View Full Version : Incentives to prescribe Meds

Miike Snow
02-05-10, 12:52 PM
I took my boys to their ADD/ADHD specialist this week and before reviewing how their current med is working (Strattera) or talking to our kids, quickly recommended Intuniv.

I know Intuniv is new on the market and is likely being pushed heavily by Shire. I know we should trust our doctors, but I felt like Intuniv was being pushed on the kids.

She said Intuniv is better than Strattera for impulse control and anger. The Dr. couldn't clearly state why he felt this way. He also suggested that Intuniv has less side effects than Strattera, but again, no indication as to where that info came from.

Does anyone else have this cynisism when it comes to Dr's prescribing meds? We had switched before, but that was after bring issues to our Drs attention. Here the dr. brought the drug to our attention without any indication that Strattera had problems. Of course once presented with an option every little thing with Strattera was then scrutinized in our mind.

Anyone feel this way?

02-05-10, 01:50 PM
That is a bit odd, that he would ask you to switch without evaluating whether the current med is working adequately or not. Many doctors are hesitant to prescribe Intunive because it is so new. Although, it is just a time release form of a medication that has been around for a while.

I would be curious to hear what he would say if you said you wanted to use the less expensive generic version of the non time release version?

Both the doctors that I have seen regarding my daughter have always been carefull to explain why we should stick with a med or why we should change. It is just strange that your doctor could not articulate clearly the reasons.

Miike Snow
02-05-10, 01:57 PM
Well he simply stated that it will be better for impulse and anger behaviors, which have been a problem even with Strattera. Although I believe environmental factors are also contributing to this (divorce). Does anyone know for sure Intuniv is indeed better than Strattera for impulse and anger? What about side effects?

02-05-10, 05:07 PM
Hey, I just did a search in the literature and while it seems clear that Stratterra is probably most helpful for inattention and less helpful for the hyperactive/impulsive symptoms, it is not entirely clear that Guanfacine or Intuniv are necessarily better for the symtoms of anger and irritability.

It does seem, from the literature, that most research has been done of the positive effect that the stimulants have on anger. I suppose that the stimulants then would be the best medication for those symptoms. The Guanfacine works well apparently for hyperactivity and impulsiveness according to the studies and if you feel that the anger outburst are related to impulsiveness, than the Intuniv might be helpful.

Below is a review article on the mechanisms of action of these drugs, and what they preferentially act on, in the brain. It terms of safety. Guanfacine is amazingly safe and doctors are quite familiar with using this class of drug for high blood pressure. The drug does not lower the blood pressure of kids with ADHD in any clinically significant manner.

There is a post on Guanfacine archived from 12/09 here:

Good Luck!! Tess

Behav Brain Funct. (http://javascript<b></b>:AL_get(this, 'jour', 'Behav Brain Funct.');) 2008 Feb 28;4:12.
Pharmacological and therapeutic directions in ADHD: Specificity in the PFC.

The data suggest a possible hierarchy of specificity in the current medications used in the treatment of ADHD, with guanfacine likely to be most specific for the treatment of prefrontal attentional and working memory deficits. Stimulants may have broader effects on both vigilance and motor impulsivity, depending on dose levels, while atomoxetine may have effects on attention, anxiety, social affect, and sedation via noradrenergic transmission. .

02-10-10, 06:03 PM
Intuniv isn't a stimulant and ADHD (both types) in general have better symptom control on stimulants such as Adderall, Vyanse, Ritaline, Concerta, etc. Also expect for it to take a while notice a difference if you switch as a lot of the non-stimulants take a while to build up in the system and I understand it.

The only advantages that I'm aware of are less symptoms around reduced appetite and insomnia.