Once you have made the decision to start a stimulant, such
as methylphenidate (Ritalin, Concerta), dexmethylphenidate (Focalin), Adderall, or dexamphetamine (Vyvanse), for ADHD there
are a few things you need to know to make the process go more smoothly.
When should I start
the medication?
There usually isn’t time to wait for a long school break or
vacation, or for life to get completely stable.
However, it may be a good idea to wait to start the medication on a
weekend so that you can be at home should any severe side effects occur.
When should I give
the medication? What about medication
breaks?
Most stimulants are given once daily in the morning, but
some are given twice, or even three times daily. You should follow your doctor’s
instructions.
Some people find that it is best to take their medication
after breakfast, to allow time to eat before
the medicine kills their appetite. Other
people, especially children who are unable to sit down for a meal, find that
giving the medicine before breakfast allows them to focus on eating.
Most doctors do not recommend routine medication breaks,
except in specific circumstances. This is because patients often need treatment
so that they can get along with their families and friends on weekends, and
because sometimes readjusting to medication can be difficult even if you’ve
only been off it a day or two.
Should my child give
the medication to themselves?
Stimulants are potentially addictive medications with
dangerous side effects in overdose. Younger
children should definitely not handle medication on their own. Impulsive children may need to be monitored
well into their teens before they can demonstrate responsibility need to
administer their own medication.
Young children should be taught to recognize their own
medicine, and to never share their medicine with anyone. Older children and teens should also learn
how dangerous it is to share or sell their medicine, and to always take their
medicine only in the way it is prescribed.
What if I can’t
swallow pills?
Hopefully you got a liquid or something that can be opened
and sprinkled on food. If not, you can learn
to swallow a pill, or you can talk to your pharmacist about whether it is
safe to crush your medicine.
When should this
medicine start to work?
Usually stimulants start to work within an hour of the first
dose. If you do not notice any effect
after 3 days of medication, the dose probably needs to be increased.
Stimulants typically treat only the core symptoms of
ADHD—inattentiveness, impulsivity, and hyperactivity. However, other symptoms such as depression,
school avoidance, and being picked on by other children may not respond well to
medication alone. In these cases, it is
important to consider counseling and/or additional types of medication.
What happens if there
are side effects?
Most side effects will occur immediately or shortly after
starting a medication. Some can occur
4-6 weeks into treatment with longer acting medicines as the body starts to balance
out blood levels. Side effects can go
away after a couple of days as the brain becomes used to adjusted
neurotransmitter levels. This is
particularly true if your child seems a little bit sped up or irritable with
the first couple of doses.
Whether or not you stop a stimulant depends on the type and
severity of side effect, how helpful the medicine is, and the number of other medicines you have
tried. There are good ways to continue a
medication that is working well if you are having trouble with sleep or loss
of appetite. However, if your child
is having hallucinations, becomes aggressive, or develops daily headaches or stomach aches, almost always the medicine needs to be
stopped. Tics used to be a reason to stop medication but now doctors believe that stimulants do not cause tics and they usually encourage patients to try to wait it out or maybe pursue counseling for tic suppression. The good thing about stimulants
is that no tapering is required. It is
very safe to stop immediately.
What about my other
medicines? Is it safe to take
over-the-counter medicines when I’m sick?
You should always reveal all the medications you are taking
to any medical personnel prescribing you medication of any kind. Over-the-counter medications are mostly safe
to take with stimulants, with the exception of certain
cough and cold medicines.
My doctor wants me to
increase the dose after a few days. When
do I know it is ok to do that?
With stimulants you can usually get a pretty good idea of
how well it is working, and whether you are having side effects within 5 to 7
days of starting the medicine. If you
are not seeing the improvement you would like and you are not having any side
effects, it is ok to increase the dose if your doctor asked you to do so. However, never increase the dose of your
medication without a doctor’s instructions as it is a federal offense to do so.
Is there any way to
predict what the right medication and dose is?
There are genetic
tests on the market that say they can predict which medication is best for
your ADHD. The fact is that they cannot
be used to distinguish between stimulants and cannot predict the effective dose
at all.
Otherwise, the reality is that finding the right medication
and dose can be a roller coaster. Almost
all patients go through dose adjustments, and many have to try more than one
medication before finding the right one.
However, when you are able to find the “right one” the relief is usually
worth it.
References:
Rader, Robert, and Larry McCauley. "Current Strategies
in the Diagnosis and Treatment of Childhood Attention-Deficit/Hyperactivity
Disorder." American Family Physician79.8 (2009): 657-65. Print.
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