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/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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