some med questions

iVillage Member
Registered: 12-12-2007
some med questions
6
Sat, 05-02-2009 - 11:38am

Hi everyone. I have stopped by from time to time with questions, sorry I can't seem to hang out more frequently than that. Our family's frustrations with ADHD are getting worse, and I really need some help, please.

Zackery is 9 and weighs 62 pounds. He has been seeing a nurse practicioner (who is our only available choice with the insurance). For the first half of this school year he was on 40 mg of Strattera and finally that was increased to 60 mg. He seems to be keeping himself together well at school, but is starting to have some more trouble following the rules and staying on track. At home, he seems completely unmedicated and it is difficult for the whole family. The NP wants to increase the Strattera to 80 mg. Dh and I are very unhappy with this and switched care to our primary care giver, paying privately. Oh, and by the way, at the last NP check, she detected a heart click that was never there before. Our Pedi just prescribed him to stay on the 60mg with an additional 20 mg ritalin in the morning and 20 mg around noon. He also told me that Zackery should have been having his Strattera in the evening all along, but I have been giving it to him in the mornings before school. Could giving him the Strattera in the evenings instead of the morning make enough difference that he wouldn't need anything else? The pedi said it is normal to be on both uppers and downers at the same time, but I don't understand that at all. Could someone explain that to me?

Any and all help is much appreciated! Thanks.

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iVillage Member
Registered: 06-10-2007
Sat, 05-02-2009 - 3:25pm

Hi, and welcome!


Strattera is dosed by weight, not symptoms( stims are dosed by symptoms), so going higher and higher does not help, and often hurts. The target dose for Strattera is 1.2-.18 mgs per kilo. According to his weight he is about 10 mgs over the target( safe) dose. His target is between 33 and 50 mgs.

A child may HAVE ADHD, but it is not what they ARE. Never tell a child they ARE ADHD.

iVillage Member
Registered: 10-01-2007
Sun, 05-03-2009 - 9:49am
I agree with cl-baykirsmom. That dose is too high and going up would be dangerous. I think he might need a different med. He is taking quite a bit. I also agree with taking the printed sheets with you to the doctors and would also see a child psychiatrist for meds.
iVillage Member
Registered: 07-11-2003
Wed, 05-06-2009 - 2:23pm

Hi,


I agree with the previous posters. you need a psychiatrist managing meds not a pediatrician or nurse Prac. I have 2 kids on meds one has ADHD the other PDD (ASD). It has been my experience that a psychiatrist is more knowledgeable and capable with dosing, timing and combining different types of meds, A Pediatrician just doesn't have the experience with dealing with psychiatric meds.


Kristine

iVillage Member
Registered: 12-12-2007
Wed, 05-06-2009 - 5:12pm

Thank you everyone, for your suggestions.

How would I go about finding a psychiatrist that I can trust? This will all be private pay, and I honestly don't think it is even a possibility. Ds's insurance will only cover under their behavior health company. I have never been allowed to see a psychiatrist before, we were sent directly to the NP. I can wait 3-4 months after I request seeing one, but I don't want to. My MIL did that recently with my 14 year old SIL. He put her on medications and 1 1/2 weeks later she attempted suicide. She survived, but the more experienced professionals that took over her care said she was on a doomed mixture of meds and it was only a matter of time before she did something like that. Since it happened, she has gone back to the same psych (the same one we would be assigned to, given our area) and he tried to convince them to go back on all of the same meds again. So I feel like my hands are tied with the psych situation. I was hoping switching to our pedi would be a better choice.

I am hoping we can wean him off of the Strattera. It stopped working when he was still dosed according to his weight. I am still confused about taking that (at 60mg) and the 40mg of Ritalin at the same time.

I just wanted to say thank you again. This is a great board to come to. Been there done that experience is so important to learn from!

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iVillage Member
Registered: 06-10-2007
Wed, 05-06-2009 - 10:18pm
I would contact a Neuropsychologist for an evaluation, ask the Regular ped or NO for a referral.

A child may HAVE ADHD, but it is not what they ARE. Never tell a child they ARE ADHD.

iVillage Member
Registered: 03-25-2003
Fri, 05-08-2009 - 10:00am

It's possible neuropsych is covered by your insurance, because they are actual Drs--it's generally mental health benefits that are horrible. Around here, at least, the waits seem to be pretty long for them.

Um, with what you described? I'd go with my ped rather than THAT psych, that is for very very sure. And a lot of research on my own.

I do go through my ped, but he makes a special thing out of ADHD, much more than usual (and is pretty scathing about the average pediatrician's knowledge of ADHD). HE, however, is also willing to tell me who to go to for more diagnosis, etc., etc., when/if we need. So, ask your ped for a suggestion?

Megan
Megan