resasons.