Appointment with Psychiatrist today - nee | ADHD Information

Focalinxr(8-12hr) is a cleaner form of Ritalin and so far seems to have much less side effects. we don't see the big Come down at the end of the day. Now in order to funtion at activities that go into evening, we are going to need something to calm him down. Either zoloft or tenex has been suggested to us so far, We meet with the phych in 1.5 weeks to talk about progress and maybe ramp up the FocalinXR and see what happens, and possibly add something for late afternoons and sleep.I like my son's psychiatrist but he could be a little more innovative so we need advice from other parents.  Here goes:

My 9 year old currently (since May) takes 35 mg. of Straterra (the amount for his weight) each day and 25 mg. of Zoloft every other day. 

We have learned from this summer that, for school at least, he functions best with a small dose of a stimulant also.  We have been giving him 10 mg of Ritalin LA (I dump the 30mg capsule and divide for now) for the last week and a half.  It seems to be enough to get him through school (so he says and I haven't heard otherwise from his teachers) and he eats - yay - BUT he is an emotional basket case in the afternoons!! Even on this low dose (he took the 30mg for years)

Here's the weird part - on the first 6 days being back on the Ritalin, he was fine - great even.  But after that, he was a wreck in the afternoons and evenings.  This happened with school and non-school days.  I didn't give him the Ritalin yesterday and he was fine. 

We have tried, in the past, switching him to Adderal XR, which really gave him mood swings, and Metadate, which was no different than Ritalin.

We need a very low, long acting dose.  I wanted to try the patch but the smallest dose is 10mg, which I understand is more like 20mg because it goes directly into the blood stream.

Has anyone had success with another stimulant + Straterra?  Does anyone have the same reservations with these long-acting drugs as I do - that they don't really leave the blood stream by evening?  I am beginning to think that I should be giving him 5 mg. regular Ritalin and sending in another 5mg. with the nurse like they did it in the old days.

I'd be happy for any advice - quickly!  THank you!!
He had been taking Ritalin 30 mg. for 4 years.  The Zoloft started not long after the Ritalin because of some OCD behaviors. It was at 25 mg. every 4 days for a couple of years and then 25 mg. every 2 days. 

We only started Straterra in May.  We had tried upping the Ritalin to 40mg for school - he needed the extra concentration - but the side effects were too much.   I found a pharmacy that could make the Straterra into a liquid so we tried that.   When I asked the phsyciatrist about the Straterra with the Zoloft he said that the Zoloft could make the Straterra work better but we never discussed lowering the dose.

UPDATE:  We went to the doctor and we all agreed to try the Daytrana since most of his problems with the LA come in the afternoon when he is coming down from the meds and the patch works longer.  The other possibility was giving him a 5mg. of regular Ritalin in the afternoon but I'm starting to feel like my own pharmacy here!  Also, if the patch works then he can do an after school activity without me rushing in with another med.

I suppose if this works (or more importantly if it doesn't) then we should look at cutting back on the Zoloft.  I've never been a fan of putting 3 meds into my kid, but we need to find something to work for him.   The Straterra has been great - he has almost no side effects from it and he made it through a whole summer without stimulants.  Even now, if he can be on a much lower dose of Ritalin, then he'll still be eating OK and taking weekends off isn't a problem.  Before the Straterra, the idea that our kid could make it a day without the Ritalin was impossible.   He was bouncing off the walls from when he woke up until it would kick in and I HATED to see the zombie but it beat the wild boy. ARGH!    I SO wish that the Straterra helped with the impulse control thing or that behavior mod could be enough to get through school but for now at least, it's not. 

Anyway, I'll report back on our experience with the patch. My husband is out filling the scrip now. 
Try the patch, it ramps up slowly...and I think you got bad advice.  Yes it goes directly into the bloodstream but slowly.  It actually takes many kids 1-2 for you to see any diff. in behavior.  I had to give an IR (immed. release) med  first thing in the morning when I put the patch on, it took so long.

The patch is OK, but switching hips and maintaining the health of the skin is a chore if you have more than 1 or 2 kids, it's just another chore to do.

The 30 mg. patch is very mild.  If your child does well with methylphenidate meds (Ritalin, Metadate, etc.)  try the Daytrana.  You can probably get a free voucher and then you're out no money just to try.
< ="text/">_popupControl(); IF he is having issues with Ritalin LA then trying another med may be in order. it is also possible the Zyprexia is too high. When used with Strat alot of other meds need to be lowered, even halved. I was going to say what edbson said. Zoloft will increase the blood level of the other meds. My daughter took 20mg RLA dn we added Zoloft, the doc said it would be more like giving her 23 or 24 mg of RLA, enough to send her anxiety and tics through the roof. How would he do with just the Zoloft and RLA, no Strattera? Or just the Strattera and RLA and no Zoloft?