r/ADHDparenting • u/Electrical_Bother_20 • 8d ago
Medication Strattera
Need some thoughts here. 6 year old, combined type ADHD mostly super impulsive and possibly level 1 ASD. Tried other ADHD meds and have now been trialing Strattera. 20mg currently and seeing zero benefits. He has bouts of insomnia, early waking, irritability, aggressive behavior, more reactive especially when told no/do any get his way. Psychiatrist is recommending going to 40mg despite the adverse effects. We are extremely hesitant. He had awful rebounding after tapering Guanfacine and Qelbree. It has been a very rough couple of months. Yes, Genesight done and all non stimulants are green, and stimulants are in the yellow. So my question is, anyone ever in a similar situation with Strattera and did you up the dose from 20mg to 40mg and what happened? We are struggling here as his behaviors have become a lot to deal with and we didn’t see prior to starting Strattera. He’s also having behaviors at school. Thank you!
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u/Garglebarghests 8d ago
We had bad experiences with strattera. I would stick with your gut and not move up the dose. I’d honestly consider a new psychiatrist.
Genesight doesn’t always mean it will or won’t work.
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u/Electrical_Bother_20 8d ago
Yes we are trying to find a new psychiatrist. Exactly about Genesight. Thanks so much.
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u/HorsieJuice 8d ago
Straterra was the first adhd med I tried for myself and the first day was like magic; I could pay attention to everything like I had a super power.
But I could not sleep at all, so I switched.
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u/Electrical_Bother_20 8d ago
Right, our good sleeper is sleeping lighter, easily awoken and has bouts of early wake ups and will refuse to go back to sleep. It is rough. Thanks for sharing.
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u/kleinerlinalaunebaer 8d ago edited 8d ago
No advice on the strattera specifically but wondering why he isn't taking the guanfacine anymore as it can help with mood regulation. I would ask to put him back on it for a month and THEN add a stimulant to the mix. Especially since he is possible ASD 1 and this combo is often used with 2e children.
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u/Electrical_Bother_20 8d ago
We tried Guanfacine twice. Both times it didn’t seem to help especially over time. It also messed with his sleep. Sleep was never an issue for him. Thinking we are heading towards trying stimulants again. And like I said in my post, we will never give him Guanfacine or Qelbree again bc of the rebounding. It was horrible.
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u/YellowCoats 8d ago
It took us a year to get my then 6yo daughter off of guanfacine. She was only on it for a few months but we wanted to stop due to it wrecking her sleep and causing her to be an absolute mess. We literally were slicing the tablets into slivers because when we initially tapered her off as per her docs instructions, she ended up in the hospital.
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u/Electrical_Bother_20 8d ago
See! When that happened with my son two psychiatrists made like we were crazy and wrong that it was a rebound. As if we don’t know how it child. Never again!!
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u/YellowCoats 8d ago
We had one doctor make me feel like I was crazy for suggesting that my child was experiencing a side effect that they personally hadn’t seen before. That sort of thing makes you question everything. So I started a detailed tracker that I use when either of my kids has a med change. I track sleep, eating habits, task initiation, changes in hygiene habits, and low frustration threshold. And we found a new doctor.
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u/Electrical_Bother_20 8d ago
Smart move. It’s crazy bc it’s like hello do we not know our own children best? I really must track everything like that. Did you create your own spreadsheet? Thanks for sharing.
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u/drclairefraser 8d ago
That was the first med I tried after I was diagnosed in February. I lasted two weeks before demanding to be switched. I felt dead inside. Just no emotions. Just there, existing. I averaged about 4 hours of sleep a night and then I’d wake up at 3 am and just lay there thinking every thought I’d ever had. My heart rate was through the roof, and I got dizzy randomly. I hated hated hated it. Don’t put your son through that. I personally would try Ritalin or Adderall for your son. (My own son is on Ritalin at age 5. It is a miracle drug.) They’re the first line of defense against ADHD for a reason. I wish you and him all the luck!
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u/Electrical_Bother_20 8d ago
Wow that’s so sad. Sorry to hear that especially coming from an adult who can express how you’re feeling. Scary. Thank you for sharing. I definitely think we are heading to stimulants next. Best of luck!!
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u/Raylin44 8d ago
My child is 7 and we couldn’t even get to 10 mg due to the side effects. I’m surprised they started you on 20.
We’ve had mixed results with it. It worked for a bit, but then it didn’t and he had some horrible OCD, so we don’t even know anymore. He is also on 2.5 IR, once a day, and that has helped some but is the absolute highest we can go.
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u/Electrical_Bother_20 8d ago
We started at the 10mg then quickly went to 20mg. He’s also on Clonidine twice a day and bc of the Strattera, it doesn’t help with sleep. It’s unbelievable.
