Vyvanse & Risperidone: time of dosage

[Tanya]

Just curious: has anyone experimented with the time of dosage when taking both these medications? My boy, ADHD combined, is prescribed 40mg of Vyvanse daily in the morning and 0.5mg of Risperidone daily at bedtime. He is 11yrs old, 48 inches tall, and weighs 49 pounds. (Small size: he has a type of dwarfism and likely abnormal IGF levels which we are currently investigating). He has tried Concerta, Biphentin and Straterra.

I'm told he is doing well at school. Grade four, this is his first year in a DevEd placement due to developmental delays. Before and after schools are difficult. He refuses to go to bed and refuses to get up in the morning. Bedtime is 9pm, alarm goes off at 6am. Impulsivity is not well controlled, anxiety levels are high, he is verbally mean and he has a need to control everything.

I have been playing around with the dosage time of his meds. Last night he took both medications at the same time, immediately before bed. He fell asleep well. There was some anxiety, he gets very anxious at the thought of me not going to bed at the same time as him, but nothing severe. He woke up easily this morning and he was nothing but pleasant all morning with me (had a morning of doctor appointments before going to school in the afternoon). I cannot remember the last time he woke up in good spirit and remained that way throughout the morning routine. Our normal is a lot of screaming and rudeness. Again, after school, nothing but the perfect boy. I have sent the teacher a message asking her if she has noticed anything different with him today.

Historically, there have been a few times where he has taken his Vyvanse at bedtime. On those days he has fallen asleep well. Only once did he wake up during the night and had difficulty falling back to asleep. I've mentioned this to a Developmental Pediatrician once and they told me that had read this sort of reaction was possible but very rare and they had never personally heard of a case. My boy has always had sleep issues. Results of a sleep study stated he suffered fragmented sleep with episodes of heightened arousal consistent with night terrors. Melatonin was ordered but did nothing for him.

I am so tempted to regularly give him both medications right before going to bed to see if today was just a fluke. Like I said, I have been playing around with the time of dosage trying to find that sweet spot for him and wonder if this might be it. I am scheduled to see his pediatrician later this week and will definitely be bringing this up. Today my boy has been an absolute dream up until about 8:40pm when he started to show some angry verbalizations because he has to lean up his toys, but not severely, and he recovered well.

[Mayleng]

The question would be if without the vyvanse in the morning, how he does at school. If this schedule works for him, then it is the right one. It might be he needs a dose of vyvanse at bedtime and in the morning. (maybe a smaller dose at bedtime if that works as well). It is all trial and error when it comes to finding what is right for each child. It would be good to try this schedule for a week or so and see how he does, to see if it results lasts.

[dwolen]

As medical person (FNP), I would feel comfortable with you experimenting with the dosing and timing. You are doing this in the best interests of your son and his well being. I agree with Mayleng, and just wanted to put in my vote of support. I hope you get support and can work well with the physicain on this, too.

[jw]

Hi,

Just some thoughts - my son takes Vyvanse, and has a short-acting prescription for dexedrine that we can use as needed. Vyvanse works for about 10-12 hours, depending on the patient. So if your son needs the medication to stay focused at school then if you take it at night he won't have any medication "on board" when he goes to school. Having said that, I have heard from several people that if their kids rebound from the medication at the end of the day, a dose of short-acting will help them stay on track and will avoid the mood issues in the evening, and even help them get to sleep. So if you are dealing with rebound from the Vyvanse, the solution might be to get a prescription for the short-acting med and take that about 5:00 or so. This is one of those areas where trial and error might help you work out the solution.

Some people deal with the morning problems by bringing the medication to their child 30 minutes or so before they need to get up, waking them up enough so that they can take the pill, and letting them go back to sleep until the usual time. That way the second time they wake up the medication has started to work and things go a little bit smoother. If you are taking a booster in the evening, then taking the Vyvanse a little bit earlier would not be a problem.

Anyway, just some food for thought. It will be interesting to see what the teacher has seen this week.

Good luck! It is always a challenge to get this medication issues worked out, but worth it to wrestle with the details until you find something that works for your child.

jw

[Tanya]

Thank-you for all you insight. To update: I have discontinued Risperidone completely and we have replaced it with a low dose of Zoloft. Things are a lot better! We chose Zoloft as a means to try and address the anxiety. His anxiety has increased and everyone is in agreement that it is posing as a road block to his learning and success. No more anger in the morning and the edge has been taken off the anxiety. The plan is to run this course for three weeks then if needed, increase the dose of Zoloft. We are two weeks into this trial. I expect to follow-thru with the increase at the three week mark to see if we can get a better result with anxiety.

[jw]

Hi,

I didn't even think about the anxiety piece! I have been told that anger and anxiety are two sides of the same coin - I see this a lot with one of my boys. Hope you continue to see progress!

jw

[Tanya]

My boy has been on the increased dose since May 8th and so far so good. Yes, he still has anxiety but the edge has been taken off so that the teaching and applying learned behaviour skills is much more realistic. We will stick with this med cocktail of Vyvanse and Zoloft for a while :-)

[Mayleng]

Good, hope it continues.