Adderal XR and Guanfacine

[2KidsWithADHD]

We’ve struggled finding the right medication for our 7yo daughter with combined ADHD. The best single med that has worked is Adderal XR. But this past 3 months it really hasn’t worked. Our Dr suggested adding guanfacine to help. At first it was a miracle. She was less impulsive. Not as LOUD. She stopped having 2-3 accidents a day. It was amazing. Then she stopped sleeping. Completely. We’ve never had a sleeping problem with any other medication. My son takes Focalin XR and guanfacine at night because it helps him slow down. Anyone else seen this drug interaction?

[Canadianmum]

Is she taking short acting guanfacine or Intuniv? How much guanfacine is she taking?

We see the best results with Intuniv at the higher end of the weight dosing range (3mg). I can’t speak to how it is interacting with the Adderall. We are actually thinking of trying to switch my daughters stimulant.

[2KidsWithADHD in reply to Canadianmum]

She's taking 2 MG of Guanfacine ER. That really did seem to help with her impulsiveness and inattention, but suddenly she had trouble sleeping. We've stopped the Guanfacine for a few days to see if her sleeping improves. Then we may stop the Adderall and just do the Guanfacine to see how that works.

[Canadianmum in reply to 2KidsWithADHD]

How long has she been on 2mg? Sometimes there is an adjustment period and it can affect sleep.

[2KidsWithADHD in reply to Canadianmum]

She was on it for about 5 days and stopped sleeping completely. So we weened her off and now are going to try 1MG and slowly bring her up to 2MG.

[Cjkchamp in reply to 2KidsWithADHD]

Be careful stopping Guanfacine. It’s a medication that needs to be weaned.

[2KidsWithADHD in reply to Cjkchamp]

Yes, got it.

[Onthemove1971]

We use Ritilin and Initiv ( 24hour given at night). These work great for us. It seems like an easy swap if you want to try it. Same class of medication.

Good luck, it is amazing when you find the right medication.

[2KidsWithADHD in reply to Onthemove1971]

My son is on Focalin XR (which is in the same class as Ritilin) and Guanfacine ER and it works great for him. Unfortunately, my daughter burned through the Focalin in hours. So, we moved to Adderall which was better, but she still had trouble maintaining focus and sitting still. The hope was that the Guanfacine would provide a little boost, and it worked, except for the sleep problem.

[Nats2005]

Have you made any changes to the Adderall recently, or just added the Intuniv? Also when are you giving the Intuniv?

Our son at one point recently had been taking 5mg of Adderall twice a day + 2mg of Intuniv. We were seeing a spike in bad behavior when the 1st dose of Adderall worse off, so we went to three 5 mg doses. The last was coming at around 4pm. Almost immediately he started not falling asleep until around 10pm.

Our psychiatrist suggested giving him the Intuniv at the same time as the 3rd dose; prior to that we'd been giving it to him around 6:30-7pm, i.e. just before the bedtime routine. Almost immediately he started falling asleep between 8-9pm, now he's pretty much falling asleep shortly after 8pm. So getting the Intuniv in him a bit earlier seems to help the sleep.

We did just go to 3mg on the Intuniv as we're still having some issues with impulsivity, aggression and destructiveness. We'll see what happens.

[2KidsWithADHD in reply to Nats2005]

Before the Guanfacine, we tried increasing the Adderall XR to 20 MG, but she showed no difference. The Guanfacine ER really helped her (she was less LOUD and able to manage her own bathroom needs), but man, the not sleeping was new. She used to pass out at 8:30 and once we added 2MG of Guanfacine she was wide awake all night. We tried in the morning and evening and it didn't seem to make a difference. Another poster suggested moving slowly from 1-2MG and we've asked the doctor if that seems like a good plan.

[Aspen797]

Our son is on Guanfacine and Focalin. We tried advancing him quickly from 1mg to 2mg and he could not sleep through the night. It affected behavior and undid the benefits of the medication. This is a known issue in the medical literature (effect on REM sleep in doses over 1mg). We went back to 1mg and changed the Focalin dose and the sleep problem went away. A year later and we are now trying to increase to 2 mg again but are doing it VERY slowly (over months) and using 1/4’s of a 1mg tab immediate release guanfacine as a bridge. So far 1 1/2 mg is as far as we get before sleep issues (night waking) occur. Don’t give up on the guanfacine (it’s been very, very helpful for us) but make sure you are working with a psychiatrist as they really know these meds and can help much more than the pediatrician. Also, Cjkchamp is right that you need to be careful about tapering slowly either up or down due to BP effects.

[2KidsWithADHD in reply to Aspen797]

This is very helpful. Increasing Adderall XR didn't do much for us, but adding the Guanfacine showed strong benefits to her behavior. I sent a note to doctor to discuss a plan for gradually increasing the Guanfacine and we'll see what she says. Perhaps going to Short Acting is an option.

[anirush]

MY 25 year old 6 feet tall grandson is on Intuniv 2mg. 3 mg caused problems. Maybe try 1mg ?

[2KidsWithADHD in reply to anirush]

Thanks. 1MG didn't do anything for her. The doctor suggested moving up to 2 and then perhaps 3. But the sleep problems began at 2. I'm hoping we can figure out a way to try 1.5.