View Full Version : intuniv is it sedating or interfere with stims


hollywood
02-03-10, 04:03 PM
somebody chime in. Nobody addresses's this.

Momofadder
02-04-10, 11:02 AM
Do you take it at night? Your Dr. should be able to help you.

Momofadder
02-04-10, 11:02 AM
somebody chime in. Nobody addresses's this.
Yes it is sedating.

hollywood
02-04-10, 11:19 AM
does the body get used to it?

ADHD Ceilidh
02-05-10, 11:08 PM
I just started it and dropped the Aplenzin I was taking with my Vyvanse. I'll let you know my impressions once I titrate up and have some experience with it.

Momofadder
02-10-10, 06:38 PM
does the body get used to it?No...my son takes it at night and sleeps like a baby. Has taken the same dose for years.

ADHD Ceilidh
02-11-10, 05:02 AM
Just a matter of pharmacodynamics, but the extended release guanfacine in Intuniv peaks roughly 12 hrs after ingestion. Thus, taking it at night is likely to make one most drowsy when they are trying to wake up in the morning.

However, it has a half life of about 17 hours. So once somebody reaches steady state on it, (about 5-6 half lives if taken at the same time each day with the same dose) then this difference would likely be fairly negligible given the long half life.

Having said that, I'm on 2 mg daily now and will likely titrate up to 3mg. I take it with Vyvanse and the drowsiness with me is occasionally noticeable in the evening. I would say it does not interfere with the focus of stims, but does temper the feeling of being "amped" when they kick in. Thus far I have not had any significant or annoying side effects but will keep you all posted.

Cheers.

hollywood
02-11-10, 09:59 AM
what do you mean by temper the feeling of feeling amped when they kick in ? Is this good ? bad ? indifferent? I would like for it to level out the peaks

ADHD Ceilidh
02-13-10, 11:46 PM
I just don't feel hyper when they kick in. I don't feel jittery if I took it on an empty stomach and I get more of an instant release bolus as opposed to taking my vyvanse on an empty stomach. I dunno about smoothing things out or leveling peaks. I get all the focus I used to get but perhaps less hyperfocus and less anxiety-like adverse side effects. I am anxiety prone and I find the intuniv helps me to relax and focus on the moment... instead of living in the future in my head at the expense of the present. I've only Been on it about 2 weeks thus far though so I'll let you all know if my experience changes over time.

Overall, thus far I like it. I wouldn't really call it sedating, more calming really. But perhaps that's cuz I take it with stims. Ymmv. I would say I like it as an add on and it is doing more for me more quickly that bupropion was as a stim add on.

Cheers.

mikeo
02-14-10, 07:21 PM
Ceilidh- when do you take it?

Been on it one week myself. Took it at night first few days and went straight for bed. Nice to be able to shut off brain, xbox, books, etc but the sleep was not so deep (little light on rem?).

Generic guanfacine here. Get very tired before/between stim doses. Little more focused on important things and less distracted then just stims alone.

ADHD Ceilidh
02-14-10, 07:31 PM
I take it in the am when I wake up, at the exact same time as my Vyvanse. But I'm on the extended release Intuniv. Not sure what peak plasma time is for ir guanfacine.

hollywood
02-14-10, 08:28 PM
I
feel wellbutrin helps as a stim add on with hypervigilance. Weak for focus. Helps attentiveness a bit. I feel intuniv may help as a stim add on. Between that and cymbalta as a add on.

hollywood
02-14-10, 09:56 PM
I
feel wellbutrin helps as a stim add on with hypervigilance. Weak for focus. Helps attentiveness a bit. I feel intuniv may help as a stim add on. Between that and cymbalta as a add on.

mikeo
02-15-10, 12:32 PM
Thanks C. Need to look into the extended release and will try am again.

Guan seems to help impulsivity more than anything (and yes the hypervigilance.. same thing?) but that's based on limited experience.

Cymbalta?

hollywood
02-15-10, 12:55 PM
mike

hypervigilance is the ability to get motivated and stay motivated which is an issue with people like us where our brains have not developed in some portions like the normal brain. It is why we attempt and then try but then give up. Wellbutrin with its NE helps with that a little. I think cymbalta has NE reuptake as well which would in theory help at higher dosing. I' think intuniv does play a role in locking in NE in specific alpha 2 receptor sites.

mikeo
02-16-10, 12:06 AM
It's a tryclic antidepressant.

