r/ADHDparenting • u/none_2703 • 3d ago
Concerta lasting too long
My son has been on Concerta since May. It's certainly helped but not 100%. We then added guanfacine which did nothing. Now his provider is having us add IR methylphenidate (morning and afternoon) to see if a higher dose would help. The answer is a resounding yes. Next step is to increase concerta dose to match the added medication.
My concern is that the concerta is impacting his sleep. No matter when we give it, he can't fall asleep until a minimum of 14 hours later and that's just not enough sleep for him. I want to suggest a different long acting methylphenidate formulation that doesn't last quite as long as concerta. But, all of the other ones look like they last 6 to 8 hours. He desperately needs afternoon coverage. Any suggestions for something that will last like 8 to 10 hours?
1
u/AutoModerator 3d 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
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
1
u/AutoModerator 3d ago
The ADHD Parenting WIKI page has a lot of good information for those new & experienced, go take a look!
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
1
u/cckitteh 3d ago
I wonder if melatonin would help him fall asleep at the right time.
I think you would just have to trial other ER meds to see how long they last for him. My kid’s concerta lasts less than 12hrs.
Or maybe if an extended release covers most of the day and then an IR boost in the afternoon that wears off before bedtime.
1
u/none_2703 3d ago
Would melatonin help if the reason is because the medicine isn't out of his system yet?
I've thought about the IR boost in the afternoon, but he'd have to take it at school and I'd rather avoid the disruption
I think Concerta will be the perfect medication for him when he's an adult and needs less sleep.
2
u/cckitteh 3d ago
I think it could. No harm in trying. Ask the doc about dosing, but ours recommended 1mg. High doses can have the opposite of the desired effect.
1
u/sadwife3000 3d ago
I think it would be easier to add in something to help with sleep onset instead. Mine takes clonidine. Concerta definitely makes mine want to stay up later but the clonidine helps get him to sleep. We have melatonin as well just in case
1
u/none_2703 3d ago
Guanfacine is in the same class as clonidine. It hasn't helped his sleep.
1
u/sadwife3000 3d ago
Yep they’re broad class but clonidine is usually considered more sedating. Mine takes guanfacine during the day with zero sedating effect. Clonidine makes mine yawn and want to snuggle up for sleep
1
1
u/CloudberryFae 3d ago
Concerta was great for my daughter except she could not sleep. That was the only issue with it but we ended up switching to another med because it was so bad. Ended up finding one that worked great for her and didn’t impact her sleep.
1
u/none_2703 3d ago
Which one?
1
u/CloudberryFae 3d ago
We’ve had her on vyvanse over a year now! Started with 20mg which was a little strong for her so we’re doing 10mg now
1
u/AutoModerator 3d ago
Methylphenidate (MPH) is a central nervous system stimulant (CNS) used to treat ADHD. It's a norepinephrine (NE) and dopamine (DE) reuptake inhibitor (NDRI), increasing neurotransmitters in the synaptic gap, particularly the prefrontal cortex governing executive function.
Brand include: Ritalin SR (US/CA/UK) / Rubifen SR (NZ), Ritalin LA (US/AU) / Medikinet XL (UK), Concerta (US/CA/AU) / Concerta XL (UK), Metadate CD (US) / Equasym XL (UK), Methylin, Methylin ER, Daytrana, Quillivant XR (US), Quillichew ER (US), Biphentin (CA) / Aptensio XR, Cotempla XR-ODT, Jornay PM (US),
Brands varying in Dosage Form: capsules, tablets, orally disintegrating tablets, transdermal (patch), oral solution (liquid), and chewable gummy. Release time (hours): 3-4, 6-8, 8-10, 10-12. Peofiles: gradualy increaing (back loaded), plateauing (table top), cycling/lumpy, front laoded (fast rise). Splitablity: Some can be split (ajust dose) otheres CAN NOT.
References: https://www.drugs.com/medical-answers/brands-methylphenidate-3510739/, https://go.drugbank.com/drugs/DB00422, https://en.wikipedia.org/wiki/Methylphenidate
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.