Intuniv Driving And Watching: Possible Detailed
Regular CorePsych Blog readers already know that we don't like wrong medication turns. Intuniv dosing is important. Intuniv safety has been carefully explored. Maps do help, but watching where we are going is even better. Consider this recent comment from a mother worried about Intuniv and Prozac:
Mom asks: It is such a relief to find some information from other parents and doctors who are trying Intuniv as it is such a new medication. My daughter has been taking it for about 6 weeks now. We went very slow on dosing just as you have recommended, and it is working wonders. I will say that she has become more irritable and extremely sleepy. I believe that as she adjusts to the dosage that the irritability goes away. However, we have just increased her dosage to 3mg, so she is still adjusting to the extreme sleepiness.
The doctor we are seeing put her on Prozac for anxiety, but have I read correctly that you would not recommend Prozac with Intuniv? She has been experiencing very strange sleeping patterns. She is either staying awake many hours, going to sleep right away and then waking hours early, or so sleepy she falls asleep around 6PM and sleeps through the night. Considering her sleepiness, the doctor recommended giving her the Intuniv at night and the Prozac in the morning, but this has not been helping. Should we be giving her the Intuniv in the morning despite her sleepiness? Also, would you recommend something other than Prozac for her anxiety.
Thanks for your kind remarks, and, yes, you read it right: Prozac and Paxil [and Luvox] should not be given with Intuniv, they inhibit appropriate metabolism, – interfere with Intuniv being processed by the body correctly. – And do skip the idea, suggested by some, that you should ‘simply use less Intuniv and do use Prozac' – the drug interaction experts entirely disagree with that incorrect strategy. Good guess, bad idea. 😕
Intuniv is a 3A4 substrate, but is not listed on the Prozac and Paxil link just above [is listed as such in the Intuniv PI [package insert]. You will see on this first linked list that they left out guanfacine as a 3A4 substrate, but they did cover the bases with the rest of the inhibitors I just listed. Also, on the induction [making it burn too fast and disappear] side, have to watch Tegretol or Trileptal, as they can both induce Intuniv [cause it to run through to fast requiring higher doses [see the first link], and for those treating bipolar disorder with Intuniv watch for Depakote as a inhibitor as well.
Your girl is very likely accumulating Intuniv by the blockage with Prozac, and is coming out the ‘Top of the Therapeutic Window‘ – with the result that your doc is doing what he/she knows best, changing the dosage time of day to accommodate to the obvious side effect. – Great idea if that basic drug interaction wasn't the key problem.
In this case I strongly recommend you download and print the above interaction link for your doc, and get off that Prozac. What I find so disconcerting in this interaction scenario: Intuniv gets blamed for this weird reaction, and Prozac [and others noted] are the culprits. I have repeatedly seen this kind of problem with AMP products such as Vyvanse and Adderall for years, as many continue along in denial that the CYP 450 system doesn’t require attention – and the fact that dirty drugs can create significant problems with otherwise clean medications that work very well, if used correctly.
The good meds often get blamed as they are new, and the old dirty ones get off, based simply on familiarity! Sounds like a popularity contest, not science. – Not good form in the context of evolving science – and not implying your doc has any of these attitudes – just reporting they are clearly out there. Please talk to your doc about all these matters.
Drugs that are clean on both 2D6 and 3A4 are Effexor, Pristiq, Lexapro, Celexa, – and Lexapro [see the list] has recently found an FDA approval down to 12 yo. Irritability and sleepiness should go away – but, without knowing more, I would try her just on Intuniv alone before running another med in there, it might work well as a stand alone.
For a very brief ~2 min audio message on this topic: Intuniv at CinchCast –
Over at Intuniv Interactions at Drugs.com they simply aren't looking at the CYP 450 challenges, and are waiting for someone to report these predictable interactions noted here. On a more positive note I do suggest going over there to look at the methylphenidate [Ritalin family] products as they appear to be interacting with Intuniv for some other unexplained reasons. Adderall, Vyvanse and the amphetamines appear clean and not interactive.
What do you readers think? Please drop your comment on these interaction matters when you have a moment-