Stims act on catecholamine system (dop+NE). Tris act on catecholamine + serotonin system with the greatest effect being on NE. (Driven to pg. 283)

Well and Cym are also tryclics from what I could find.

The other positive for me is lower BP. Feels better. Apparently there's some testosterone production effects which I thought was interesting (tied to bp?).

mikeo
02-16-10, 12:14 AM
Hypervigilance from the definition I read sounds like it refers to a state of increased sensory sensitivity towards sounds, stimuli and evironmental threats. Either way.. sounds familiar =>}

ADHD Ceilidh
02-16-10, 02:39 AM
Neither wellbutrin nor cymbalta are tricyclics.

hollywood
02-16-10, 10:04 AM
thankyou adhd cel,

I had not yet had the chance to chime in but you right. Wellbutrin is metabolite that is similar to amphetamine in structure once digested and once it becomes active in the body, it's a dnri, but its properties are not completely understood. Cel , so you like the addtion of intuniv to your stimulant? I was using wellbutrin as an addition but felt that I felt a bit stale or backed up after time goes bye. However it is effective in some way shape or form. Do you feel intuniv is a better addition in coadministration with stimulants.

ADHD Ceilidh
02-16-10, 11:14 AM
Yes. I haven't ruled out adding back Aplenzin down the road if need be but the benefits of Intuniv for me are far better and began rather quickly after starting the 2 mg dose, after maybe 10 days on the med or so my wife and I had noticed a number of obvious changes for the better. For now I'm leaving the bupropion out and titrating up to 3 mg on the intuniv.

I'll be sure to keep you posted on any side effects but thus far I haven't had any to speak of. Went skiing this weekend and no orthostatic hypotension or other badness. I was actually able to relax on my mini vacation from day 1 which hasn't happened for me in decades. I'm still concerned I could run into sexual side effects but none so far. Apparently most adverse reactions with guanfacine are dose dependent so I could always kick back down a mg if need be. Cheers. Good luck to all but I would say Shire is on to something with this one whether you love them or love to hate them. Of course, YMMV and everybody's chemistry is different. I would be interested in what others think of Intuniv as well but for me thus far Vyvanse + Intuniv = big positive changes my wife really appreciates and I notice as well in a number of different ways.

I would also be interested in knowing if ADDers without an anxiety component benefit as much though. Guess we'll see as more post their experiences. My guess is that we will hear more once it's approved for adults and Shire can market it to PCPs more agressively.

hollywood
02-16-10, 12:03 PM
ceil,

I need or would really like to know why you started taking intuniv with your stims. The only problem I have is having anxiety or boredom thoughts at work which lead to worrying.

SamCurt
02-16-10, 12:33 PM
Brief summary of ADD med actions:
Amphetamines: Increase NE release.
Methylphenidate: Increases NE release (not as strong as amphetamines) and blocks NE reuptake.
Atomoxetine: Blocks NE reuptake.
alpha-2 agonist (Clondine/Guanfacine): Stimulates one type of NE receptor that is mainly sedating.

So yes, Intuniv is supposed to be more sedating than most.

hollywood
02-16-10, 12:46 PM
I thought so... I've discovered something interesting. If I am bored and not taking an antidepressant at work then I start to worry. I was thinking cymbalta or pristiq.

ADHD Ceilidh
02-16-10, 02:06 PM
Why I started Intuniv with stims would take forever if I explained all of it. I'll try and condense:

My wife was about ready to divorce me due to a number of issues. Some of them were directly related to my ADHD. The stims helped with things that bothered me a lot but her only a little--like performance at work, 6 trips to the car in the morning to get all the stuff I needed with me, messyness in our office, inability to multitask while cooking dinner , etc.

She came with me to see my ADHD specialist and noted that the stims had improved many areas of my life except how ADHD directly impacts our emotional connection, Such as kids going crazy and she's trying to deal with it and I'm just doing my thing and not realizing that she needs help which makes her think I don't care. Or not being able to stop worrying about things I have to do in the future thus I'm spacy and not attentive in the present. This is specifically bad if it's family time and I'm there physically but not mentally/emotionally. Really bothers her.

