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Attention Deficit Hyperactivity Disorder

Adjusting to Adderall

12/30/1998

Question:

My 11 year old nephew was just out on Adderall 10mg Dec.23. He is suppose to to take a 1 1/2 pills in the morning, and 1 pill around 3:00 p.m. Since he has been on this he is alot calmer but he has ate very little and only gets 4-6 hours of sleep at night. He has been on it for 5 days now and doesn't seem to be getting his appetite back. How long does it usually take to get adjusted to this type of medicine? Is it normal for him to eat so little and get so little sleep? We are use to him eating just about everthing. He won't eat anything not even junk food. How long should we wait to see if he adjusts before we get worried?

Answer:

FIRST, PLEASE BEAR WITH ME AS I EXPLAIN A FEW KEY POINTS ABOUT STIMULANTS AND ADHD. 1. In general, the list of possible side effects and potential therapeutic effects of the more commonly used ADD/ADHD stimulants is the same for every drug. However, "possible" and "potential" are key words here. What becomes "possible" in someone on one drug (such as Adderall) may not be seen by him/her with another drug (such as methylphenidate). The same holds true for therapeutic effects. 2. Although one can state with reasonable certainty that some stimulants (such as Adderall or Dexadrine Spansules) will exert their positive and negative effects longer than some other stimulants (such as regular dexadrine or methylphenidate), the time period varies by individual. 3. In general (although there are a few exceptions) the side effects of anorexia (decreased hunger) and sleep disturbance decrease over time, usually within 4-6 weeks. Again, keep in mind #1 above...one stimulant's anorexia may leave within a week while another stimulant may still cause anorexia after a month, in the same individual. YOUR NEPHEW The positive effects of Adderall for persons with ADD/ADHD last an average of about 6-7 hours; however, we see people in whom they last three hours and others who benefit for 12. Unfortunately, in a few persons, the unwanted side effects of anorexia or sleep disturbance last longer than the cognitive (help with thinking) ones. ANOREXIA - If a child is doing very well, otherwise, on a medication, many physicians would encourage high calorie supplements (such as Instant Breakfast) during snack times and wait it out. The weight usually stabilizes by 4-6 weeks, then increases back to baseline after 1-2 more months. Of course, many children's small bodies may not tolerate that well, and some children remain anorexic past the six weeks. YOUR NEPHEW'S CAREGIVER NEEDS TO WORK WITH YOUR NEPHEW AND HIS PHYSICIAN TO DECIDE WHAT IS BEST FOR YOUR NEPHEW. ADDITIONAL INFORMATION, FYI -- THE STIMULANTS COMMONLY USED WITH ADD/ADHD THAT THE ABOVE INFORMATION REFERS TO: Adderall (a combination of four amphetamine and dextroamphetamine salts), dexadrine (an amphetamine), Dextrostat (an amphetamine), Dexadrine Spansules (controlled release amphetamine), Ritalin (a specific brand of methylphenidate), Ritalin SR (a specific brand of slow release methylphenidate), methylphenidate (generic) and methylphenidate SR (generic, slow release).

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Response by:

Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati