I just wanted to make sure I didnt hurt your feelings. Right after we got Marcels diagnosis we were
referred to a nurse practictioner who was a nut. I think what it was is she's an old d*** which is
fine by me but I dont think she liked men & she was irritated that whenever we'd go in her office
we'd go as a family because I have no sense of direction & her office was down town. Frankly I
couldnt find my way out of a paper bag. ANYWAY I can get along with just about anybody but this
chick made me uncomfortable so eventually we found our way to Dr Fierro. He's so kind, down to
earth, he's younger than me, and he likes my silly sense of humor. I research and at the same time
I know he's researched plenty before we try something new, but thank you. You are very sweet,
if you ever find yourself down this way you've got a place to stay. Remember the Alamo!!
Why administer a
Why administer a time-release formula? Why not go to the IR formula to ensure that the first dose is accurate and the second dose gets administered at the appropriate time?
You're not hurting my feelings (will I ever live that one down? - lol) and I'm not trashing your doctor. I'm sure he's very good, but he can only work with the information you give him - and I am sensing some fear that your son will be taken off a drug you see as being effective and that he really does need. You're continued "thanks but not thanks" responses from my very first post on this topic just tells me you're locked down and you really don't want to explore it at all. That's OK with me - but, I think your fears are unwarranted. I think the Focalin is doing it's job and that he is burning it at an average rate (manufacturer's half-life is listed as 2 to 4 hours, so 3 hours to burn off the effects is not unreasonable at all).
However, I don't think his system is agreeable with the time-release agent in the XR formula. If the time release was working, he would be getting a second full dose four hours after taking the capsule and you would be seeing an improvement in his behavior at 4 hours (regardless of how he burns off the drug itself). Maybe you are the same, since you haven't said whether or not the Adderall you took was a time-release formula. Some people aren't compatible with time-release formulas, but do better on the same drugs when the time-release factor is not involved. If he's not getting that second dose, you're wasting 1/2 your money.
I should have explained we
I should have explained we have a tough time getting the Focalin down. Daddy has to do it before work. When it
wears off I can give him Clonidine. He's on medicaid so it doesnt cost us anything THANK GOD. Some of his meds
are extremely expensive. His Trileptal runs $335 a month (anti-seizure med). I realized after I finished my
post last night that I forgot to mention I took regular adderall and later on adderall xr. I had to take one every
three hours or I completely lost my focus. I could drive when I was medicated. We used to have a Lincoln Towncar,
I loved that car!!
It is possible that the IR
It is possible that the IR formula would go down easier (i.e. by crushing the pills and putting in food), but I can't find any data specifically on that point. Certainly, if you can't get the drug into him, it can't work - so this is a valid consideration.
If you'll bear with me, Cindy, I'd like to pursue this thread in more detail because there are a lot of people out there who have no real idea about how time-release drugs should work.
If the time-release mechanisms were working correctly (for example, for you) - the Adderall XR and the Adderall IR should have behaved differently. On IR, you should have experienced one "hit" shortly after taking the drug, lasting "X" hours. On XR, you should have experienced 2 "hits" about 4 hours apart. If the first hit was lasting 3 hours, then there would have been a rough hour in between and a noticeable "pick me up" at 4 hours. If the first hit lasts the 4 hours, the second hit goes in almost imperceptibly. If what you are describing is how you felt on both the XR and the IR, then it seems you were getting 1 hit lasting a normal length of time with no second hit.
Upping the dosage then increases the impact of the 1st hit and may make it last a little longer (e.g. your son on 15 mg Focalin is now going 5 hours instead of 3). To illustrate how this works, I need to insert some math. On 10 mg Focalin XR, he should be getting 5 mg at the outset. At the half-life point (probably about 3 hours in his case), 1.5 mg would still be in his system; but this would now be too low an amount to keep up a noticeable effect on his behavior. At 15 mg Focalin XR, he should be getting 7.5 mg and at the half-life (still about 3 hours), he would have 3.75 mg still in his system, which is probably still enough to have some effect on his behavior. As the levels continue to drop off, the remaining effect wears off until the levels get too low (probably below 1.5 mg) at about 5 hours. There is still no evidence of a second hit.
