Vyvanse for Treating ADHD in Children

ADHD Medications for Children | ADHD Treatment

Vyvanse for Treating ADHD in Children

To understand medications for ADHD treatment, you need to keep two neurochemicals in mind: dopamine and norepinephrine. Both are important for attention and focus, for the functioning of the pre-frontal cortex region of the brain. Think of it as the secretary of the brain: It’s the locus of what’s referred to as executive functioning—how you plan, how you organize, how you execute.

These two chemicals are critical for those functions, dopamine for decreasing signals from the external stimuli that might be distracting to you, and norepinephrine for improving the signal you’re trying to focus on, to pay attention to. When you take Ritalin, Adderall, or any other stimulant medication, what it does is help bring up the levels of dopamine and norepinephrine.

If you get optimal levels of dopamine and norepinephrine, you are pretty focused. But if you get too much, you can stress out the brain. Then you look almost the ADHD is worse.

There’s a perception, especially among teenagers: “Oh, if it’s good at this dose, more will be even better.” No, it won’t. It can feel worse, and you can get a lot of side effects.

So trying to get that right balance is what’s key.

When it comes to stimulant medications for ADHD, there are a lot of alternatives to choose from, and they’re not all created equal. So if I don’t think one med is working as well as I would , I want to try something else. Children can respond very differently to different formulations.

Effectiveness of medications

If you have ADHD, studies show there’s an over 80% chance that you are going to respond to medication. Within that group, 50% will respond equally well to the two main classes of ADHD medications: methylphenidate (Ritalin and other brands) or amphetamine (Adderall and other brands). Of the other 50%, half will do better on methylphenidate and half on amphetamine.

There are also several medications that aren’t stimulants, but they are considerably less effective in treating symptoms.

The challenge with stimulant medicines is how to deliver an effective dose over a desirable period of time. When Ritalin was first used to treat ADHD in 1961, it was with a kindergartener or a first-grader in mind. It lasted three or four hours.

But kindergarteners now have homework, and the older kids get, the longer they need to stay focused to succeed in school and get along with their friends and family.

So technology has been developed to make the medication release gradually, peaking at the desired time, so users don’t have to remember to take pills multiple times a day.

Related: Will ADHD Medication Change My Child’s Brain?

Methylphenidate medications

Ritalin, the granddaddy of them all, is a short-acting formulation of methylphenidate that lasts about 3-4 hours. Focalin is another form of methylphenidate that also lasts about 4 hours.

Both of these medications begin to work about 30-45 minutes after taking them. For children who have trouble swallowing pills, this medication can be crushed and mixed with foods.

  There is also a liquid and a chewable tablet form of the short-acting methylphenidate.

Other forms of methylphenidate that have been engineered to release optimally over a particular period of time.

First up is Concerta, one of the longest–acting methylphenidate medications on the market, lasting 8 to 12 hours, the equivalent of 3 tablets of Ritalin. What’s unique about Concerta is that it has a hard shell; you can’t chew it or open it. You’ve got to swallow it whole, which can be a problem for some kids.

It has triple-release: First, there’s a coating of medicine on the outside, so within 10 or 15 minutes you’ll be getting some effects of the medication. On the inside, there’s a push compartment filled with a polymer fiber that expands a sponge as it gets wet, and pushes out the medicine through a laser hole on one end.

The capsule itself doesn’t get absorbed.

Concerta has two compartments of the drug, 30% in the first, and 70% in the second. This is called an “ascending dose,” and it is designed to offset a decline in the impact of the medication that can occur the second half of the day. But for some kids, it might be too long.

There are also capsules filled with medication in beads. What’s good about these is that for kids who can’t swallow pills, you can open up the capsule and sprinkle it on a spoonful of applesauce, yogurt or Nutella.

One of the beaded forms is Metadate CD, which lasts about six to eight hours. It has two kinds of beads in it, also in an “ascending dose”—30% are quick release, to work the first four hours, and 70% slow release, for the latter four hours.

