Quillivant only lasts 6 hours. Love it but need it to last longer!

[Cathy30]

My son was diagnosed with ADHD with impulsivity at 2 years old. I started medication 2 years ago and he has been on 3mL of Quillivant for the past year. I give it at 7:45 and by 2:30 it has worn off. It has been great and so far the only side effect I have seen is a lack of appetite. At 2:30, the impulsivity starts again so the doctor prescribed him methylin 5mL and that doesn't work at all and upsets his stomach. Has anyone had s similar experience? The Quillivant is supposed to last 10-12 hours but doesn't. I really would like something like Quillivant that would actually last 10-12 hours. Any suggestions would be helpful. Thank you!

[Cathy30]

Hello! We went back to the doctor at the end of August and I told her about the Quillivant dose and how it wears off within 6 hours.  I also mentioned about the OJ, which she said she hadn't heard before. She said to increase his dose from 2 ml to 4ml I did this and it seemed to last for 8-9 hours for the past month. Just the past few days though, it seems to last only 6 again. Today, I gave it at 8am and by 2pm he was jumping off the walls. I also stopped the OJ in the morning so not sure if that helped at all. His doctor said that taking Vyvance would be the next step because it could be more long lasting. I've read some reviews on Vyvance and people seem to take their kids off it to put them on quillivant. I really like quillivant, he hasn't had any issues with mood or coming off of it badly. The only thing I saw was a lack of appetite but he makes up for that in breakfast and dinner. He is also good about earting snacks through the day such as fresh fruit or Nutella. He just won't eat a big lunch. He will be 9 next week and weighs about 55 lbs. Any feedback on increasing he quillivant dose again or on Vyvance would be greatly appreciated. At the appointment, she also recommended him get tested for auditory processing disorder. We are having that test done in 2 weeks.  Thank you!

[Cathy30]

I changed his dose from 3mL to 4mL, not 2mL to 4mL.

[Cathy30]

Thank you so much for this advice. I am trying it this week.

[Sandman2]

   Oh, if going off the OJ makes a difference --please post and let me know.  It will let me help others!!!

[Sandman2]

   I double checked the dosing/ food requirements for Q and could find no mention of avoiding OJ.   Its possible that because it is in liquid form the OJ does not effect it like it would a pill based stim med.  But, I think it is more likely they just have not tested for that.  It is true that OJ (or citric acid products) taken about an hour before will make most stim meds not as effective.  See this link http://danarayburn.com/four-common-adhd-medication-mistakes-avoid/
  So it is very possible that the OJ is making his dose seem to low.   It will take some trial and error to find out.  I would give him a good breakfast, take the Q, and then try some OJ about 30 to 45 min. afterwards (if he is really missing his OJ).  
    Hope this helps.

[Cathy30]

Thank you again. He is going to be 9 in October. Thank you for the advice on breakfast. I wasn't given any guidance on this and he lives OJ and that is why he drinks in the morning. He has never has sleeping issues so that has been good. It seems like his dose is too low. Thank you!!!

[Sandman2]

Ya, that direction by your doctor doesn't make sense.  Q is easily increased in dosage.   The standard is to go low, and if its not working to increase the dose.  At least one standard to tell when to increase the dose is length of duration.   I don't understand why the doctor has not simply increased the dose of the powder.   https://www.pfizerpro.com/product/quilli-brands/quillivant-xr/tailored-dosing

[Cathy30]

Thank you very much for the response, I appreciate it. From what they said, increasing the dose wouldn't make it last longer so that is why they told me to give the methylin. If the dose is increased, will it just extend the time it works or increase the effect of it during the 6 hours it is currently working? I would like the same effect just longer. I had him on one medicine in the beginning and it was too strong and it made him completely out of it. We go back to the doctor the first week in August so plan to talk to them about it there. Thank you!!!

[Sandman2]

The info I have on Q is 8 to 12 hours and I think the 8 hour range is more realistic.  With him lasting about 6 hours he is on the low side of the range.  As I said above - time of duration is a decent indicator of strength of dose.   He is on a fairly low dose.  I don't know his age, but I would imagine that the docs would start off low.  And, adding a kicker  of M in the afternoon is a fairly standard approach.  However, if it hurts his stomach - thats not good, but might be avoided with a supplemental food source ( milk shake).
   Speaking of food sources, make sure he has a high protein breakfast and does not have any thing like orange juice just before taking the Q.  A high protein breakfast (use liquid protein, if you have to) will help.
   But essentially, the docs should not be afraid to try the next dose up.  It is all trial and error.  All studies say that it is not the  size or age of the child that decides the dose - it is how the child reacts to the dose.  Starting dose for 6 year olds is 4mgs.
     Final thought is other factors do come into play.   Sleep is a huge factor in how kids deal with ADHD.  If he has trouble sleeping at night, he will be really cranking during the day.  
   Hope this helps.