Attend and Stimulants Together : Question and Answer
Hi Dr. Cowan,
As part of an effort to utilize our medical review board I was writing you
with the hopes that you might assist me with an email question I received.
Nancy said that you had some protocols established regarding how individuals
might wean of pharmaceutical medications while taking Attend. Of course
this would need to be discussed with their primary care physician first, as
Växa want to take no liability in this, however it is a question that pops
up from time to time. Could you please share with me your thoughts
regarding this email? Your time and input is most welcome.
Manager, Customer Service
Here is what I have observed...
When someone is currently using a stimulant medication such as ritalin (or other
methylphenidate compound), dexedrine, or adderall, they may make the decision to try to
switch to Attend.
There can be a lot of reasons for this. Perhaps the person is not a "positive responder"
to the medication (somewhere between 10% and 20% who try stimulants end up being
non-responders). Perhaps there are benefits, but there are side-effects that are too
intrusive or too severe, so there is a search for another treatment. Or perhaps there is
just the perceived threat of potential side-effects lingering over their heads.
For the non-responders the decision is easy, they should try something else.
Here is one of my favorite sayings: If what you are doing works, don't mess with it -- if
it doesn't work try something else.
But for those who are receiving some benefit from the stimulant medications the decision
is a bit more difficult. Usually what the family is looking for is to maintain the level
of benefit received from the medication but lower the severity of side-effects, or lower
the risk of potential side-effects.
Attend can often help to achieve this.
I have suggested to families that they (1) talk to their doctor, of course, and then (2)
start with the Attend, Extress, and etc. I recommend that they start the Attend slowly...
1/day for a few days, then 2/day for a couple of days, then 3/day, then 4/day. Once they
hit 4 per day, 2 in the morning and two in the afternoon, then the "clock starts" and it
will be about 20-30 days for the Attend to really start to work.
Often, around 30 days, it will begin to look like the patient is "over-medicated" from
the stimulant: "too much foot on the brake petal," "heading toward being a zombie," maybe
overly flat affect, maybe over-focused.
This is the time that the family should look at reducing the stimulant medication dose,
maybe about 25% less (from 20mg ritalin to 15mg ritalin per dose for example).
What they are looking for is to still receive the optimum benefit from the medication,
but at a lower dose - in fact now the search starts for the lowest possible dose that
will provide optimum benefit.
Over time the family should try to lower the dose to 1/2 the original beneficial dose,
and see if they still get the same benefits as the original dose. If so, then they should
see far fewer side-effects, both in the short-term and for the long-term.
This level, 1/2 of the "baseline" beneficial dose, is a great goal - a healthy goal. If
they can do better than this, it is outstanding.
By the way, it is somewhat rare for stimulant medication to be completely replaced by
Attend, Extress, and etc. I think it is because even small doses of stimulant can be so
"performance enhancing" that people just want to keep a bit of the stimulant in use.
Its sort of like going to Starbucks in the morning and afternoon for a "lift". In fact it
is estimated that 5mg of Ritalin is about equal to 100mg of caffeine, which is a small
coffee at Starbucks.
They can use as much Extress as they need from day one, they don't need to be careful
with the Extress. Great product for temper, mood swings, impulsiveness, etc. If temper is
a problem they can start at four per day, or more. It works quickly while the Attend is
taking its time to make a difference.
Memorin can cause temper problems, so people need to be careful. It is best with
"inattentive" ADHD, not the impulsive-hyperactive type. It is usually either Extress they
need, or Memorin, but rarely both.
Stay in touch