Re: clonidine

[Guest guest]

Dear ,

Wow. Poor Luke, poor you. It's so awful when school falls apart because

then everything else seems to follow. We were in your shoes last year -

thankfully (knock on wood) things are going much, much better this year.

Annie used to take only .5 mg Clonidine (half a tablet - I hope I'm

remembering the mg. right). It really helped her knock out. But she only takes

18

mg Concerta, and I remember that when we tried to raise that she was up all

night. Our pdoc stopped the Clonidine because she said it only stays in their

system for four hours, so unless we wanted to dose it continually during the day

it wouldn't help her tics. It seemed to ME that it was helping her tics, even

during the day, but this could have been from the increased sleep. At any

rate, we solved the tic issue with increasing the Risperdal. She still has some,

but right now they are barely noticeable.

Sleep is so important for kids. When Annie gets a full night (9-10 hours)

she is a different person. I used to wonder last year whether her school

problems were from not sleeping well, or what. What seemed to help us the most

with the school problems were a) a different teacher because of the decreased

stress, and switching to Lexapro. She seems more capable of remembering

things

this year, and is doing all her homework on her own. That could also be from

an added year of maturity though.

If increasing the Concerta doesn't help, could you try a different ADHD

med? I can't remember what you've done in the past. Have you tried Strattera?

Adderall? It seems to me that there must be a point at which increasing the

dose of the stimulant has to just keep the kids from sleeping, at which point

they definetly won't concentrate.

Keep in touch. I'd like to hear how things go for you.

Best wishes,

in NV

mom to Annie (11, on Lexapro, Concerta and Risperdal)

[Guest guest]

In a message dated 12/2/2003 8:48:04 AM Pacific Standard Time,

msmichelle@... writes:

> I meet with the principal this Thursday, and would sure appreciate

> any support and advice you can lend so that I can feel a little more

> confident going into that meeting. His issue is getting Luke to

> school on time.

I'd suggest asking your doc to send a letter. Our doc typed up a letter for

me in her office, saying that the severity of 's OCD and depression were

interfering with school, and that she recommended " home hospital " . Perhaps if

your doc described what it's like to get a compulsive kid up and moving and

out the door, it would help. Also, if the princ. sees that it's either

allowing you to do some homeschool or having to cough up some district funds for

tutoring, he might see the light about partial homeschooling, since it wouldn't

affect his budget. Good luck. We're in CA and I'm grateful that the school has

been extremely cooperative.

Suzanne

Suzanne Stone

480 Lomer Way

Milpitas, CA 95035-5933

Weekenders Independent Team Leader and Fashion Coordinator

Weekenders.... The Clothes You Love to Live In.

www.weekenders.com

[Guest guest]

Hi - we are trying clonidine right now, too. Be very

careful in changing the dosage - it does affect blood pressure, and

our p-doc has us titrating up very slowly over a month, starting

with 1/4 of a 0.1 mg tablet at night, then 1/2 tablet at night, then

adding 1/4 tablet in the morning to the 1/2 at night, changing every

5 days and checking our son's blood pressure often. We are going to

start giving it 3x a day this week. Haven't seen any real changes

in behavior or tics yet, but at least it hasn't made his ocd any

worse.

Here is some helpful info on clonidine I found on the web -

originally from the TSA - it is so frustrating that it takes so long

to know if these medications are helping or not, isn't it!

regards, Sandy

http://www.texaschildneurology.com/Tourette.htm

Clonidine

Clonidine (Cataprese) is an imidazoline compound with alpha-

adrenergic agonist activity. In low doses it " down-regulates " alpha-

adrenergic neurons in the locus ceruleus, decreasing the release of

central norepinephrine. Since 1979 it has been considered to be of

benefit for the treatment of TS although the response rate is lower

than that of either haloperidol or pimozide. In general it is of

advantage because of the low incidence of side effects associated

with its use. Perhaps of greatest importance is that it does not

have the potential of causing tardive dyskinesia. Clonidine has

been approved by the FDA only for use in hypertension, but

clinicians can prescribe it for TS without special government

approval as long as they understand its indications and share the

basis for their decision with the family and child.

In addition to reducing the simple motor and phonic symptoms in TS,

clonidine seems especially useful in improving attentional problems

and ameliorating complex motor and phonic symptoms.

In general, clonidine is started at low doses of 0.05 mg/day and

slowly titrated over several weeks to 0.15-0.30 mg/day. Since

clonidine has a 6 hour half-life it is important that patients take

small doses 3 to 4 times each day. (An alternative to multiple doses

is the transdermal patch that needs to be changed only once a week.)

Doses of 0.4 mg daily are not infrequent, but doses above 0.5 to 0.6

mg/day are more likely to lead to side effects. When the medication

is working effectively, patients may experience the need for their

next dose by sensing an increasing anxiety, frequency of symptoms,

or irritability. Unlike haloperidol, which may lead to clear

improvement within a few days, clonidine tends to have a slower

onset of action. When larger doses are used earlier, improvement may

occur sooner, but there may be more sedation. With slower titration

to therapeutic levels, clonidine may take three weeks or longer to

show a beneficial effect.

The patient may experience a reduction in tension, a feeling of

being calm, or a sense of having a " long fuse " before tics are

reduced. A gradual decrease in complex motor tics and compulsions

also may precede clear improvement in simple tics. In the most

successful cases, attentional, behavioral, and complex phenomena

seem more responsive than the simpler tics. Evaluation of the

medication's effectiveness may not be possible before three to four

months. When there is a positive response, improvement may

progressively appear over many months and up to a year or more

later. Patients gain confidence in themselves, adjust better to

school, feel less irritable, and have fewer tic symptoms. Those

therapeutic benefits reinforce each other.

The major side effect of clonidine is sedation, which appears early

in the course of treatment and especially if the dose is increased

quickly, but which tends to abate after several weeks. A few

patients have dry mouth, although it is experienced less often by

children than by adults. There are occasional reports that patients

feel that things are " too bright, " perhaps because of the impairment

of pupillary contraction. At high doses, there may be hypotension

and dizziness, particularly if clonidine is given at high doses

quite early or if it is increased to over 0.4 or 0.5 mg/day. At

lower doses, blood pressure is not clinically affected, although a

fall of several mm mercury in diastolic and systolic pressure can be

detected. Slight prolongation of the PR interval on the

electrocardiogram has been noted, but this has not been considered

to be of significance. Increased irritability, nightmares, and

insomnia have also been reported.

When clonidine is withdrawn, it should be tapered gradually.

**********************

[Guest guest]

Kelley,

I am so happy that the medication is working so well for your

daughter. I can't imagine struggling for that long with the sleep

issue. We have had trouble with our son's sleeping patterns from

infancy until now.

I've read everything I could find re: helping one's child to sleep

and it hasn't proven fruitful. Nevertheless, we're going to keep on

trucking and once I change my mindset and accept the fact that

medication may be part of the answer, I'll get more educated about

clonidine. It is so difficult for me to come to terms with the need

for medication... but the day will come.

in AZ