Problems w Strattera, Concerta. Now What? | ADHD Information

This is rather long but I thought it would be helpful if I added her background.

My dd is 11 years old.  She was diagnosed with ADHD at 7 years old and was given Strattera.  We used it for several months and while I saw no improvement in her ADHD symptoms, I did notice a change in her overall mood or demeanor.  She seemed to get mad more often.  There were several times where she would have episodes to where she would be so mad that there was no controlling her and it would always be over the simplest things.  By the 4th time this happened, we finally associated this with the Strattera and took her off.  She continued out the 2nd grade with no meds but she never had any more rage episodes.

At the beginning of the 3rd grade (8 years old), we decided to try something new....Adderall.  She only took it for 4 days before she had an episode where her heart literally looked like it was pounding out of her chest.  We discontinued the Adderall and toughed it out for another year in school.

For 4th grade (9 years old), we really wanted to find something that would work and asked about Concerta.  The difference was night and day for my child.  She could now finish all her school work in school and not bring it home each night.  Homework now took about 20-30 minutes instead of the usual 6-8 hours the previous years.  She continued this for 5th grade as well.  If we missed a dose in the morning, it was obvious because she couldn't complete anything at school.

But by the end of the 5th grade (10 years almost 11), she started having episodes where her heart was pounding out of her chest.  It looked almost cartoonish.  We were eating dinner the first time we noticed it.  I immediately stopped the Concerta and took her to the Dr the next morning.  He ran all sorts of tests and ruled out a thyroid condition, anemia or enlarged heart.  She was referred to a pediatric cardiologist who repeated the echocardiogram.  She had a leaky valve but did not have the usual heart defects that are associated with ADHD med related deaths.

I asked the Ped Cardiologist about going back on Concerta in the fall and he said that there was no way he would ever recommend those types of drugs because of the black label on them.  And that I would have to weigh the benefits verses the risks.

She continued out the school year without meds.  It was horrible.  Everything came back with a vengeance and her teacher asked if and when she was going to get to go back to her meds because she was worried about her academically and socially.

We just took her back to her regular Dr who is now hesitant to give her any of the usual meds.  She only felt comfortable with Strattera.  I agreed that we would try it and she is now on day 4 of her initial start up dose.  However today has been horrible.  She has been aggressive with all of her cousins, told me she was just mad at everyone but couldn't explain why, and wanted to go home.  All of this from a child that has always begged to go to this particular home and never wants to leave.  I know it's Strattera.  She seems to already be having the same symptoms as she originally did on it. 

But now I don't know what to do because her Dr doesn't want to prescribe any other drugs because her heart was pounding last April.  And I certainly don't want to give my child anything that will harm her, however I have my doubts about how she'll make it at school without some sort of help. 

If you've made it this far, thanks!  I would love to hear suggestions on what we should do next?

You might need to look at the 3rd line of meds like antidepressants, mood stabilizers or blood pressure meds (tenex and clonidine). It may be that something like tenex will work alone or with a very low dose of stimulant. These meds all have effects on dopamine in the brain and can be very useful for some patients. Look up the Tenex thread on the medication board for info on this med.

I would get a referal to a child psychiatrist who is very experienced with med managment. They will have more options than a pediatrician would be able to offer.

I agree with vickie, you should see a pediatric psychopharmocologist. They will really understand all the meds and potential risks. Most peds will not prescribe off label, which is good, we dont want just anyone giving our kids just anything. There are other options out there. Stimulant meds and Straterra are just always first option as they have been studied and approved for ADHD treatment. As you are experiencing though, they don't work for everyone. We had the same problem. Could not tolerate stimulants due to side effects.

hi my son also started stattera last week, i was thinking the same as you with it all.... ITS NOT WORKING.. what now.. but we went and saw the doc and he told us that it needs to be ramped up properly and it may take as long as 4-6 weeks to see any positive effects.. my son has been the same a little moody and the behavior seems to be getting a little worse but.. persist with it i have heard it does great things when it all comes into swing and the effects are at there peak... pm me if u needa talk i know what ur going through!!

 

 

keep ya chin up it will get better.

Strattera needs to be ramped slowly, and started at 10mgs. It is dosed by weight, at a rate of 1.2-1.8 mgs per kilo. It is possible her dose is too high, and that will cause mood swings and aggression.

What is his weight? Strat is very strictly dosed by weight, and issues are usually caused by too high or too low a dose. Steroids DO cause behavior changes also, something we just deal with when dd's asthma flares.

edbson- his weight is 53lb. So do you think his doses r right?

My son is also on straterra.  He is 5 yrs old. Sometimes I feel the same as you ( OnlyOne). In the morning he takes 10 mg. and 18 mg. after dinner.  We feel like we CANNOT take him anywhere. He acts so out of control! Come to find out his psychiatrist moved and now I'm in the process of finding someone else  My son has not been on straterra quite a year yet. My other son who is 4, is the total opposite,sooooo calm. And YES it is exhausting! I have the summer off with them. I'm happy to have that option, but then I feel like I'm gonna pull my hair out!!!! School starts tom., and I'm soooo relievied! I'ts like a big weight lifted off my shoulder. I feel horrible saying that though, but I do! I work in their school, so when they r off so am I. When I started my son on Strattera my mother freaked, and so did everyone else. They don't think he should be given those types of meds. They're not good and etc...... Well all I have to say is that unless you put urself in my shoes you wouldn't understand! They're not with him 24/7. Also just found out he has asthma. Mixing his straterra and his inhailer(steroid) has made him into a monster!

Any one have any suggestions, let me know!!!!  

 

His target dose is between 28-43 mgs, so he is on the very lowest dose for his weight. He might benefit from a slightly higher dose.  OnlyOne,

have you tried dexedrine/dexostat and/or Vyvanse? It's another
stimulant (dextroamphetamine) but supposedly it doesn't effect the body
like other stims do. Vyvanse is basically a long acting version of
dexedrine. I just started Vyvanse and so far so good. I definately don't
have the racing heart I have had with adderall and concerta. It might be
worth asking your Dr. about. I think the dexedrine comes in 5mg pills
that would need to be taken throughout the day, which might be good if
your child did have a bad reaction. Vyvanse lasts 12 hours (so they say).
hth

I think focalin (in the methylphenadate family (ritalin/concerta) might not
have the jittery, increased heart rate stuff like concerta, but i'm not sure
and don't know how it works.Well, once we find another doc. for him I will have to ask about up'n the dose.