Ritalin-LA also has beads, but they’re 50-50—that is, half the beads are going to be released immediately, to peak in the morning, the other half in the afternoon, for a total of six to eight hours. So you have much more of a two-equal-phases effect on focus and attention.

Aptensio XR and Focalin XR are also capsules filled with medication that can be opened and mixed with food. They typically work longer than Ritalin LA or Metadate CD.

For kids who have trouble swallowing capsules and even have trouble with beads, there are liquid forms of methylphenidate medication. Quillivant XR is a long-acting formulation that I often describe as “liquid Concerta,” and is a good alternative. The liquid formulation may also allow more precise dose adjustment or “titration.”

Quillichew ER is a chewable longacting formulation of methylphenidate that can last up to 8 hours.

Related: Side Effects of ADHD Medication

The patch

And then there’s Daytrana, which is the methylphenidate patch. Basically, the patch is a carpet of medication that’s embedded in this adhesive, so you peel the liner off, and you put it on the hip, because the hip is the area that has less muscle, so the medicine will get into the body quicker.

In developing the patch, the company thought two things. First, it’s good for kids who can’t swallow pills. And second, you bypass the gut, so it doesn’t have to be metabolized to get into your bloodstream. It will go through the skin, right into the bloodstream.

Now, that said, it doesn’t work right away. Since it absorbs slowly, it takes about two hours to get up to therapeutic level. But once it’s there, it stays pretty constant until you actually take it off.

So another thing that parents is that they feel they can have more control over when the medicine ends by taking off the patch. If you want to take it off at 2:00pm one day but at 5:00pm the other, you have that ability.

Usually the medicine will drop in the bloodstream an hour and a half to two hours after you take off the patch.

Kids often aren’t as enthusiastic. Some kids don’t the idea of wearing a patch. A lot of ADHD kids are tactile-sensitive, and they’ll take it off. And when you take it off it doesn’t go back on.

But I have some college kids who the patch because they don’t have to worry about taking medicine later in the day; they can just keep it on as long as they want to.

If they forget to take it off it doesn’t matter: There’s only about nine to 10 hours of medication in the patch, so they’re still able to fall asleep.

Amphetamine medications

On the amphetamine side, Adderall, Evekeo, Zenzedi and Dexedrine are all short-acting forms of amphetamines, that take effect about 30-45 minutes after taking them and they are effective for 3-4 hours.  Amphetamines tend to be slightly more potent than methylphenidate and last a little longer, but in general the effects are similar to methylphenidate.

As with methylphenidate, some preparations of amphetamines have been created to release the medication over a greater period of time, extending the duration of the effect of the medication.

This is of great benefit when trying to provide a response that lasts through a school day (typically 6-8 hours).

  Some of these compounds take effect as quickly as the short-acting forms of these medications.

Adderall XR is the longer-lasting form, designed to be effective for 10-12 hours. It’s a capsule with beads that are 50-50, so 50% of them are immediate release, and the other 50% are delayed release. The capsule can be opened and the beads mixed with food.

Vyvanse is amphetamine plus an extra compound called lysine, which attaches itself to the active ingredient in Adderall, amphetamine, creating an extra step that the body has to go through to cut it off, to make it active.

That means Vyvanse lasts very long—up to 14 hours. That could be too long for a seven-year-old, but if you’re in high school or college, or an adult, it could be great. It’s not beads; it’s just a powdered medicine.

But it’s going to have a consistent release, without peaks and troughs.

Dexedrine Spansule is the long-acting form of Dexedrine and typically lasts about 6-8 hours.

Dynavel XR is a long-acting liquid form of amphetamine. It can have an effect that lasts as long as 10-12 hours.

Adzenys XR-ODT is a tablet that dissolves in your mouth and doesn’t need to be swallowed. It has a duration of response of 10-12 hours.

