It took 3 weeks at one dosage level of guanfacine to see the optimal effect.
According to our ped. psych., we should have seen results within a few days.
So, the whole process took a few months b/c he started with .5 mg just at night, then added .5 mg AM, then went to 1 mg PM and .5 mg AM, and finally to 1 mg AM and 1 mg PM (he stayed at each dose for at least one week before we changed anything, and of course additions were based on how he was functioning).
At what times of day is the aggression occurring?
Various with no pattern. That was also a question the ped. psych. asked me.
That might be very telling, for it might be when one of the medicines is wearing off.
Also, when do you give the two medicines? I found it works best not to give the Metadate CD and the guanfacine at the same time. We space them by about 45 minutes.
We were giving them together in the a.m. and then just the Tenex in the afternoon.
Re dosing, stimulants are not based on weight.
I think I said the Tenex was weight-based or that's the impression I got from the ped. psych.
They're based on how the individual responds. My 50 lb. 7 year old has found 50 mg to work well for him (at least so far. He's been on Metadate CD for only two months now, but we slowly climbed up to 50 mg and finally I feel like we're in a good place and I've gotten great feedback from school. May it stay this way!).
Hope it works for you! It was good for us the first few months, and then Justin started picking his skin on his fingers until he removed enough layers that it was bleeding. But this didn't happen until he was close to the 5-month mark. That's why we lowered the dose after discussing it with his primary care dr.
[/QUOTE]Some kids get good results with risperdal, but some parents have posted that it increases anxiety. As with all treatments, effects are very individual. My youngest does really well on risperdal for anxiety and aggression, but since we are going into a new school year, we must be ever vigilent for the return of anxiety. One side effect of this class of meds is weight gain; which is welcome with my skinny child.
I was at first reluctant to use this med, as it was first developed for schitzophrenia and then used for bipolar and more recently approved for autism. Then I found studies of the med in kids at the lower doses and positive effects so gave it a try. Talk to the doc about what to watch for (good and bad). Here is more info than you probably want to see:
http://www.dshs.state.tx.us/mhprograms/ticsalgo.pdf
http://www.fda.gov/cder/foi/label/2007/020272s46s47,20588s36 s37,21444s20s21lbl.pdf
http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index. cfm?fuseaction=Search.DrugDetails
It took 3 weeks at one dosage level of guanfacine to see the optimal effect. So, the whole process took a few months b/c he started with .5 mg just at night, then added .5 mg AM, then went to 1 mg PM and .5 mg AM, and finally to 1 mg AM and 1 mg PM (he stayed at each dose for at least one week before we changed anything, and of course additions were based on how he was functioning).
At what times of day is the aggression occurring? That might be very telling, for it might be when one of the medicines is wearing off.
Also, when do you give the two medicines? I found it works best not to give the Metadate CD and the guanfacine at the same time. We space them by about 45 minutes.
Re dosing, stimulants are not based on weight. They're based on how the individual responds. My 50 lb. 7 year old has found 50 mg to work well for him (at least so far. He's been on Metadate CD for only two months now, but we slowly climbed up to 50 mg and finally I feel like we're in a good place and I've gotten great feedback from school. May it stay this way!).
Then I'll definitely be back in touch with you, Diane.
Thanks!
Thanks,
When the new neurologist told us to stop Strattera, she gave us a script for the Focalin. Then we saw the Primary Care Ped and he said not to change the medicine, but lower the dosage, because he knew it was way too high.
Hopefully, this Ped. Psych. doctor will call me before I have a nervous breakdown. I lost my first husband in the Gulf War and didn't think anything could affect me as bad as that, but having an ADHD child is more stressful than when my husband died.
I can understand the frustration and pain you are going through as far as having an ADHD child. My husband did not die but at this point he is of no use whatsoever and he might as well be off somewhere else anyway. The focalin works great so far. The teach says he is doing great, saw her yesterday, he has almost no side effects. I would go with what the child phychiatrist tells you. Good Luck with whatever you choose. And my heart goes out to you as far as your huband goes.spamula39343.3741319444
Thanks Spamula,
I talked to the doc's receptionist and she assured me he will call me soon and we'll get the medicine straight.
I'm willing to try other meds, but this is the first time we've had a Psych. to really follow him on the medication and determine the best med. or combination of meds.
I'm just really hoping that the extra attention they are giving Justin at school helps him do better today. At least they understand meds and side effects of meds at this school and are trying to work with us on this.
Okay everyone,
I spoke to the doctor and told him the situation. We are stopping the Tenex today and starting Resperdol. He said we should know if it's helping after one or two days. I guess I'll post again in a couple of days.
Thanks!
good luck momval. My first husband also passed away and it's hard enough getting past that, so I truly understand where you're at.
