Have you read carefully the warnings on most antibiotics? I know that antibiotics are not as strong as the stims but if you read those pamphlets, there is a long list of 'possible' side effects on all of them as well...headache, nausea, cramps, dizziness....
As long as you have had your child checked out by a doctor before he began the meds and he will be checked regularly while on it, and you pay attention to how he acts while on it, I am sure he will be fine. Keep in close contact with the doctor and be sure to ask any questions that you have.
The heart related deaths that occurred were never proven to be at a higher rate than for children that were never given stimulant meds. The unmedicated population of children has about the same rate of unexplained deaths of children with sudden heart issues.....
Hello,
I just picked up my 3rd medicine for my 8yr. old ds. We are going the way of the patch this time. Daytrana 10mg which we are starting low because of tics. The warning on these meds. are enough to make you go screaming into the night. My goodness, the things they say in the pamphlets make me want to stop all this.
I will not though, I have seen glimpses of what could be with my son. I know in my heart he needs these meds. and I will see it to the end to find the right dose and meds.
Are these warning as ominous as they sound??
Thanks Vicky,
Both her anxiety and ADHD symptoms have been worse. And as I stated she has now developed trichotillomania (may be unrelated, but I don think so). We added Clonidine the past few days to see what happens. Today I skipped her Ritalin, she is VERY calm, but sort of sedated. I thank you all. I think I'll take everyones advice and call doctor...........again........ Maybe we need to focus on her znxiety, trich issues, and put the "ADHD" symptoms aside for a few weeks. Maybe going with Guanfacine and the Zoloft she is currently taking without a stim for now. Aaaaaaaaagh, all so frustarting. She looks terrible, she is pale and sort of withdrawn. She is just not right. She is a sweet kid, who doesnt have any of the aggressive issues. It is all the anxiety and extreme disorganization, concentration and very, very "fidgety".
The doctor who wrote the article referenced above has received grants for clinical research from Organon, Otsuka, Pfizer, Janssen, Eli Lilly, Abbott, Forest, and McNeil.
A statistic of 19 child deaths, with 13 of those having pre-existing heart disease is just impossible to side-step. It speaks for itself. You can toss around all the arguments that you want, it won't make the statistic go away.
This is where the guidelines for baseline blood work and ekg prior to starting meds are real impotant. Not only can you then avoid placing an at risk child on a med that might increase the risk, but you have the opportunity to identify a child that might benefit from inteventions to reduce the cardiac risks.
Unfortunately, some docs take these meds for granted and do not do proper screening and managment.
This is like the person who is put on lipitor without proper labs for liver issues or blood pressure meds without followup blood pressure messurments.
There are almost no thought leaders in any medical science area that have never receive grants, given lectures, participated in clinical trials, etc for pharmaceutical or device companies. Most companies want the most expert thought leaders as the principal investigators for thier clinical trials as well as on thier scientific advisory boards. If you want to design a good trial or determine if your approach to a disorder makes sense, you go to the experts. The good thing is that they are usually really good about letting you know thier ties to industty. Much better than those who do not disclose this information.
[QUOTE=chasesmom79]The heart related deaths that occurred were never proven to be at a higher rate than for children that were never given stimulant meds. The unmedicated population of children has about the same rate of unexplained deaths of children with sudden heart issues.....
[/QUOTE]
Where did you get this information? Of the 19 child deaths in the study, 13 had pre-existing heart conditions. The comparison is medicated children with and without heart conditions, not medicated heart children and unmedicated heart children.
Have any you using Daytrana seen fewer side effects than some of the long acting stimulants? My daughter suffers with side effects tics, no appetite, increased anxiety with most all stimualnts we have tried so far. Not sure if we should really try the non stimulant route or maybe the Daytrana, we havet tried it yet.
Diane V,
Anxiety can make tics worse and ADHD symptoms worse, and in you daughters case these get worse with the stims. There is a very long thread called Tenex on the medication board that has info on this med.
Guanfacine can be added to help with tics. It has effectiveness for many ADHD symptoms and it can make it so a lower dose of the stim can be used.
Alternatively, treating the anxiety with an antidepressant might be needed.
Those are some things to discuss with the doc. I am sure there are other approaches as well.
My youngest had severe anxiety before treatment for ADHD. Her anxiety gets worse when the meds are not helping enough. We are also watching for the return of the anxiety to maybe add treatment for that if needed. She also is slowly gaining weight with the focalin/guanfacine combl. The doc switched her to focalin because it may not be as bad at suppressing appetite.
vickie39201.3287962963The warnings on tylenol are just as bad. It is said that if tylenol were new today, it might not be approved. It has more serious side effects like liver damage than methylphenidate does.
