Catapres TTS

Description

Brand Name
Catapres
Catapres TTS
Kapvay

Advantages
Clonidine is only moderately effective for ADHD symptoms. but it is a good alternative for very young children. It has the advantage that when used with a stimulant, clonidine will minimize most of the stimulant side effects (insomnia, tics, irritability).
One patch lasts 7 days. It is often covered by insurance.

Disadvantages
Sedation and low blood pressure are the two most common side effects. Sedation is usually mild and if a stimulant is added, the sedation will disappear. Low blood pressure can cause light headedness or fainting, but this is not usually a problem at the low doses used to treat ADHD.

Excerpt from the book: ADHD Medications: Does It Work and Is It Save? Available on Amazon

Clonidine is not a stimulant like methylphenidate and amphet- amine but is in a group of medications called alpha-2 agonists. It was one of the first non-stimulant medications approved for the treatment of ADHD.
In the 1960s, clonidine was used to treat nasal congestion. However, it had two side effects. Patients on clonidine were some- what sedated, and their blood pressure dropped. This was about the time physicians had identified the dangers of high blood pressure and were beginning to be more aggressive in its treatment. Clonidine was restudied, then received approval from the FDA for the treatment of hypertension.
Tourette’s syndrome is a medical condition characterized by obses- sive-compulsive behaviors and vocal tics. In 1979, it was reported that children with tics due to Tourette’s syndrome improved on clonidine.6 Tourette’s syndrome is often accompanied by ADHD in children, and physicians noted that children on clonidine had significantly fewer tics, but they became less hyperactive as well. Research studies showed that all of the symptoms of ADHD improved, although not as dramatically as with stimulants (methylphenidate and amphetamine).7 In 2008, cloni- dine was approved for the treatment of ADHD.
Early in my career, I saw a five-year-old boy who was hyperactive, impulsive, and having trouble focusing and attending in school. That was difficult enough, but this child was also disrespectful to adults, easy to anger, and aggressive toward other children. The least little thing would precipitate a twenty-minute tantrum of screaming, spitting, and kicking. I diagnosed ADHD and a second disorder, oppositional defiant disorder (ODD).
I started him on Ritalin LA. His hyperactivity disappeared. He was more attentive in school, although he still had some difficulty attend- ing to something that did not interest him. Unfortunately, he was still aggressive, angry, and oppositional, and it seemed that these behaviors had actually increased since starting Ritalin LA. Further, since starting to take Ritalin LA, he would take an hour and a half to fall asleep. I discontinued the Ritalin LA and started an amphetamine-based stimu- lant (Dexedrine Spansule). Like the Ritalin LA, Dexedrine significantly improved his ability to focus and concentrate, but his moodiness, anger, and aggressiveness were even worse than with Ritalin LA, and he even had more difficulty falling asleep.
I was aware of research studies that indicated that clonidine might be therapeutic in situations like this. I discontinued the Dexedrine Spansule and started clonidine.
He and his mother returned in two weeks. She said that since start- ing the clonidine, his personality had changed. Before, he was angry, irritable, and aggressive. Since he started taking clonidine, he was almost always smiling, happy, and agreeable. He seemed to enjoy pleasing his parents and his teacher. His teacher said it was like magic. In addition to these gains in behavior and school, it was only taking fifteen minutes to fall asleep at night. Unfortunately, on clonidine alone his hyperactiv- ity had returned (although milder than before medication), and he was having more trouble attending for long periods of time, although these symptoms were better than without any medication.
Because the symptoms of ADHD had disappeared with Ritalin LA and then returned with clonidine, I continued the clonidine and started Ritalin LA again, at a lower dose than before. His hyperactivity again vanished. He was attentive and focused in school, and the teacher said he was like a model student. At home, he was happy and agree- able. The combination of these two medications treated two different sets of symptoms. Ritalin LA increased his ability to focus, attend, and concentrate while reducing his hyperactivity and impulsivity. At the same time, Ritalin LA was responsible for increasing his anger and aggressiveness. Clonidine minimized the negative effects of Ritalin LA, helped stabilize his volatile moods, and helped him get to sleep and sleep more soundly.