IF the second hit is getting absorbed right away or two quickly, the curve might look exactly the same; but the possibility of an overdose increases as the overall dosages go up. For example, your son may have been getting a first hit of anywhere between 5 and 10 mg instead of just reliably 5 mg; and now is getting a hit anywhere between 7.5 and 15 mg. Unless it has been determined absolutely that 100% of the second hit is not entering his system, the real amount of the first dose is an unknown.
This is why dosing with an IR formula could be more reliable than using an XR. If he is not "digesting" the second XR dose, you may find that a single 5 mg dose of IR goes 3 hours (same effect as 10 mg XR) or a 7.5 mg dose of IR goes 5 hours (same effect as 15 mg XR), and you could still revert to Clonidine for the second dose. If he isn't getting the 2nd XR dose anyway, 1 dose of IR in the morning would be as effective. If IR tastes better and goes down more easily, you might be able to administer that second dose. If IR tastes worse and doesn't go down at all (even one dose in the morning), then XR at 1/2 effectiveness is an alternative, I guess.
This is why it is so important for anyone to consult their doctor on all the picky details of a drug's performance. It's not just a matter of drug goes in and effect happens. There is a lot of additional science involved.
P.S. And Cindy, I DO believe that you are doing this with your doc and I'm sure he is giving you the BEST possible advice that suits Marcel's individual circumstances. In his particular case, there are also other meds to consider, etc. It really IS a complex issue.
LOL Perz honey you should
LOL Perz honey you should have been a pharmacist =) And I agree we're hopefully helping others. I suffered
real bad rebound between dosages (rebound feels like being stoned folks). To tell you the truth I cant remember
exactly what happened with the XR because I lost a baby during that time. Here we had given up all hope of
ever having children, I went to the doctor for something else and come to find out I was pregnant. That baby died
probably because of my diabetes and from taking ADD meds. I miscarried right before valentines day 99. The
baby was too little and the heartbeat was too slow, ANYWAY I immediately went off the adderall just in case I
could get pregnant again and I did obviously. I got pregnant April fools and Marcel was born Christmas eve, full
term, very healthy. I havent been on any ADD meds since 99. Anyway while I was on adderall I had to time my
dosage carefully so I wouldnt get the rebound effect. While I was on it I could drive because my reaction time
was better. I do okay at home as long as Im not upset, when Im upset I lose my focus really bad. Sorry if I didnt
answer all your questions lol.
I found a general article on
I found a general article on stimulants and ADHD that might be of interest to some:
http://www.ncpamd.com/Stimulants.htm
It does not specifically discuss how Focalin's time-release works, but it does cover a number of the others and other issues and concerns about using stimulants to control ADHD.
Novartis' website for prescribing information on the drugs they manufacture:
http://www.pharma.us.novartis.com/products/prescribing-information.jsp
Select drug name and info comes up as a PDF. The one for Focalin XR contains a graph showing how the concentration levels in the blood are affected by the time-release element.
Cindy, to pacify your insatiable curiosity - I'm neither a nurse nor a pharmacist. Just a mom. My family does have some experience with ADHD and stimulant medications; however, I don't think Focalin itself is available yet in Canada.
By the way I couldnt take an
By the way I couldnt take an anti dipressant like some people with ADHD can. I was on Wellbutrin for a few days
and all of a sudden when I would talk the little words wouldnt come out of my mouth like AND and BUT. My mom
was alive at the time and freaked because she thought I was having a stroke. I guess what happened is it slowed
my brain down too much. I could focus but not talk properly.
Despite what some studies
Despite what some studies say, I remain very leery about the use of antidepressants, particularly for youth, since I have personally lost friends and children of friends to suicide while they were being prescribed antidepressants for various reasons, including people who were diagnosed with ADHD. I can't help but think that at least some of them would still be with us if they had not been put on drugs with such powerful emotional effects.