adding Tenex to Focalin? | ADHD Information

OK, so he's more than maxed out on Focalin, becoming an emotional, moody, defiant wreck (which is why he's been on Focalin for so many years, every other stim made him a sobbing heap of tears and Focalin was the only one that didn't... until now) and we are panicking.

Considering Tenex as an add on, will discuss w/doc in a few weeks, but many questions first.

Starting dose to avoid zombie side effects? 
Once a day?  Twice a day?
Can we lower Focalin once Tenex kicks in?
Will it affect his blood pressure during sports (he's VERY athletic)?
Anything else I can think of?

I desperately need some advice here.  Help! aesposito39958.8748263889Every person is different, but this is what we did/found.   We use tenex in combination with Concerta.  We started it to manage tics & some anxiety.  The combination works well for my daughter.

Started with .5 in the PM for a week and then added .5 in the AMAfter 5 months or so,  went to 5. am and 1 pm and then to 1 mg AM/PMWe've played around with 5. am and 1.5 pm and that didn't work well for us.  She was more agitated in the evenings. 
Initially, it did make my daughter tired but it got better with timeAt 1 mg total - I saw no decrease in athletic performanceAt 2 mg total - she has not performed as well - but I also don't know if it is related to puberty, growing,, weight gain, growing, lack of interest, coach, etc.  It's been really hard to pin down.   We tried switching decreasing the dose in the AM and increasing the PM dose for the same amount, but that didn't work for us.  We tried decreasing the over all dose and then didn't work well either (her tics increased) - so we were back to the 1 mg am/pm.
Thank you so much for your response... the sports thing is important because it's one of the few things he feels really good about and proud of....

Do you give the evening dose for sleep?  Or is it one of those meds that has to be given evenly throughout the day to work right?

Oh, and were you able to lower the concerta after a while, or did it stay the same?

Audrey
aesposito39959.2507986111

OK all, starting Tenex tonight... fingers crossed....

Got it from my pediatrician, he seemed relatively comfortable with it... wanted to start him on 1 mg once a day but when I told him I'd heard .5 once or twice a day is a better place to start, he agreed.....

So I'll start with .5 tonight and probably hold off on a morning dose for a week or so.  Also dropping his Focalin back to 20 mg xr bid and will hold off on Melatonin as well for a bit.....

I'll probably start a new thread as I see results...

Audrey

We slowly increased Tenex, too.  We started w/ .5 mg PM only, then added .5 mg AM about a week later.  Then, 1 mg PM, then increased to 1 mg AM.  We stayed there a long time until he's now at 1.5 mg PM and 1 mg AM.  He takes it to lower impulsivity, hyperactivity, and anxiety. 

Since this medicine lowers blood pressure, he had blood pressure checks after each dosage change.  I think he went on Day 5 for the check, but I forget exactly when the doctor did it.

We found the Focalin dose got too high when combined w/ Tenex, so we lowered the Focalin.  That worked well for a little while, but Focalin XR never worked for him at one dosage for more than a few months.  He's done better on Metadate CD.  He's been on the same dosage since October '07!

For the first few days on a dose, Tenex made him tired.  Then, he got used to it and was his normal self energy-wise.  It also increased his appetite some, which was good.  He used to not eat anything from breakfast until dinner.

Know that Tenex does not help with focus.  We've had that problem w/ sports that take place after the stimulant has worn off.

Mom2ADHDboy39959.5908680556 [QUOTE=Mom2ADHDboy]

We found the Focalin dose got too high when combined w/ Tenex, so we lowered the Focalin. 

Know that Tenex does not help with focus.  We've had that problem w/ sports that take place after the stimulant has worn off.[/QUOTE]

Both excellent things I need to know..... thank you!  It sounds like we may be able to back off on the Focalin a bit, but not a lot.....

Audrey
My daughter is currently taking Concerta at 27 mg.  We haven't adjusted this dosage in 1.5 years.   We've debated all school year increasing her to 36 mg, but left it as is as she is doing well. 

We started tenex for two reason - to help reduce tics and to reduce reduce the bouncing off the walls in the evening.    It doesn't aid her sleep but with her more calm,  it is easier to get her to bed.

Tenex is an interesting medication. The results are ones that are more subtle.  She started it during a really difficult basketball season for her.  She always hung with me before practice.  After starting the med,  she was less anxious and would go right on the court and play with the other kids.    She's more mellow in the evenings, but not sedated.
Thank you for all this feedback.... so, so helpful! 

Another question to all: did your pediatrician prescribe the Tenex, or did you use a pdoc?  Currently my son gets his Focalin through his ped, but we have a pdoc for my older daughter so I could easily switch him over..... I don't know my ped's comfort level on Tenex and other non-traditional meds....

Audrey We use a psychiatric nurse practitioner to manage my daughters medication.  We have been working with her for almost 3 years and she is knows her stuff. We went to ped nerologist for tics and she put him on focolin and clonidne- wanted to put him on tenex but i had read some articles about clonidne and wanted to give it a try.  It has helped a lot.  Made him happier and not as angry.  He also has sleep apnea and restless leg syndrome.  Found that out thorugh sleep study.  took his tonsils and adnoids out and he now requires less hrs of sleep and isn't as cranky.  He's on iron supplements for the leg disorder.  I personally love the combo orf the tenexor clonidine  and stimulant together.  My family dr wouldn't prescribe tenex or clonidine because he hadn't had experience with it for tics.  Of course that is the nerologists area.At first, the psychiatrist started my son on .5 mg of tenex about an hour before bedtime because it can cause drowsiness. He then added .5 mg in the AM. He now takes 1 mg AM and 1 mg PM. After his body was used to the meds he moved the bedtime dose to evening. Like Horsemom said the effects are subtle. It really helped my son with his frustration and anger. He used to get frustrated and then angry many times a day. He has much more patience since taking tenex. If he does get frustrated his anger is not as strong and does not last as long. It has really improved his all around mood and anxiety. My son uses Daytrana during the day. I used to give a short acting afterschool  dose of focalin but since using tenex it is not neccessary. My son does't seem to have any side effects from the tenex. Thank you again everyone, your experiences are soooo helpful!  We have a pediatrician appointment June 6, and we'll see where we are after that....

Thank you!!!

Audrey