Friday, April 22, 2011
Stimulants used to treat ADHD

By Dr. Anthony Policastro

Whenever a new ADHD drug comes out on the market, parents are interested in trying it. We have used stimulant medication for almost 50 years and there have been few significant side effects. However, I frequently will have parents complain about all that they have heard about stimulants. I am not clear who they heard it from. What I do know is most of what they have heard is incorrect information. Even so, there have been requests for non-stimulant medication over the years. The first of these medications to come along was a drug called Cylert. Popular in the early 1980's, it was the first full day drug. Parents liked the fact that it did not need to be taken more than once a day. We used it for several years and it worked very well during that period. One of the things that we knew was that it could affect the liver. For that reason, I used to do liver function tests every three months in the children that I used it on. Not all children got their blood tests done regularly. The result was that three children died from liver failure. Everyone stopped using the drug and now it is no longer made. The next non-stimulant that we used was called Desipramine, an antidepressant medication. It had ADHD effects as well. It was especially good in adolescents who had some depression in addition to their ADHD. One of its side effects was to occasionally cause a change in heart rhythm. For that reason, EKG's needed to be followed. If there were any changes in something called the QTc, the medication needed to be stopped. Not all children got their EKG's done. The result was that three children died from an abnormal cardiac rhythm. We stopped using the drug for ADHD when that happened. The next non-stimulant that we used was called Strattera. It was popular in the early 2000's. Before it was approved by the FDA, it was studied in 5,000 children. That meant that rare side effects would not be seen until we used the drug in many more children. It was a 24 hour drug so its effects lasted longer than the 12 hours we got with the stimulant medication. After about a year of using Strattera, we found out a few things. The first was that it did not work as well as the stimulants. I had 11 patients whose parents requested that I change their child from stimulants to Strattera. Nine of the 11 called to ask me put their child back on the stimulants since they worked so much better. Strattera still has a place. However, it is a second line drug to the stimulants. The other issue with Strattera was the rarer side effects. Once we had used it for about a year, we had information on over one million patients. We found three issues. The first was that about 1 in 20 children on it developed manic-depressive symptoms which went away when the drug was stopped. Therefore it was not a big issue. The second issue was that some of the adolescent patients developed suicidal ideas. None of them took any action on those ideas. The ideas went away when the drug was stopped. However, there needed to be caution in this group of patients. Like Cylert, Strattera could affect the liver. Therefore, liver function tests had to be done. Three patients developed jaundice and liver failure. The drug was stopped and they all got better. For these reasons we use a lot less Strattera than we once did. The newest drug is called Intuniv. It is a former blood pressure lowering medication which seems to have an effect on ADHD. I frequently have parents ask me about it. The studies that were done only lasted 9 weeks. The package insert indicates that they can only vouch for its use for a 9 week period. ADHD lasts a lot longer than that. For that reason, we have to use it for a longer period than it was studied for. It is a drug that lasts for 24 hours which is longer than the 12 hour period that we get with stimulants. It also means that the drug must be taken every day to keep the blood levels up. I do not use stimulants every day for my patients who only need coverage during school hours. I have found out several things about using Intuniv. The first is that it does not seem to work very well as the only drug for ADHD. It helps control symptoms in children who are on high doses of stimulants. Therefore, we can lower their dosage if we add Intuniv. However, every child that has been referred to me on Intuniv alone arrived with the ADHD symptoms out of control. The second is related to side effects. Far and away the biggest side effect is the sleepiness it causes. I had one mother carry her sleeping 8-year-old into a 2 p.m. appointment. I had a 6-year-old screaming like an infant during the exam because I was interfering with her 3 hour afternoon nap. The napping had started once she started the Intuniv. For this reason, I use Intuniv as a bedtime dose. My hope is that most of the extreme sleepiness will wear off by the next morning. The other thing that I have seen with Intuniv is excessive weight gain. I have only seen two patients with this. However, that is based on a total of about a dozen patients. One of them gained 13 pounds in three months. Thus, Intuniv might not be the savior that many parents are hoping for.

