Do most teenages who take adderall or adderall xr also take insomnia pills also?
Tuesday, June 30th, 2009 at
12:24 pm
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Dextroamphetamine salt combo (the adderalls) is a stimulant used to treat ADD. It works by causing an increase in Norepinephrine in the synaptic cleft of neurons. While this balances the chemical imbalance in people with ADD, the increased NE has some consequences including decreased appetite, mild increase in blood pressure and heart rate, and insomnia. This is most common with Adderall XR because it lasts longer into the day. This is also the reason why there are so many formulations of adderall.
For some people the XR works great. In others, it works best to give them an IR (immediate release) or SR (sustained release-somewhere in between). The IR lasts for only 4 to 6 hours so in order to get through a school day, kids need to take another tablet at noon or around 3 pm. Many kids do this and can sleep fine. Parents don't like the SR form because it wears out right after school, and they have to deal with non-medicated kids. This break in medication can also cause rebound ADD, worsening behaviors.
A common adjunctive therapy is the Alpha-2 agonist class. By activating this pre-synaptic NE receptor, they decrease the frequency of NE release. Drugs like Tenex (guanfacine) and Catapres (clonidine) can decrease the both the blood pressure/heart rate and insomnia.
Last, some patients still cannot cope with the insomnia, or just don't respond to the stimulant (about 20% of kids). These kids may need to switch to another choice. The primary option would be Strattera (atomoxetine), a selective NE reuptake inhibitor (sorta works like prozac only on different receptors). This medication can cause somnolence so if a kid can't sleep, this med should make them fall asleep.
It is a stimulant. Taking too much or too late in the day can make sleep difficult.
Let me warn you about this.
Adderall is an amphetamine, it stimulates the brain, and increases blood pressure. The high blood pressure makes the heart have to work more just to push the blood out.
Reciently, there has a been a trend to add the drug clonidine to the adderall as a night time medication to combat the insomina, since clonidine causes drowsiness.
Problem: clonidine is a blood pressure medication that acts to supress what is called 'sympathetic outflow', as a side effect it causes drowsiness.
There are at least two problems with this:
Missing a dose of clonidine causes a rebound increase in sypathetic outflow promoting hypertension. Even without the adderall, if a person has been taking clonidine for a peroid of time it is dangerous to discontinue it. Many doctors do not know what it takes to discontinue the drug, it takes both a beta blocker and and alpha blocker.
The other problem might secretly relate to why their is a promotion of clonidine, it makes the brain secret growth hormone. People on these stimulant drugs for ADHD are thought to have stunted growth. So does it sound like a bad idea to get this growth hormone effect from clonidine? Well, growth hormone can stimulate cancers to grow.
This use of clonidine is 'off label", meaning it is something not approved by the FDA. The FDA won't do anything to stop its use, just like with Fen-Phen, unless someone comes up with data to show its dangerous. Yet using common sense, it imposes serious risks.
You can substantiate what I say if your apply logic along with the known pharmacologial properties of the drugs. But, you are not going to find explicit warnings in a text, it would take a Fen-Phen disaster to get that done.