September 11, 2018 at 1:26 pm #98958
Hi! I’m so confused, hoped I could get some feedback from others more experienced. My son is 7yo in grade 2. We started him with Vyvanse last fall but it made his symptoms worse, so then we switched to biphentin, which he took from about Dec to the end of school. Started at 10mg (lowest possible) then went to 15mg. Stayed at 15 for quite a while but then tried 20mg which worked even better. Back then, I had noticed that he would complain of queasiness ~1hr after taking it, but I thought that had only been a temporary thing while he adjusted to the new dose. Looking back, I almost never gave it to him on weekends so I guess I didn’t really know that for sure. Found out after school ended that he had been commenting to his teacher about 1-2x per week that he felt queasy at school. She would encourage him to go for a walk or have snack or water and she said he was always ok again shortly after he did those things. It has never caused him to vomit. So this was after being at the same dose for about a month, he was still noticing queasiness some days. Or who knows, maybe he felt it every day but only mentioned to his teacher occasionally, it’s hard to tell. She noticed that it worked *beautifully*, and he had the best SNAP questionnaire he’s ever had while at 20mg. He was very happy overall, doing well in school. Without meds, he was unable to focus, unable to get any work done, moving around the classroom too much.
We tried to give him 20mg a week before school started (after being off all summer) and he then felt quite queasy (no vomit) and was in a terrible mood that day, holding onto a “bin” (just in case) most of the day. Then I stopped the med and asked his pediatrician about this. He said that it most of his patients have no problem going right back to their regular dose, and said that it shouldn’t cause queasiness beyond just a few days or a week, and that it shouldn’t matter what food he takes it with, as long as he does take it with food. I asked about trying another type of methylphenidate to see if it may have less side effects, but Dr said that wouldn’t make any sense, all the drugs in that family will have same effectiveness and same side effects. He said there’s no harm starting him with low dose and ramping up, and that if this one is a problem then the next thing to try would be intuniv. So we’ve started him on 10mg (doc said to start at 15mg) and he’s still noticing queasiness but it’s less severe, and his mood is fine. Meanwhile he had his first week of school with NO med (since we were confused about dosage etc) and his teacher said he did great…?? Maybe he’s been putting in a big effort to make a good impression during his first week of school? I’m beyond confused. At the moment we’re continuing on with the 10mg to see whether the queasiness does go away after about a week.
Is it reasonable to hope to find a med that doesn’t cause ANY queasiness, or is this a good result as far as these things go? It’s mild, starts 1-1.5h after taking med, seems to last around 30min. I just know I wouldn’t be too happy if I had to feel that way every morning. And I’ve read that what you eat with it CAN make a difference, so I’m not sure what to believe… Teacher says he’s doing great without, but maybe he’s just not finding him to be disruptive, maybe he could be focused much better with the med. Teacher last year said it made a world of difference, and I do trust her opinion.
Sorry for the rambling, please let me know if you have any experience or wisdom to share!
September 11, 2018 at 4:27 pm #98983
I could have written this exact post. My 7 year old 2nd grade daughter was on 10mg focalin (methylphenidate) all of first grade and did great. We stopped drug use in the summer and restarted one week before second grade to find that she was complaining of nausea, specifically in the morning… it would ease as the day progressed. She also complained that it made her nervous in her new environment and made it hard to talk to other friends.
So we went off drugs and her teacher said that she seems like a normal second grader without medication, but we have noticed as the weeks have gone on that she is making more mistakes in her work now that the novelty of second grade is wearing off.
Since Focalin worked so well in first grade I hate having to explore other drugs, but I don’t like her feeling sick and anxious, but I also hate watching her not meet her full potential because she is all over the place without drugs.
Last night I took her to a volleyball game and she could not sit still and my friends were commenting on how wired she seemed. It pains me to not be able to take her to restaurants or sporting events because she just can’t sit and watch, but I also hate the side effects of the drugs. So I have no idea what to do.
I just wanted to let you know that we had the exact same issue.
September 12, 2018 at 9:15 am #99004
As a Mom of ADHD children and a physician, I have some comments. First off, when kids are on and off meds (summers, weekends), they often have more side effects so resuming meds in September or on Monday mornings typically causes the issues described in these 2 children. The other issue is that children get the notion that they don’t “need” their meds and often fight the resumption of meds – a problem that worsens as they become teens when they need management of their ADHD more than ever. Many children will complain of symptoms that they may not actually have to push parents to stop their meds. In these children, I’m sure the resumption of meds is the cause of their queasiness but give it time and it will settle – start at a lower dose and don’t stop meds on weekends – ADHD exists 365 days a year not just on school days.
September is not a good month to be unmedicated when new routines and learning are being established. Kids often start the year well as it is novel and interesting but as they get into their learning phase, they lag behind and it is often November before it is picked up so have them start out with their attention and focus at their best.
I encourage my patients to talk to me about making med changes. I would rather children take a reduced dose of meds during the summer and weekends then stop altogether – in the long run, they are better. When it is time to see how a child will do off meds, it is better to do that at a time of year when the child is in school and one can really monitor their performance off and on. Let the school know their meds are being adjusted – you don’t have to say stopped – and then get teacher feedback and stay in close touch with their school/coaches/daycare/whatever to see how they manage.
September 12, 2018 at 11:30 am #99015
Thanks very much for the comments. My son only just *yesterday* realized that his meds could possibly be causing the queasiness. Hopefully he won’t start refusing them now… he didn’t refuse today. Before that he had no idea, because there’s a 1-1.5 hour delay between pill and queasiness. So I really don’t think he’s faking it or exaggerating to convince me to stop his meds. I asked him how severe the queasiness has been, if it’s terrible or if it’s sort of ok… he said it’s sort of ok. But it still concerns me.
We had been giving him weekends and summer off med to give him a break from the suppressed appetite, to hopefully allow him to eat extra and catch up with growth. And we honestly didn’t mind if he was off med during those times because he didn’t need to be learning or sitting at a desk, he was free to do what he wanted really. But maybe you’re right that during the school year he may have noticed more side effects on Mondays, it’s so hard to know when he doesn’t seem able to give me reliable information himself (his memory is pretty bad) and my only other source of info for his school day is his teacher. I wish he could just tell me exactly how the drug makes him feel (both mentally and physically) but I think that will be easier for him to do as he gets older.
How do you know whether a side effect is “good enough”, or whether you should try a different drug? I’d love to find one that has no side effects but I realize that’s probably not going to be realistic, and each drug trial does take some time to figure out.
I was thinking of keeping him on 10mg (which is not enough to offer any benefit in terms of adhd symptoms) for 1-2 weeks to see if the queasiness settles out, before increasing the dose to 15 then 20. I assume the queasiness would only get worse with the higher doses. But it’s hard to know.
September 12, 2018 at 12:34 pm #99038
I would find a new doctor. There’s a reason there are many different methylphenidates on the market — because they all are different in some way, even if it’s just the added ingredients or the delivery mechanism (time-release). Do not accept perpetual queasiness and a side effect — that has to be so miserable for him.
I would find a doctor who will listen to you and your child and try a different medication.
ADDitude Community Moderator, Parenting ADHD Trainer & Author, Mom to teen w/ ADHD, LDs, and autism
September 12, 2018 at 2:24 pm #99053
Thank you! Do you agree with the previous comment that it’s better not to take med breaks on weekends? We’ve always done weekend breaks, to let him eat more, and because the med doesn’t seem necessary on weekends.
I had thought the same, that we might have the right med “family” since it was SO effective for his symptoms, but maybe another in this family might be better for side effects. But the Dr said I was “talking in circles” and said that wouldn’t make sense at all, that if biphentin side effects aren’t acceptable then we should stay away from methylphenidate altogether. I should add that I’m in Canada so I’m not sure how many other options there are here, in that family. Anyway, the queasiness isn’t persistent as you said, it seems to be brief (30 mins ish?) but daily. I’m still hoping it will resolve over time but based on last spring there’s a good chance it won’t completely disappear. I do wonder though if I need to find a Dr who specializes in ADHD treatment specifically, rather than a pediatrician. Our pediatrician says he has 20 years of experience treating kids with ADHD. Is it really possible for everyone to find an ADHD drug that has no side effects? This one also causes suppressed appetite and trouble sleeping but those ones seem a little more manageable than queasiness. We use melatonin to help with sleep, and he can eat more on weekends.