These complaints (amongst others) coupled with my hx of anxiety (which was misdiagnosed as GAD for 19 years rather than a secondary issue due to untreated ADHD which I Now know I've had since I was about 7 at least) led my ADHD doc to recommend Intuniv as he has used it more and more recently both with and without stims with good results in about 80% of cases per his unscientific estimate. Anyway, maybe that is TMI but perhaps it will help someone. Good luck.

lk44
02-16-10, 02:19 PM
intuniv is sedating but when used alongside stimulants, that side effect is much, much less of an issue. see health + life, side effects & efficacy of intuniv (http://healthlifeandstuff.com/2009/09/intuniv-for-adhd-concerns-efficacy/)

there are many issues around this medication - we have a lot to learn about its use. hopefully its helpign you out!! :)

hollywood
02-16-10, 02:32 PM
I have some generalized anxiety issues. It's been going on for too long. My doctor said intuniv may help or cymbalta may help. I really need to try one of these medications. I too find out that when I'm not massively over worried or focused on what I think I cannot do then obviously I wonder why I am struggling with my adhd when really no matter what sparked this it is my generalized worries that are messing with my attention span... When I take something for it all of a sudden I realize how much more improved my adhd is ... Its between cymbalta or intuniv... Obviously I'm so worried about which one to take well I haven't taken one yet... I keep worrying it will make my symptoms worse.

hollywood
02-16-10, 03:01 PM
would anybody care to chime in for some advice. My doctor is good but leaves it up to me and I just have an issue about trialing all this stuff... The problem is generalized worry with adhd . The worrying takes place in the same environment and seems to be learned when I am bored and irritated. Worry effects my working memory because I'm not focused on work during these times and it seems very similar to my adhd scattered brain.. It may be a bit of them of them both feeding off of one another.

mikeo
02-16-10, 05:31 PM
Why I started Intuniv with stims would take forever if I explained all of it. I'll try and condense:

My wife was about ready to divorce me due to a number of issues. Some of them were directly related to my ADHD.

Man this was familiar and almost word for word why I chose to try to supplement stims. All that and I was defensive when my wife pointed out my shortcomings :) Thanks for sharing.

Hollywood- My doc is the same way and it wasn't a good feeling. Fortunate for me my daughter's pdoc was much better versed with this med. She described for me at the time what it did and how it could help me. Can you get a second opinion?

hollywood
02-16-10, 05:37 PM
second opinion for my adhd or for what the medication is used for? I don't know man, it's hard to tell whats going on with me myself... All I know is that I am quite smart and things shouldn't be like this.

hollywood
02-17-10, 10:32 AM
this is excellent information. I was going to trial adderall but honestly ritalin works very well for me . I just do not like some of the peaks ,as I find it distracting if I drink caffeine. I feel as though intuniv may really help my stims work better for me and I feel very good about trialing intuniv as all I need is something to calm me physically during peaks or if I drink caffeine which is really not a good idea to cut out in the mornings . I cannot tolerate ssri's or snri's ... I feel good about this.

hollywood
02-17-10, 10:14 PM
I have a very mild heart murmur..virtually not detectable , played athletics in high school and in college , workout no issues... never had a doc really bring it to my attention other than the fact that I know I used to have one as a small child ..etc... is it safe to take intuniv with stims if you had a heart murmur... I have heard its safe...

ADHD Ceilidh
02-17-10, 10:42 PM
Intuniv has no specific contraindication related to heart murmurs unless you have a history of orthostatic hypotension or syncope. Stimulants, on the other hand, are absolutely contraindicated in patients with certain structural heart defects... Some of these can initially present as only a heart murmur.

Patients with murmurs of undetermined etiology are generally recommended to have an echocardiogram prior to beginning stims for safety's sake.

You mentioned a hx of anxiety and then mentioned considering adderall. Of all the stims, adderall is the most likely to exacerbate anxiety due to it having the highest peripheral activity due to the L form salts. Just an FYI, but a long acting agent with as much central activity and as little peripheral as possible is the usual approach in anxiety prone pts.

Cheers.

hollywood
02-17-10, 11:33 PM
THANKS CEL

man , it looks as if you are really focusing well with your combo of stims and intuniv. I hope it brings me the same luck as its giving you. I'm going to start the combo tomorrow and I may add wellbutrin into the regiment if needed down the road. I hope that it keeps my mind from shifting from one thing to another a little bit better in times of boredom at work. I think if I address this one category I will be really good.

hollywood
02-18-10, 11:55 PM
somebody tell me whats better for adhd with worry and distracted thoughts .... intuniv in combination with stimulants or pristiq in combination with stimulants? I cannot seem to break a thought pattern lately and its very annoying. I need to know which addition will not make my adhd worse... I cannot focus because there is too much on my mind.

hollywood
02-19-10, 09:31 AM
Lets Go. Which is better for my situation.