Diane,
Sorry to hear that. Thanks for your response.
My husband wants to research the Risperdal before starting it since it is in a different class than anything we've tried before.
Hopefully, some of this aggressiveness and anxiety will be better just by stopping the Tenex. Today, the doctor told me we should have seen results within the first few days of taking it. But the only thing we noticed the first few days is that it did help him sleep better. But it was no help for the anxiety and made aggression much worse.
Justin may wind up being one of those kids who can't handle stimulants. I don't know anymore.
well my daughter is also one of those kids who cant take stimulants. There are a few members who have children on Risperdal, you can get some answers here on that too.have you tried just 1mg of tenex for the day?have you tried other stimulants besides metadate? Some increase anxiety more than others.
On the dosing, we were on too high of a dose of Metadate; he was picking fingers until they bled. That was 40 mg., we went to 30 mg - because I told our neurologist we needed a lower dose for him at Summer Camp. THen our son's primary care doctor told me that he needed to be on the lowest dose possible. At the 30 mg., he tended to go on cry jags at Summer Camp. So we went to the 20 mg. and he is able to sit and focus, but still has the anxiety issues.
I don't know what to think. The Tenex, I believe is according to weight. He takes .5 twice a day. Our ped. psychiatrist said 30 percent of kids can't take stimulants. He didn't explain why, but I'm wondering if all the side effects are one reason.
Oh, and we keep a behavior chart. He occasionally has rebound, but not daily. He's never on or off medicine had 5 straight days with aggression, although he has been aggressive.
It was prescribed to be taken two times at .5 because it keeps the blood levels even.
We tried Strattera, but had to give Metadate at the same time on camp days, so while we didn't notice anything but better sleep while on Strattera, we were told to quit it rather than wait another week since school was going to be starting soon.
I'm hoping there's some type of medicine out there that will make a difference for Justin, because one-on-one and with people who he sees regularly, he's a great kid. When he gets overstimulated is when the problems seem to start.
may be worth trying a different stimulant.
I agree, A new stimulant might be in oreder. Have you tried Focalin yet? My son had anxiety issues and I was told by a couple of reputable docs that it has a better side effect profile for anxiety. it has actually helped some of his anxiety. I would say another talk with your physician is in order. Good LuckCould the dose not be the right dose? I remember changing within days or a week. My son was metabolizing quicky and we were trying to keep up.
The mad, sad, happy, etc description sounds like rebound but I may be wrong.
You might keep a diary of when he takes each med and the responses through the day. This might help determine if it is med or rebound. Also, if anxiety has been increasing, it can make the brain less effecient and make meds not work or only work poorly.
What dose tenex is he on and what has been the titration schedule? Tenex without the stimulant can control impulsivity and hyperness (but not as good with attention).
It may be that dropping or decreasing the metadate will be needed to get the anxiety under control. And if tenex is not good enough, the doc might need to move to other meds for anxiety, like antidepressants or antipsychotics.
It can take work to get the best combo for the individual, so hang in there.
My youngest has anxiety that causes issues from time to time. In her case it is due to frustration with school. We went from stimulant to stimulant plus tenex and now stimulant plus tenex plus risperdal. I have my sweet daughter back and the aggressiveness is gone (but school is starting again).
Hi everyone,
We finally got in to see a good ped. psychiatrist and explained that while we see some positive results from the Metadate CD, the increased anxiety from this medicine is causing new problems. He added Tenex to treat the anxiety.
Justin is 6 and was originally diagnosed with Sensory Processing Disorder and received lots of OT for that, but in school, he was acting out very impulsively - either trying to be funny and doing inappropriate behaviors and showing impulsive/agressive behaviors.
Once he started on Metadate, his handwriting improved overnight; he met all of his public school OT goals; he also met all his public school Speech Therapy goals and was released from both of those programs.
His private OT said his ball skills improved 300 percent from no medicine to starting medicine and all 3 therapists were happy that he was able to sit, pay attention and follow directions better.
Now, we have him in a Private school for ADHD kids and the staff is excellent.
We started the Tenex two weeks ago, and he has been aggressive either at home or at school 5 out of the past 5 days. Even before medicine, he didn't show this much aggressiveness. On just the Metadate alone, he was aggressive, at the most 3 days out of a week.
Could we have gone from having too much anxiety with Metadate, to having even more anxiety plus aggressiveness when we added the Tenex?
I appreciate any replies I can get on this.
Justin is "very" everything - sweet, mad, tired, thoughtful, kind, etc. - and I am worn out.
Ready to ditch it all down a toilet...
Val
Yes, you could have the wrong med combo which would cause problems. I would say that NEITHER one is the right med.