Read More:
Is Your Child Getting the Right Dose?
Behavioral Treatments for Kids With ADHD
Talking to Kids About Medication

Source: https://childmind.org/article/understanding-adhd-medications/

Vyvanse: ADHD Medication Overview

Vyvanse for Treating ADHD in Children

Vyvanse (Generic Name: lisdexamfetamine dimesylate) is a once-daily, timed-release stimulant ADHD medication primarily used to treat attention deficit hyperactivity disorder (ADHD or ADD) in children ages 6-12, adolescents, and adults. According to the FDA, Vyvanse is a federally controlled substance (CII) because it can be abused or lead to dependence. It is an amphetamine.

Vyvanse may improve focus for people with inattentive ADHD (aka ADD, and decrease impulsivity and hyperactive behavior — hallmark ADHD symptoms for many patients. It is not known if it is safe for children under the age of 6.

The American Academy of Pediatrics recommends ADHD treatment with behavioral therapy before medication for children under the age of 6.

For children ages 6 to 11, the AAP says “The primary care clinician should prescribe US Food and Drug Administration–approved medications for ADHD and/or evidence-based parent- and/or teacher-administered behavior therapy as treatment for ADHD, preferably both.

” wise, the National Institute of Mental Health finds the most successful treatment plans use a combination of ADHD medication, Adderall XR, and behavioral therapy.

Vyvanse can also be used to treat binge eating disorder in adults.

What is the Typical Dosage for Vyvanse?

The optimal dosage of Vyvanse varies patient by patient. Your doctor may adjust your dosage weekly by 10mg or 20mg increments until you or your child experiences the best response — that is, the lowest dosage at which you experience the greatest improvement in symptoms without side effects. The maximum dose is typically 70mg daily.

Vyvanse capsules are available in 5mg, 10mg, 20mg, 30mg, 40mg, 50mg, 60mg and 70mg dosages. Chewable tablets are available in 5mg, 10mg, 20mg, 30mg, 40mg, 50mg, and 60mg dosages. The time-release formulation is designed to maintain a steady level of medicine in the body throughout the day.

As with all medications, follow your Vyvanse prescription instructions exactly. Vyvanse is taken orally, with or without food, once daily. The first dose is typically taken first thing in the morning; it should be taken at the same time each day for the best results.

Capsules should be swallowed whole with water or other liquids. If your child is unable to swallow the capsule, it can be opened and stirred into yogurt, water, or orange juice. Taken this way, the mixture should be swallowed entirely at once. Chewable tablets should be completely chewed before swallowing, then followed with a glass of water or other liquid.

During treatment, your doctor may periodically ask you to stop taking your Vyvanse so that he or she can monitor ADHD symptoms; check vital statistics including blood, heart, and blood pressure; or evaluate height and weight. If any problems are found, your doctor may recommend discontinuing treatment.

Some patients report developing a tolerance to Vyvanse after long-term use. If you notice that your dosage is no longer controlling your symptoms, talk to your doctor to plan a course of action.

What Side Effects Are Associated with Vyvanse?

The most common side effects associated with Vyvanse are as follows:

When treating ADHD: anxiety, decreased appetite, diarrhea, dizziness, dry mouth, irritability, loss of appetite, nausea, trouble sleeping, upper stomach pain, vomiting, and weight loss.

When treating Binge Eating Disorder: dry mouth, trouble sleeping, decreased appetite, increased heart rate, constipation, feeling jittery, anxiety.

Another serious side effect is slowed growth in children.

Taking Vyvanse may impair your or your teenager’s ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor. Most people taking this medication do not experience any of these side effects.

Report to your doctor any heart-related problems or a family history of heart and blood pressure problems.

Patients with structural cardiac abnormalities and other serious heart problems have experienced sudden death, stroke, heart attack, and increased blood pressure while taking Vyvanse. Stimulants can increase blood pressure and heart rate.

Physicians should monitor these vital signs closely during treatment. Call your doctor immediately if you or your child experiences warning signs such as chest pain, shortness of breath, or fainting while taking Vyvanse.