SamCurt
02-19-10, 06:51 PM
intuniv in combination with stimulants

As the amphetamines and methylphendiate can be quite different in their actions, which stimulants?

hollywood
02-19-10, 10:55 PM
Well right now I'm taking concerta and ritalin ir .... I've always taken that . It helps my attention span and attentiveness but can make me fidgety at times on ramp up and peaks.... I find this annoying. Also , ritalin has more of a predisposition to increase hyperfocusing which can be repetitive in nature... Trying to balance the equation out. I tried adderall , although it's smooth , I didn't find alot of help with attention to detail. Although I didn't give it much time. Anyways , I'm taking ritalin or concerta now -

ADHD Ceilidh
02-23-10, 09:17 AM
HW:

For anxiety secondary to ADHD the stimulant profile you want ideally is 1) Gradual on and gradual off along with 2) as much central activity with as little peripheral as possible because increased peripheral sympathetic tone mimics the anxiety response and most with a history of anxiety will recognize these symptoms as such, thus becoming more anxious. Any stmulant given to a person without ADHD and diagnosable anxiety disorder is likely to induce panic/anxiety but when the anxiety is due to untreated ADHD there is a paradoxical response. I hope helps explain the rationale.

Dex or Focalin would thus be expected to be better tolerated than straight up methylphenidate, which in turn would be expected to be less peripherally stimulating than adderall. This assumes that from a chemical standpoint the drug is effective at controlling one's ADHD. Once the effective chemical is found then the longest acting and most gradual onset version is generally preferred to avoid slamming the nervous system with loads of stimulant at once and providing steady benefit.

Personally I take Vyvanse. However, in certain circumstances the vyvanse can occasionally all release fairly quickly so I have occasional days with more peripheral tone than I would like. Problem is, it turns out my ADHD is kinda bad so I doubt Focalin would be as effective as dex but I've never tried it.

Intuniv is still doing well by me after wy 1st week at 3 mg and I think I will be holding at this dose for a while. Unless you are depressed clinically I would not personally expect your serotonin axis to have much, if any, bearing on your anxiety thus IMHO I would recommend Intuniv over Pristiq but I have never evaluated you formally and I am not board certified in psych thus u should take my opinion with a grain of salt.

Good luck.

hollywood
02-24-10, 04:33 PM
thats what my doctor says. He told me that intuniv would help my attentional system more directly. I don't know about the depression man. I'm so sick of my current job it's driving me nuts. I can't sit here and be bored for much longer! Yet, I am having problems paying attention too so it's not like I feel confident lately. I am streaky. I know cymbalta made me not worry but I also felt like I couldn't remember what I was doing... It's so difficult to say for certain. At times when I took cymbalta I was calm and for once I knew or remembered what it's like to feel not bothered by ten million different things... Tough to say.

Realmom1
03-15-10, 01:55 PM
Just wanted to chime in here and tell you our experience so far with Intuniv. We incorporated Intuniv with my daughter's Vyvanse to combat the rebound hyperactivity she seems to have in the evenings and mornings. Though Vyvanse seems to have less ups and downs, for my daughter it lasts only about 6 hours and when it wears off she is extremely hyper.

Here is a link to my experience so far: http://www.addforums.com/forums/showthread.php?t=79661

I guess since she is young we dont exactly call it 'anxiety', but it is like an all over wiggliness that requires constant movement and talking. Our ultimate goal is to reduce/eliminate the Vyvanse but I think the ped is being overly optomistic about that.

She only weighs 65 pounds and takes lots of allergy asthma meds too. I have to be careful of what drugs I put in her.

LA

hollywood
03-15-10, 03:09 PM
so intuniv has not really helped thus far is what I gather from reading this. I read that the sedation was not that much and it is supposed to go away after time. I do not know how it really helps adhd but hear its preferred with stimulants. I still don't know how it would help. I guess it may help calm a person down giving you less stress which would enable attention after one adjusted to the side effect profile. I don't know it's either this or a snri for an augmentation with my stims.

