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Anyone with experience with Vyvanse and Intuniv?


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#1 JoanJett

Posted 23 September 2019 - 07:34 PM

So, long story short (although not so short looking at the length of my post), we ie my almost 11 year old boy, swapped from a Concerta/Ritalin combo to Vyvanse in April this year due to a combination of plummeting weight, less than optimal management of Ritalin top ups at school and concerns about the emotional blunting on increased stimulants.  Vyvanse has been good, but bad.  The good is he's more himself, the bad is that means that when it's good, it's good, when it's not, it's volcanic eruptions and meltdowns and re-emergence of social problems.  It's been hard to know what is due to his underlying ADHD, what is due to the medication and what is being a tween boy with hormone changes and increased social demands.

So now, we are starting Intuniv as an adjunct in the hope that it helps with weight, helps with the morning unfiltered ADHD rollercoaster, helps with the evening wear off tsunami and hopefully some of the impulsive symptoms. There's a hope that it will perhaps allow us to dial back the stimulants, as there is some concern that that some of the aggression is potentiated by them.

Just wondering how anyone who has been on this combo has found it?  Specifically, how significant was the sedation/somnolence starting the Intuniv, how long til you really saw some effect (if any) and what have been the pros and cons?

Thanks.

#2 Tbird24

Posted 23 September 2019 - 07:39 PM

My son is on those meds. He’s 11. Intuniv worked when he got to the 4mg dose. It makes the mornings heaps heaps better and overall mellowed him out a bit. He takes the Intuniv at night time and hasn’t had any issues with sleepiness during the day. We can tell when the vyvanse wears off in the afternoon but it’s managable.

#3 JoanJett

Posted 23 September 2019 - 09:09 PM

Thanks Tbird24.

#4 Navy Blue

Posted 24 September 2019 - 10:41 AM

My DS is on intuniv and risperidone.

Tbh I didn't really notice any effect on the 1mg intuniv. Now he's on 2mg and his focus has definitely improved. He is pretty tired atm but I'm hoping that evens out soon. It has calmed him down but he complains of no energy for sport etc so it's a bit of a trade off, for now at least.

He takes it in the morning.

Oh, to add he was very tired the first few days on 1mg, then came good pretty quick. The focus improved after a couple of weeks on 2mg.

#5 JoanJett

Posted 24 September 2019 - 12:11 PM

Thanks Navy Blue.

#6 IamzFeralz

Posted 28 September 2019 - 12:27 PM

My DS is on those meds too. He is of the very impulsive aggressive subtype of ADHD and ASD.  It’ helps a lot with the aggression but he is still quite impulsive in a silly way.

We haven’t had any issues at school this year so that is great.

#7 ali-song

Posted 28 September 2019 - 01:01 PM

We had a similar experience with Vyvanse, such that DS didn’t stay on it for more than a couple of months. From memory, he was a similar age to your DS at the time. There was one epic meltdown related to a lack of sour cream that really sealed the deal. At the time DS only had an ADHD diagnosis; ASD has been added since then.

We went back to Concerta and just dealt with the side effects - a very good thermos and hot lunches have helped with weight. Since then we’ve added Lovan - which was a subtle improvement - and about a year ago, Intuniv. DS is now up to 7 mg, taken at night. He isn’t generally too tired, but his sleep does get disrupted if he forgets a dose or when doses were changed. For us, this has been a great combo of meds - there have been no behavioral concerns at school this year, and he’s generally just been much more pleasant to be around.

#8 JoanJett

Posted 28 September 2019 - 01:38 PM

Thanks IamzFeralz and ali-song.  It's useful to hear others' experiences.

So far (after a few doses only at the starting dose), the upsides have been easier transition to sleep and more appetite through the day.  Luckily no noticeable sedation.  It's too early to say much more than that. Here's hoping we see  more ADHD specific benefits as the dose is escalated.  

Thanks everyone for replying.

#9 QuirkyMum

Posted 28 September 2019 - 06:08 PM

Due to losing weight on Concerta and needing a higher dose, doctor changed his meds to same dose of Concerta + Intuniv 2 mg.
Intuniv only caused sleepiness and made him placid/more compliant for 3 weeks ( first week was on 1 mg so first two weeks on new 2 mg dose). After that it no longer helps with sleep, unfortunately. But it definitely helps with mornings ( still gets silly but easier to handle) and evenings. Our evenings are definitely better if Intuniv is given with dinner ( at 5:30-6:30 pm). If we forget or eat late, then things escalate. I know Intuniv sort of needs to build up in the system and missed dose shouldn't be as obvious as a missed ritalin tablet ( haha as if this can be missed!) but our experience has been different to this...
Anyway, good luck with this combo.I hope it works for your family. You should see Intuniv in action after a few weeks...