Or look at the heart warnings on decongestants.
Or aspirin and the chance of Guillain-Barré Syndrome with aspirine.
It is good to start low so that if there are side effects, they are mild and you don't advance to higher doses. Close med managment by the doc really helps reduce or elimiate serious side effects. Were baseline blood tests drawn and an EKG done? These are becoming pretty standard.
My mom was recently telling me about some guy in her church who had a psychotic episode that the doctor's finally linked to an antibiotic he was taking. I went and read through the packaging on the cipro I was taking for a uti. Scary, but I never thought twice about taking it as it was doing way more good than harm.
Just keep in mind that those scary side effects are extrordinarily rare. Like Vickie said- Tylenol can cause serious liver damage. The guy I get my first aid/cpr training from is an emt and he said people have no idea that they can OD on tylenol and are very suprised when they find out that's why they've ended up in the hospital.
The good news is that with the added attention, docs are more careful about monitoring patients on these meds so that increases the safety.Here is the article comparing the cardiac death rates in the general population to that on AHDH meds:
http://www.medscape.com/viewarticle/527857
This shows that the cardiac death rate in the ADHD med catagory is less than that of the general pediatric population.
The guidelines are a recent response to the additional warnings and if there has been not heart related problems then there probably wont be. The EKG is for baseline so that if you get the racing or pounding heart side effect, you can better wait it out rather than stop the med and try something else or investigate the symptoms. The blood work is to rule out some disorders that can mimic ADHD and to get baseline enzymes for organ function (heart, liver, kidney) and the CBC for anemia and platelets. Liver function is followed for potential damage due to med metabolism (most meds are metabolized by the liver and disposed of by the kidneys), anemia can occur due to poor nutritian and cause lack of attention, platelets can drop in some people on these meds, etc. These are not common but it is to err on the side of safety to monitor.
My kid's doc has never seen a problem in kids for the ADHD meds but still monitors. He has seen issues on some of the heavy duty meds for more serious disorders especially with multiple meds.
Many docs do not monitor thier patients on things like lipitor, but as you age and are on more meds, it is important to follow for potential liver damage.
Thanks Vickie
Do you do just the initial monitoring or is it ongoing while your kids are being treated? I still find it strange that our dr. wouldn't do these initial tests. He did say that if we added guanfacine to her stimulant that she would need an EKG but that if we waited until the new extended release form came out that the EKG might not ne necessary because of the newer information from the new studies. It's almost like he doesn't want to deal with doing tests on her!! We've already tryed one other child pyschiatrist but didn't love him. There is a good children's hospital here. They have several pyschiatrists listed on their website that treat ADHD. I wonder if I should try one of them. What kind of dr. do you use?
Thank you so much for all this info!!!!
Here are some of the guidances for monitoring meds (and the addition of guanfacine does merit an EKG):
http://cme.med.umich.edu/pdf/guideline/adhd05.pdf
http://www.adhdtraining.co.uk/medsmonitoring.php
Most of our blood baselines were done by the pediatrician during the initial testing to rule out things that can mimic ADHD. The psychiatrist ordered a few more tests.
The psychiatrist uses guanfacine with the stim on a fair number of his patients (to give 24/7 symptom coverage). This, and his individual experiences with patients and thier parents are probably different than the experiences of your doc and his patients and thier parents. This affects the meds they choose first and the way they practice medicine.
If your doc fits your needs, ask the pediatrician to order blood work to monitor CBC and organ function at your child's next physical.
Both of my ADHD kids are on adderall XR, the oldest for almost 4 years. We go to a very highly respected child pyschiatrist and neither one of my kids ever had bloodwork or EKGs prior to starting meds. It's weird too because I consider our dr. to be very conservative. I have really pushed to add guanfacine to my oldest's stimlant because I think she could really benefit from it. He doesn't want to because of the potential risk of combining the two meds. He said maybe we could try guanfaine by itself this summer.
What are they looking for when they do EKG and bloodwork prior to starting meds? I thought that the risk with stimulant meds is higher for children who have structural abnormalities of the heart which are not detected by bloodwork or even EKGs. A structural abnormality would probably have to be detected by an echocardigram or something even higher level. Did your dr's indicate what info they get from bloodwork and an EKGs? I want to make sure we are doing the right thing!
Thanks!