ADHD Ceilidh
03-16-10, 02:48 PM
I'm not sure you interpret my bottom line with Intuniv correctly. I do think that for adults the sedation may be too much for some people who do not want or cannot take stims. However, with stims, I'm not sure I could write a more glowing review of Intuniv. It has been life altering in a very positive way as discussed by me above. I'm Shocked that no other adults on Intuniv are posting here and would love more opinions to chime in, particularly from those with ADHD and anxiety. I quite literally had not relaxed in about 19 years.... Until I started Intuniv. For me, it has been remarkable. I'm going to try titrating up to 4 mg while on vacation a week from now to see how it goes. My wife has noticed a big difference. I live in the moment now. I'm not sure how I could be more specific than I have been but I Love me some Intuniv. And no, I don't work for them. And no, I don't hold stock. And no, I don't Rx it in my practice. But it has helped me a ton, more so in my personal life than professional, Whereas stims helped more in my professional life than personal. The combo = new me.

Cheers.

hollywood
03-22-10, 01:58 PM
I'm still trying to keep this thread alive. So far honestly through working in office where things are hot and cold and don't know what is really throwing my attentional system for loops when things get boring. I seem to start getting bored and then thats when my attentional system starts getting too many popping or distracting thoughts that come in and throw me off task daily. Right now I'm going to try cymbalta to see if it's anxiety based. Cymbalta is supposed to be good for a host of issues and help mood as well so I figure its like killing 3 birds with one stone. I'm not sure whats throwing my attention for loops every so often but the only way is to trial one thing and see if it works and then keep it or move on. Bottom line is I have alot of guilt thoughts and get down on myself for daydreaming and having these constant pop thoughts is really tiring. I will try cymbalta and then if that doesnt work try intuniv. I think it may be distraction based which would mean intuniv would help but I have to rule everything out, thats the only way scientifically that would make sense.

Realmom1
03-25-10, 08:14 PM
Just wanted to input that I take Cymbalta along with Wellbutrin. I take them for depression/anxiety and not ADHD. I found that the higher dose of 60mg makes me very tired. I have tried to increase to 60 mg twice over the past 2 years but I cannot get past the sleepiness. The 30mg dose is just right for me. I know you were worried about sedation so I just wanted to put that out there.

Good luck.
LA

hollywood
03-25-10, 09:25 PM
Does the wellbutrin counter the sleepiness. I feel relaxed with cymbalta and have no physical symptoms of anxiety but feel demotivated and sleepy . Been on CYM for 4 days

Realmom1
03-25-10, 11:29 PM
Hmmm, not sure that it counteracts the sleepiness. It just effects different receptors than the Cymbalta. I have taken the Wellbutrin for years. They both are actually considered a more stimulating antidepressant, but the 60mg of Cymbalta was just too much for me. I took it for 1 month and never got over the sleepiness. I went back to the 30mg dose and the sleepiness is gone. You might give it a while though before you make a decision. I would take it at least 2 weeks because it takes that long for your body to adjust, then if you are still sleepy, maybe you should ask abou a lower dose.

At least it hasn't made your anxiety worse yet.

LA

hollywood
03-26-10, 09:29 AM
Realmom,

Actually the first 3 days it made my anxiety alot worse . I felt like I had to hold my chest the entire first three days that I took it, how fun it that? Now I'm on like day 5 and it's evened out a little . I'm only on 15mg and I feel a bit tired but it's not horrible. I guess the good news is that I'm not feeling anxious and not feeling like I'm being pulled ten million different directions. I think I have just had alot of negative stress, there is good stress and bad stress and mostly I feel I had the bad stress like doing things I hate for 8-10 hours daily, not easy sitting in a desk for 10 hours with adhd , not good at all. Yeah so I think I should give it another week just to know what this drug is doing at all. I know the positive stuff hasn't even started yet, but I don't think I will have weight gain or anything with cymbalta and the sedation isn't horrible. I think granted my inconsistent attention , ... I seem to do really well and then when a worry thought would come it would be weeks before I got back on track and I've gotten to the point where I know thats just not a normal reaction.

DesertDave
04-13-10, 04:22 PM
Wow, I'm glad I ran across this thread. My pdoc just rx'd Intuniv for me so I thought I'd look around here for feedback.

I've been absent from here for a while. Things I've tried just haven't worked. I got a little weary of the experimentation with no results (other than costs & more frustration).

I've been taking Vyvanse and adjusting the dose most recently. It was making me just too wired.

I am also on a small dose of Buspar, which I don't think does anything. But the doc wants me on it, so I'm taking it.

I'm so glad to read about others experiences with Intuniv. Here's hoping that mine are good and perhaps is finally something that helps.