September 17, 2018 at 3:01 pm #99432
To Cookie Monster- I agree with ADHDmomma- all the different variations of ADHD meds are slightly different- different versions of the molecule, etc. It’s true that one “family” (either the methylphenidate or the amphetamine) tends to work better than the other for most people, but once you find your correct family you can experiment with different formulations. Some may cause nausea some may not. For example, my son was on regular ol’ methylphenidate for years until we wanted to try an extended release, so we tried Concerta. Concerta has some fancy release mechanism that allows a slower release and more gradual come-down. And all the amphetamine versions are slightly different variations on the same molecule, but those variations can make a big difference. ANYWAY my point is I would find a different doctor.
I think the side effects are a cost vs. benefit ratio. The nice thing about these drugs is you can try different ones once or twice- no need to wait weeks to see if it works, because you’ll be able to tell.
We do not give our son breaks, and I have read that giving them a break on the weekends or summer is now thought not to be advantageous. Although I hear you with the weight gain- I give my son calorie rich (yet somewhat healthy) foods because of this.
Finally, Kondasa- honestly if my kid’s teacher told me he seemed like a “normal second grader” I would re-evaluate how you got him/her diagnosed. Was it taking the Vanderbilt questionnaire in the Dr. office? Or was it a 4-hour test given by a psychologist? There’s a big difference.
It’s hard to have a wiggly kid. But some kids, ADHD or not, are never going to sit still and watch a sporting event. I am in absolute awe when I see some 4 year old with no toys or anything to do other than sit on the bleachers and watch their brother play soccer. But my friends without kids with ADHD feel the same way!!!
- This reply was modified 5 days, 22 hours ago by LimeRabbit.
September 17, 2018 at 3:10 pm #99438
Just an update to say that the queasiness seems to have gone away, or at least it’s not every day. We’re still monitoring to figure this out. This weekend he was on meds and he felt fine. But he’s eating VERY little during the day, and not sleeping nearly enough. Hope these side effects will improve with a little more time as well. I try to give him a “Boost” drink sometimes but he *always* refuses it. But eating has always been a big challenge with him, even before meds. I’m starting to wonder if the reason he was mentioning queasiness at the end of last school year may have been related to coming back onto meds after being off them each weekend, not sure. I don’t know if he was feeling sicker on Mondays, or not. Obviously I don’t want him to feel unwell. But at the same time I know for sure this med makes a huge positive difference for his adhd symptoms. Thanks so much for all the comments, feel free to leave more of them!
September 17, 2018 at 3:24 pm #99446
I make my kid smoothies- they are nice because you can make a big batch and freeze them. Whole plain or vanilla greek yogurt, frozen strawberries/blueberries/mango, banana, coconut water, other fruit you have on hand. I also sometimes put protein powder in it but if your son doesn’t like Boost the protein powder does have a similar vitamin-like taste. My son will also eat the Fiber One protein bars, the sugar isn’t out of control and they have a lot of protein and fiber. Good luck!
September 17, 2018 at 3:31 pm #99447
Thanks! He hasn’t even tasted the Boost, he refuses it, almost in tears, because he’s afraid he might like it too much and then never be able to drink regular milk again. He’s ridiculous, I know 🙂 He does like protein bars too.
September 17, 2018 at 3:47 pm #99450
I’m an adult who has been working (under doctor’s care) with trial doses of some of the above-mentioned stimulant meds. Definitely experiencing nausea. Due to an uptick in my migraines on some of these meds, I’ve been having to go off them, start others, and try, try, again.
But for those (especially young people) for whom these meds work except for the annoying nausea, may I suggest taking crystallized or candied ginger? I also have an anti nausea prescription called Zofran (ondansetron 8mg), but the ginger chews (“The Ginger People” company) that I buy at Trader Joe’s grocery have actually worked better on my ADHD med-instigated nausea than my prescription antinausea drug does.
It’s hard to get through a morning feeling like that. It may not work for everyone, but ginger has long been used for nausea in Asian countries and other regions. It’s worked well for me. Hope that helps.
September 17, 2018 at 6:23 pm #99479
Cookie monster have you tried pedisure instead of boost? My son likes it and I think they have powder form that you may be able to add to regular milk. Also, we have been battling my our son’s weight too. Through his pediatrician we added an antihistamine medication called periactin that is used for its side effects one of which is increased appetite. It has helped us tremendously. Another side effect is drowsiness so given at night it can help sleep. It might be worth a discussion with your doctor(s).
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