Past Intuniv Posts:
This post is the fifth, with four others, documenting Intuniv Overview, Dosing Details, Drug Interactions and Addiction Indications. Please review all of these posts and the many comments [over 200] on the Overview post to see what readers are saying about Intuniv, this interesting new ADHD non-stimulant medication.
If you have been reading CorePsych Blog you will note that I have been writing about my new book, – and the good news, it's finished, and in edit at this moment – I do hope to get it out by March '10. ADHD Medication Rules: Paying Attention To The Meds For Paying Attention details an entire chapter on Burn Rate, as everyone who takes ADHD meds should absolutely master the burn rate principle.
This Specific Q & A:
– Is an example of the many Intuniv questions, challenges and positive remarks in these several posts:
“I have just stumbled across you and [CorePsych Blog] in my research into Intuniv. My son just recently turned 8 and was diagnosed with ADHD this past spring. As I continually read about ADHD kids Luke seems wise beyond his years, is very bright when it comes to building things, or math, and picks things up quickly when he is receiving instruction one on one or in a very small group,- but he struggles in school generally. Long story short, we started with a Central Auditory Processing Disorder diagnosis when he was six.
His primary issue seemed to be language, both receptive and expressive. An exam with an audiologist confirmed a fairly significant CAPD at the time. As he progressed in school it was obvious that ADHD was also a large part of his problems as impulsivity, restlessness, inability to attend, and defiance increased as he got older. We saw a neurologist who, after an EEG, prescribed Focalin XR. This worked “like MAGIC, “- at first. [See Roving Therapeutic Window here.]
We started with 5mg and after about a month moved up to 10mg. He was able to focus, concentrate and made great strides in school. His language issues even seemed to improve. Now it seems the Focalin is either failing him or is the wrong drug. His ability to focus has tanked, he has become very impulsive (throwing things, slamming things on his desk) and is increasingly defiant (refuses to do work, follow directions). While other times he seems spaced out, and at home sometimes too compliant, and sometimes melancholy for no reason.
With age it seems his receptive language abilities are about right, and at developmental level, but his expressive abilities are still below, which of course is leading to some frustration on his part especially when he is supposed to expressing himself through writing. We were seen by the NP [I love NPs!] in the neurologist’s office today and she suggested Intuniv. From what I’m reading it sounds like it may work for Luke but she has suggested we stay on the Focalin while we start the Intuniv? Do you agree? (She mentioned d/c’ing the Focalin eventually)
Second, in one of the posts above you mentioned something about “immune dysfunction, bowel challenges and is-he-a-picky-eater”. While Luke is rarely sick, I don’t think he has a solid BM in his life (not watery, but always very, very soft) and he would live on Mac and cheese, peanut butter and jelly and chips if I’d let him. He NEVER willingly tries anything new and is indeed very picky about what he eats. As all of this is very new to me can you shed some light on what this may have to do with anything and what to do about it – or point me to the best place to read about it? We have tried adjusting his diet, etc. in the past but because he is so picky it is very difficult to do.
An Additional Metabolic Point – Headaches
One additional thing that the NP this a.m. more or less ignored – prior to starting meds Luke would wake up in the middle of the night crying and saying his head hurt. He’d be up 30 min. or more, would eventually throw up and then go back to sleep. In the morning you’d never know anything happened. This would happen about once a month from the time he was about 6. I only recall it happening once during the day at school. Once we started Focalin those incidents ceased completely. We had our first return of that 2 nights ago. Any idea what that’s all about? Initially the neurologist said it was “interesting”but had little else to say about it.”
My Answer, Abbreviated To Stay With Metabolism and Burn Rate:
My reaction to this question and many others seen on the many comments on Intuniv and Vyvanse: We must always look at the metabolic hints, the possible changes in metabolic rate before starting the meds. They are subtle but include the following:
– History of bowel issues, too soft, too hard, constipation, diarrhea, monolithic stools, too slow in transit time,
– Developmental delay issues: CAPD, speech issues, Asperger's, Autism,
– History of Fetal Alcohol exposure
– Headaches, stomach aches, tired all of the time, dark circles under the eyes, pale skin
– Picky Eater
– Not eating breakfast, waking with stomach issues and no appetite
– History of failure with many meds – including stimulants or non-stimulants [Intuniv, Strattera]
– Narrow Therapeutic Window
– History of food allergies even back to early childhood, e.g. “lactose intolerance”
– History of rashes, allergies, asthma, upper respiratory infections, ear infections
If we don't look at these issues [and more] we cannot predict what the outcome with the medications will be – and every one of these issues can significantly change the underlying metabolic patterns, the amount of neurotransmitters in the body, and the cofactors that burn the neurotransmitters effectively.
Medication management now requires a full awareness of the entire pattern including nutrition [which feeds the amino acid building blocks for neurotransmitters and cofactors], – without more careful questioning at the outset we will have predictable problems – as the burn rate will vary dramatically with all of these variables. Burn rate will effect Duration of Effectiveness [DOE] – dosage patterns and speed of titration at the onset of meds.
Then, if Burn Rate varies, we must always take the next step to measure the immune dysregulations, the neurotransmitters, and the downstream endocrine issues so often found with these upstream irregularities.
Phone Consult Availability at CorePsych…
Check out these remarks regarding how to start these reviews with a phone consult [I consult regarding these issues by phone]: See this post on Intuniv: Comment by Gina Pera on January 29, '10 2:30 PM