#10 JoanJett

Posted 08 January 2020 - 09:59 PM

Just stopping by to update, for my own reflection but also knowing that I've found threads of this type useful in our "journey" (although I have unreasonable hate for that term...).

It's a few months down the track and our son is now on 3mg Intuniv, which was the target dose for his weight.  Initially there was a benefit for quicker onset of sleep - the degree of his hyperactivity has meant that since infancy, his sleep onset time is around 11pm.  That faded quickly, and then we saw some sleep disturbance, with more awakenings and nightmares/vivid dreams.  It was difficult to work out how much was medication-related, and how much anxiety-related due to significant escalation in social problems at school.  The benefits in that time - he managed the social problems and was able to not react impulsively and ask for help.  That was a huge moment for us, as it meant that all sides of the problem were obvious, rather than just the reaction side of things ie him being the problem.

We've now moved to morning dosing, as he has not had any problems with sedation, and it's been a game-changer for us.  The afternoons/evenings have been soooo much better, as the wear-off of his stimulant therapy has been ameliorated more effectively than with evening dosing.  There is conflicting evidence/advice about duration of action, but our Paediatrician  has discussed 7h as peak concentration, and that seems to have been borne out for us - it has always been the real problem time for us (afternoon/evening).  So our trial of n=1 has been effective in that regard.  There's also been more noticeable benefit for daytime appetite with morning dosing.

So that's my anecdata - for anyone who is in this thread and looking at medication changes/combinations.  

Thanks to all those who responded and good luck to anyone who happens here searching for some individual experience of the rollercoaster ride of ADHD.

#11 IamzFeralz

Posted 09 January 2020 - 07:59 AM

That’s an interesting report Joan Jett.  We give DS his meds in the morning too.  Glad that it’s working out for you.

Now that DS has been on the Vyvanse / Intuniv combo for a year now I can say this has been our best medication configuration ever.  Until DS was about 12, my feeling about the benefits of ADHD medication for him was mixed.  It was very hard to find something that really worked for him as he was often so aggressive due to the ASD.  His school reports in primary were always quite negative too.  
His school report for his first year of high school however was really good!  Lots of comments on how he was a positive influence on the class and tried hard at his work.

#12 Winging it Mum

Posted 13 January 2020 - 08:16 AM

I only just came across this one. DS13 is on a combo of Vyvanse and we introduced Intuniv last year & he's also on Risperidone to help him cope with the meltdowns. He has been on Dex in the morning & needs another 5mg in the afternoon. His system seems to burn off the Vvyanse in about 6 hours and having the Dex in the afternoon extends the good effects but also seems to reduce the crash of coming off of the Vyvanse in the afternoon. Trialled a higher dose of Vyvanse and that was ineffective in lasting longer.
Finding the right dose of Intuniv was difficult as too high and he would revert back to bed wetting so he's on a 2mg dose. Still needs melatonin to go off to sleep.
Medication wise it's been a difficult couple of years finding what works for him without turning him into someone that's vague and unresponsive.
There are times it still is horrible but I do think that's a combination to of being a teen and mornings are not good until he's eaten and the Dex starts to kick in. Stress from school had impacted him greatly in the first half of last year and that all came out in his behaviour.

Edited to add, I'm glad JoanJett you have found something that is working for your DS! It's interesting to hear about the morning dose of Intuniv working to, I'll be keeping that in mind.

Edited by Winging it Mum, 13 January 2020 - 08:18 AM.


#13 JoanJett

Posted 13 January 2020 - 10:48 AM

Thanks for the replies.  

I think ideally, our son probably needs a short-acting dex top-up in the early evening, as getting to sleep is still the bug-bear, despite Melatonin - it's always clearly been the ADHD effect rather than meds, as when he was on Concerta/Ritalin top ups, late small doses of Ritalin were magic for sleep.  A 24-hour stimulant would be the holy grail.

Good to hear everyone's experiences - it's clear that combination therapy has been best for us (mainly hyperactive/impulsive symptoms).




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