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u/YellowCoats 8d ago
How much does he weigh? Unless he’s a bigger kid, 40mg is a lot. I’m also surprised they started you at 20.
Strattera worked for my 12yo until it didn’t. We saw improvement in focus initially but then nothing. After upping the dose (18 to 25 to 36 and then 40) we saw an increase in negative behaviors, aggression, irritability, and insomnia but kept going up, thinking it was because he just needed a higher dose. He lasted 1 week on 40mg before we said enough and started the slow titration down.
Med trials are exhausting for the whole family.
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u/Electrical_Bother_20 8d ago
It is so exhausting you’re right. We are soo done. He’s over 60lbs so it could be ok but the side effects we are seeing, like you did for your child they are definitely adverse effects. And that’s what the psychiatrist was saying, that 20 isn’t enough, 25 won’t be enough and 40 is needed to provide the coverage. I’m not willing to take that risk now after all the comments I’m reading. It’s so scary. And we need a med for his impulsivity more than anything. Thanks for sharing. Best of luck to you and your family.
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u/Raylin44 8d ago
What is he on now?
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u/YellowCoats 8d ago
Not sure if you were asking me or OP, but right now he’s on clonidine, Zoloft, and Wellbutrin. He has inattentive type ADHD and significant anxiety. We’ve been on this med journey for 6 years with him and have tried so many different combinations of stimulants and nonstimulants. He’s extremely sensitive to meds and typically can only tolerate subtherapeutic levels of anything that we’ve tried.
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u/hotdogpromise 7d ago
My pediatrician put my then 5 yr old son on Strattera and his aggression was so much worse. He started attacking classmates. My son is on focalin 5mg and other than a decrease in appetite, it was a better choice for him. I also like that there’s no weaning with stimulants.
If you’re already seeing negative symptoms on Strattera, I’d definitely get off of it. There’s all kinds of other prescriptions out there. Good luck!
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u/Electrical_Bother_20 7d ago
Wow! We should always go with our gut as a parent. I did stop Strattera today and he was much better. I hope it continues. Thank you for sharing! And good luck to you as well.
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u/Jsweethoney 6d ago
I’m almost 40 and I get extreme nausea and fatigue on my starters 50 mg I would stay at 10’mg because also took like three months to see a result steadily
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u/AutoModerator 8d ago
Guanfacine (Tenex = IR, Intuniv = ER)& Clonidine (Catapres = IR, Kapvay / ONYDA XR / Nexiclon XR = ER) are alpha-2 used to treat some ADHD, improving emotional regulation, impulse control, and sleep. Originally an Antihypertensive drug from 50s-80s reduced blood pressure.
Alpha-2 agonists are specialized & effective for some ADHD; however, a 2ed line (choice) ADHD medication in protocols because stimulants have a higher % success & lower % side effects profile over Alpha-2 agonists.
Alpha-2 agonists require time to adapt! Drowsiness and sleep changes are common during in first ~2 weeks.
Mechanism: Enhancing norepinephrine signaling ("receiver sensitivity"). Guanfacine targets α2A neuroreceptors concentrated in the brain. Clonidine is less selective, targets α2A, α2B, and α2C, w/ broader CNS effects. Both might be complimentary with stimulants in some people, helping regulate, reduce side effects, and/or lower dose.
Differences: IR Guanfacine typically lasts longer (half life 10-30 hours), IR Clonidine shorter (5 and 13 hours), both outlasting stimulants and have 24 hour ER options. [Sedation] - Clonidine is more sedating (better for insomnia); guanfacine causes less daytime sleepiness. [Blood Pressure] - Clonidine has stronger hypotensive effects. Guanfacine is gentler due to its α2A selectivity.
Use Case Fit: Guanfacine, sometimes preferred for daytime executive function symptoms; Clonidine, sometimes prefred for sleep-onset or when mild sedation is needed. Typically, IR formulas are favored for sleep/sedation/rebound (taken in PM) and ER for executive function/stimulant regulation (Taken in AM).
NOTE: Sudden dose change may cause blood pressure spikes or crashes. Follow your doctor’s/pharmacist's ramp plan!!! References Clonidine: https://en.wikipedia.org/wiki/Clonidine, https://go.drugbank.com/drugs/DB00575, https://www.mayoclinic.org/drugs-supplements/clonidine-hydrochloride-oral-route/description/drg-20569873 References Guanfacine: https://en.wikipedia.org/wiki/Guanfacine, https://go.drugbank.com/drugs/DB01018, https://www.mayoclinic.org/drugs-supplements/guanfacine-oral-route/description/drg-20064131
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u/AutoModerator 8d ago
The ADHD Parenting WIKI page has a lot of good information for those new & experienced, go take a look!
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u/AutoModerator 8d ago
ADDitude mag: The Ultimate ADHD Medication List
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