Stimulants have been very successfully used for ADHD for close to 50 years. The side effects are sometimes bothersome. However, most of them will change if we use a different stimulant preparation. Most of them are not serious. There are few drugs that we use with this kind of track record for success and safety.

National Medicine Take-Back Day On Saturday, April 30, from 10 a.m. to 2 p.m., the Delaware Department of Public Health (DDPH) and the Drug Enforcement Administration (DEA) will give the public an opportunity to properly dispose of expired, unused and unwanted prescription drugs. Simply bring your medications for disposal to any of the 29 sites accepting medications throughout the state. The service is free and anonymous – no questions asked. To find the take-back site near you, visit and click on "Got Drugs?" or call 1-800-882-9539. Area drop off sites include: Bridgeville Fire Dept., Rite Aid on South Central Avenue in Laurel; and the Greenwood Police Dept.

Flu case identified Delaware's Division of Public Health (DPH) laboratory results confirm a sixth Delaware case of antiviral-resistant influenza for the2010 - 2011 flu season. A 55-year-old woman from Kent County was infected with an influenza strain found to be resistant to oseltamivir, the preferred treatment antiviral medication used to treat confirmed cases of influenza. Although it is late in the flu season, you should still take the same precautions. Stay informed about the latest developments on the flu by visiting

Healthy Brain workshop The University of Delaware Cooperative Extension along with its Sussex Mental Fitness partners invite the public to attend the "Brain Healthy Lifestyle: Feed Your Spirit" program on Thursday, April 28, from 1 to 5 p.m., at the Cordrey Center in Millsboro. The event is free, but pre-registration is required in order to plan for refreshments that will be provided. Register by calling 856-5618. Doors open at 12:30 p.m.for check in. Young, old, or in between, it is never too late to challenge our brain and allow it to work for us at peak capacity. Practicing a Healthy Brain Lifestyle not only enhances your overall health by promoting exercise and nutrition, it asks your brain to work in new ways which helps to prevent diseases that can manifest in our more mature years. Featured speakers include Brent Marsh, Attracting Song Birds & Other Wildlife using Native Plants; Dr. Kim Furtado, Effects of Stress on Memory; and Stan Raskin, LaughterÉRx for a Healthy Brain. The Cordrey Center is located on the grounds of East Coast Garden Center, 30366 Cordrey Rd., in Millsboro.

Bereavement luncheons Delaware Hospice's "New Beginnings" bereavement luncheons are an informal way to meet and talk with others, who have had similar loss experiences. Lunch begins at noon and is followed by a brief program. The location rotates each week of the month according to this schedule:
  • 1st Thursday: Grottos Pizza, Rt. 26, Bethany Beach;
  • 2nd Thursday: Georgia House, 300 Delaware Ave., Laurel;
  • 3rd Thursday: Millsboro Pizza Palace, Rt. 113-southbound lane, Millsboro;
  • 4th Thursday: Blue Ocean Grill (formerly Milton House), 200 Broadkill Rd., Milton;
  • 5th Thursday (when applicable): Texas Grill (formerly Ocean Point Grill), 26089 Long Neck Rd., Millsboro. "New Beginnings" luncheons are open to the public. Registration is not required.There is no fee except the cost of your lunch.
For more information, call Carol Dobson or Paul Ganster at 856-7717.

Breast cancer support group Delaware Breast Cancer Coalition, Inc. (DBCC) has expanded its Beginning Your Pink Ribbon Journey, a program for women newly-diagnosed with breast cancer, by partnering with Nanticoke Memorial Hospital Cancer Center in Seaford. The free, monthly program is offered at the Cancer Center located at 801 Middleford Road, Seaford, the third Thursday of each month from 3 to 4 p.m. Of particular value to newly-diagnosed women is DBCC's Peer Mentor Program through which they are paired with a long-term survivor for one-on-one support. To learn more about Beginning Your Pink Ribbon Journey at Nanticoke Memorial Hospital Cancer Center, call Lois Wilkinson at 672-6435. Registration is required and light refreshments and small gifts are provided.