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Monthly NewsNote
Fall 2010
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Intuniv: The Newest Medication for the Treatment of ADHD/ADD
There is a new medication for the treatment of ADD and I think it important that we know about it, how it's used and why it is important. To that end, this NewsNote will discuss Intuniv.
Here is some background on the drug: Intuniv It is a long acting form of guanfenacine. A short acting form called Tenex has been available for many years. It had been shown that Tenex could be useful in the treatment of children with ADD, but the side effect of tiredness, coupled with modest clinical results, kept it from becoming popular. And because it was short acting Tenex needed to be used two or three times daily.
Here is some background on the drug: Intuniv It is a long acting form of guanfenacine. A short acting form called Tenex has been available for many years. It had been shown that Tenex could be useful in the treatment of children with ADD, but the side effect of tiredness, coupled with modest clinical results, kept it from becoming popular. And because it was short acting Tenex needed to be used two or three times daily.
The drug is used as follows: It is a slow release tablet that must be swallowed whole and cannot be chewed or crushed. It comes in strengths of 1,2,3, and 4 mg. The child takes one mg the first week, two mg the second week and then the three mg dose. After the third or fourth week you need to work with your doctor to plan the on-going course of treatment and the dose needed. Some stay at three mg and others go up to four mg. or beyond. The dose, of course, relates to the control of symptoms and absence of side effects.
The primary side effect is tiredness, which can be significant. It does clear, usually after a few days, but the tiredness can continue for up to three weeks. It is possible for the tiredness to force us to discontinue the Intuniv. Intestinal problems can also be a side effect, but are usually not a significant problem.
A typical case for me is Rich. He is a 9 year old with distractibility and hyperactivity. Because of these and other ADD symptoms his school work was suffering. He responded very well to stimulant treatment but at the end of five weeks he had lost nine pounds. This was not acceptable and I changed to the Intuniv. Intuniv takes a while to work as you have to build up the dose slowly. After about four weeks teachers reported he was doing quite well and there has been no weight loss problem. I have continued using the Intuniv because it has been effective, though not quite to the level of the stimulant.
Another situation was that of Terry. He is a 13 year old with severe ADD of the Inattentive Type. He did very well on stimulants but couldn't sleep. Changing the medication or time it was administered did not improve his sleep. I then switched to the Intuniv and a dose of three mg. a day he is doing quite nicely.
While I have not yet done this, some physicians are combining the Intuniv with the stimulant in the hope that they will be able to reduce the dose of the stimulant.
In my cases who did a bit better on stimulants I'm considering using a short acting stimulant such as Ritalin at critical times such as an exam or big project.
There is no work on adults to report at this time. It would be an off label use.
In summary, Intuniv is a medication that is having very positive effects on ADD treatment. It is certainly an excellent addition to our treatment choices.
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