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Mixing Medications: Stimulants and Nonstimulants
Q:
"My son was prescribed Strattera. We didn't see much effect after two months, so our doctor prescribed a stimulant, saying my son should take both from now on. Is this safe?" 
A:
ADDitude AnswersStrattera often takes several weeks to start working. Doctors may prescribe both medications when switching from a stimulant to Strattera, then taper off the stimulant as the Strattera begins to work. Taking the two together during an adjustment period is quite common and is safe. However, it is not the usual practice to use both a stimulant and Strattera over the long term. Two months should be enough time to see an effect. If it's clear that Strattera is not working, it would be better to try something else instead of that medication, not in addition to it. Posted by Larry Silver, M.D. A Reader AnswersMy 6-year-old was put on Adderall and Intuniv — Adderall being the stimulant and Intuniv the nonstimulant. It worked for a while, but he had trouble sleeping and getting up an appetite. After about eight months, he was just rude and mean and cranky. I thought ODD was developing, and he was so tired he was falling asleep at school (out-cold kind of sleep) and he was going to bed at 7 P.M. and waking up at 7 A.M. Finally I went to the doctor again and we took him off Adderall to see if it affected his sleep. He was like a different child. He was less anxious and emotional. He was calm, polite, and slept soundly again. We are now on only Intuniv (3mg) and are doing fine. He sleeps deeply at night and while he is still defiant and we have our challenges, his appetite and sleep is normal. Thank heavens. Posted by Willingandable A Reader AnswersCombining stimulants and Strattera is what has worked for us. For my son, stimulants caused side effects and Strattera alone didn’t do the job — but taking the two together is working great. Strattera seems to counteract the stimulant side effects. Posted by brlk13 A Reader AnswersOur daughter, age 12, also combines Strattera and a stimulant (Ritalin) and it works great. If you are combining now, and the combo is working for his inattentiveness, I’m wondering if all options have been tried to address the side effects? Our daughter continues to have appetite suppression and sleep issues, but by switching to short-acting Ritalin, she eats high protein snacks/meals at intervals throughout the day when the meds wear off, and takes Cyproheptadine (an antihistamine) which stimulates her appetite. We also use behavior/schedule changes along with melatonin to help with sleeping. Posted by boomer A Reader AnswersMy boys take Intuniv plus a stimulant. It’s a great combo for them! Posted by Fancymom A Reader AnswersDefinitely a question for your psychiatrist. We track both our kids (who are informed and can self-report at the ages of 11 and 7) and many rounds of “experimentation” should be expected to find the right medicine, whether you do a combo or a single med, and dosage. Every individual reacts differently. Good luck! Posted by eso Read the original discussion on the ADDConnect forums.
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Larry Silver, M.D., is clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C. and director of training in child and adolescent psychiatry at Georgetown University School of Medicine. He is a former acting director and deputy director of the National Institute of Mental Health, as well as the author of Dr. Larry Silver's Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities.
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