ADHD Medications Not Working (Strattera & Others)

When do you switch your child's ADHD medication?

boy with pills in one hand and glass of water in other
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When they work well and don't cause significant side effects, ADHD medicines can be helpful in controlling the main symptoms of ADHD. Unfortunately, some children do have problems with side effects, especially appetite suppression that is commonly seen with stimulants. And these medicines don't always work.

The most commonly used ADHD medicines are Adderall, Ritalin, Focalin, Strattera, and Concerta.

When they don't work, the options are usually to adjust the dose, either up or down, or change to another medication. For example, if Adderall is making your child cry a lot, then a lower dosage might relieve that side effect. Weight loss is another common side effect of ADHD drugs, as well as disruption to sleep patterns. 

According to the American Academy of Pediatrics ADHD treatment guidelines, at least 80 percent of children will respond to one of the stimulants if they are tried in a systemic way. And 'children who fail to show positive effects or who experience intolerable side effects on one stimulant medication should be tried on another of the recommended stimulant medications. So if Adderall isn't working or is causing too many side effects after your Pediatrician has adjusted the dose, then it is reasonable to try Concerta or Ritalin.

The AAP also recommends that when children with ADHD 'fail 2 stimulant medications,' then they can 'be tried on a third type or formulation of stimulant medication for the same reason.'

Strattera is also a good option for a child who isn't tolerating a stimulant. The American Academy of Child & Adolescent Psychiatry, in their Guidelines to Managing Attention Deficit Hyperactivity Disorder, mentions an off-label maximum dosage of 1.8mg/kg, which is higher than the FDA-approved 1.4mg/kg that many doctors use.

Some doctors also have begun prescribing Strattera with a stimulant, often being able to use a lower dose of the stimulant so that it isn't causing side effects.

Other ADHD Medications

Also, keep in mind that there are some alternative medications often used to treat ADHD. This includes the medications Clonidine (Catapres) and Guanfacine (Tenex). The AACAP describes them as being effective for impulsivity and hyperactivity and sleep disturbances. Since you describe your main problem as his hyperactivity and he likely has sleep problems, since he is taking a nap after school, one of these medications may be a good option for you, either alone or with a stimulant.

ADHD Treatment Failures

If a child continues to do poorly and doesn't respond to two or three different stimulant medications, the AAP considers that to be a treatment failure and that the original diagnosis of ADHD should be evaluated. So instead of ADHD, maybe the child has a learning disability or behavioral problem causing his symptoms. The AAP also recommends that these children have further evaluation for a coexisting condition, which might include a learning disability, depression or bipolar disorder.

Behavior therapy with a child psychologist or other mental health therapist might also be helpful for your child.

Working your way through medications with your child can be frustrating. Keep in close contact with his doctors, and don't be afraid to ask questions or push for changes in medication if you see your child is struggling with side effects. 

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