Disclose to your physician all mental health issues including any family history of suicide, bipolar illness, or depression. The FDA manufacturer recommends evaluating patients for bipolar disorder prior to stimulant administration.

Vyvanse may create new or exacerbate existing behavior problems, or bipolar illness. It can cause psychotic or manic symptoms in children and teenagers.

Call your doctor immediately if you or your child experiences new or worsening mental health symptoms including hallucinations or sudden suspicions.

Discuss circulation problems with your doctor before taking Vyvanse, which has been known to cause numbness, coolness, or pain in fingers or toes, including Raynaud’s phenomenon. Report to your doctor any new blood-flow problems, pain, skin color changes, or sensitivities to temperature while taking Vyvanse.

Stimulants Vyvanse have a high potential for abuse and addiction, especially among people who do not have ADHD.

It is a “Schedule II Stimulant,” a designation that the Drug Enforcement Agency uses for drugs with a high potential for abuse. Other Schedule II drugs include Dexedrine, Ritalin, and cocaine.

People with a history of drug abuse should use caution when trying this medication. Taking the medication exactly as prescribed can reduce potential for abuse.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

What Precautions Are Associated with Vyvanse?

Store Vyvanse in a secure place the reach of children, and at room temperature. Do not share your Vyvanse prescription with anyone, even another person with ADHD. Sharing prescription medication is illegal, and can cause harm.

You should not take Vyvanse if you are allergic to any of the ingredients in Vyavanse, or if you have taken a monoamine oxidase inhibitor (MAOI) within 14 days.

If you’re thinking of becoming pregnant, discuss the use of Vyvanse with your doctor. It is not known if it can cause fetal harm. Vyvanse is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.

The safety of Vyvanse for children under age six has not been established.

What Interactions Are Associated with Vyvanse?

Before taking Vyvanse, discuss all other active prescription medications with your doctor. Vyvanse can have a dangerous, possibly fatal, interaction with antidepressants including MAOIs.

Vyvanse is similar to amphetamine and dextroamphetamine. You should avoid taking these medications concurrently with Vyvanse.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications you take with the pharmacist when you fill your prescription, and let all doctors and physicians know you are taking Vyvanse before having any surgery or laboratory tests. Vyvanse can cause false steroid results.

The above is not a complete list of all possible drug interactions.



More Information on Vyvanse and Other ADHD Medications:

Free Download: The Complete Guide to ADHD Medications
5 Rules for Treating Children with Stimulant Medications
Primer: The Stimulant Medications Used to Treat ADHD

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Source: https://www.additudemag.com/medication/vyvanse/

Vyvanse: What You Need to Know

Vyvanse for Treating ADHD in Children

Vyvanse is stimulant medication used to treat ADHD (also known as ADD). Stimulants are the most widely prescribed medications for ADHD. And for most kids, they’re the most effective at reducing symptoms. Vyvanse is fairly new compared to some other ADHD stimulant medications, but it’s well-studied.

Here’s what you need to know about Vyvanse.

Vyvanse is a brand of stimulant drug. It was approved to treat ADHD in 2008, which makes it a relatively new treatment.

As a stimulant, Vyvanse works by improving the way parts of the brain communicate with each other. Adderall, Vyvanse is an amphetamine-based stimulant. But it works a little differently than Adderall. For instance, Vyvanse is a delayed-release drug.

Vyvanse has the same potential side effects as all stimulant drugs. The most common are decreased appetite and trouble falling asleep.

Less common Vyvanse side effects include:

  • Headache and stomachache

  • Irritability and moodiness

  • Nervousness and anxiety

  • Nausea and vomiting

  • Restlessness

Vyvanse Dosage and Timing

Vyvanse comes in two forms. It was introduced as a capsule in 2008. In 2017, it also became available as a chewable tablet. The tablet and the capsule each come in dosages of 10mg, 20mg, 30mg, 40mg, 50mg and 60mg. The capsules also come in a 70mg dosage.

Both forms only come in a delayed-release preparation. Delayed release means that the body converts the drug into its active form as it enters the bloodstream. It begins to work in about an hour. But it may take two to three hours to reach its peak effectiveness.

Vyvanse is also an extended-release drug. This means it is slowly released into the body throughout the day. In studies, Vyvanse appears to help kids with ADHD symptoms for about 10 to 12 hours, and a bit longer in young adults.

Common Questions Parents Have About Vyvanse

If you’re considering Vyvanse for your child, you ly have questions about how it works and how it might affect your child. Here are answers to common questions parents ask about Vyvanse.

What’s the generic name for Vyvanse?

Vyvanse is a brand name for the drug lisdexamfetamine dimesylate. At this time there’s no generic of Vyvanse. This means that Vyvanse may be more expensive than other ADHD medications, most of which have a generic option.

It’s true, though, that amphetamine-based ADHD medications can be misused. That’s because they help with attention in everyone, not just in people with ADHD.

Teens with ADHD may be pressured by peers to sell or share their ADHD medication. Make sure your child understands the dangers of sharing ADHD medication, and not to do it.

Learn more about ADHD medication misuse, sharing and abuse.

What if Vyvanse stops my child from sleeping?

Sleep issues are a common side effect of stimulant medication. Vyvanse stays in the system for up to 12 hours. So, trouble falling asleep may be even more pronounced with Vyvanse than with shorter-acting medications.

Let your doctor know if your child’s sleep issues don’t get better a week or so after starting Vyvanse. Maybe the dosage or timing can be adjusted, or you can discuss other medication options.

Can Vyvanse cause anxiety?

There’s a lot of overlap between ADHD and anxiety. Often, trouble with attention causes anxiety. So if medication works to reduce symptoms, it may reduce anxiety. But Vyvanse is not an anxiety medication. And stimulant medications can sometimes increase anxiety in a small percentage of kids who take them.

If you think Vyvanse is making your child more anxious, discuss it with your doctor. There are a number of ways you can address it. These include reducing the dose, switching to a different stimulant, switching to a non-stimulant drug or trying a non-medication treatment.

How will I know if Vyvanse is working for my child?

If an ADHD medication is working well, your child’s core symptoms should become less severe and cause less disruption to daily life. But what that looks depends on the individual child.

One way to tell how well the medication is working is to complete an ADHD rating scale before and after your child starts taking it. Chances are, you filled out these questionnaires as part of your child’s evaluation for ADHD. (Your child’s teacher may have filled them out, too.) Doing it again will let you see if and how much your child’s behavior has changed.

What if Vyvanse doesn’t work for my child?

Finding the right medication often involves some back and forth with your doctor. Each child responds differently to each drug. If you don’t see any (or enough) improvement in your child’s symptoms, let your doctor know.

Download our ADHD medication log to help track your child’s behavior so you can pinpoint your concerns.

If Vyvanse doesn’t work at first, your doctor may suggest raising the dose or trying a different drug. And for some kids, ADHD medication just doesn’t work. There are alternatives to medication you can look into, including behavior therapy. In fact, it’s important to have behavior supports and strategies at school and home even if ADHD medication works for your child.

How can I decide if my child should take Vyvanse?

Putting your child on ADHD medication is a personal choice. And it can be a tough one for some parents. Talk to your child’s doctor about the options, and share any concerns you may have. If you’re considering medication, ask yourself these questions.

If you decide against medication, or if medication doesn’t work for your child, you can look into alternatives  behavior therapy. (Behavior therapy can be helpful if your child takes ADHD medication, too.) What matters most is finding ways to manage ADHD symptoms so your child can learn, succeed and enjoy daily life.

Understood is not affiliated with any pharmaceutical company.

Source: https://www.understood.org/en/learning-thinking-differences/treatments-approaches/medications/vyvanse-what-you-need-to-know