A Bedtime Stimulant for ADHD?

Most parents of children with ADHD are familiar with stimulant medications. These include medicines in the ritalin and adderall family. There are many brands and formulations, but they are given in the morning and wear off at some point in the day. One of the problems is that when kids wake up, they are not medicated, which makes getting out the door a daily struggle. There's a new technology that's designed to allow medicine given at night to start working in the morning. This is different from the non-stimulant ADHD medicines that are used at night. Is a bedtime stimulant right for your child?

Disclaimer

As this was only recently announced and is not yet on the market, I have no experience in using this novel medicine. I wanted to learn about it and thought I'd share what I learn, but I am not promoting its use since I have no experience with it.

I want to caution people who it will take quite awhile before this will be covered on insurance plans and available for mainstream use. It's good for parents to be aware of what's in development, which is why I'm writing about as I learn, but you must talk to your own physician about what medications are right for you or your child.

Most of the information about the new medicine is from the company that is developing it, Highland Therapeutics. This is not an unbiased source.

Stimulant vs Non-stimulant medicines

You might know kids who have ADHD medicines that already work in the morning, so you might be wondering what benefit this new system offers.

The non-stimulant medications can continue to work in the morning. This new delivery system is for stimulant medicines. For many kids, the stimulant medicines simply work better for the majority of the daytime hours, even though they don't last as long as the non-stimulants.

For more on ADHD medications, see ADHD Medications: Types and side effects.

New formulation of methylphenidate

The FDA has approved Jornay PM, a medication that uses a new drug delivery system for methylphenidate, one of the two main stimulants used for ADHD. The company that makes this, Ironshore Pharmaceuticals, is also working on one for amphetamine, but it has not yet been approved.

Jornay PM is expected to be available in the first part of 2019. This does not mean that your pharmacy will stock it or that insurance will cover it. I do not know how it will be priced, but typically new medicines are expensive.

Methylphenidate is the active ingredient commonly referred to as ritalin. For many years we have had short acting and long acting forms of ritalin to use for people with ADHD. The short acting medicines generally last 3-4 hours and the long acting last 6-12 hours.

The new formulation of methylphenidate in Jornay PM is designed to be given at night so that it begins to work in the morning. The time release will allow the child to fall asleep without any of the active ingredient taking effect until several hours later. The idea is to figure out the timing so that when the child wakes, the medicine is already taking effect.

Why is this needed?

Many parents of kids with ADHD know the struggle of getting out the door in the morning.

While many kids can be expected to follow the morning routine of getting up, eating breakfast, brushing teeth, and dressing, kids with ADHD often get lost in this process. Every day.

The distractibility is not their fault. Getting ready in the morning requires many steps. Anything that requires time management and organization is difficult for people with ADHD.

The medicines they take typically take to help with these functions take about an hour to take effect. They need this medicine to be able to stay on task and help with executive functioning skills, not just to do school work.

There are certainly things that can be done to help that don't involve medicine.  Many kids benefit from putting clothes out and packing backpacks the night before. Charts with all the daily expectations can help kids visualize what needs to happen.

But they still struggle to stay on task without medicine. They often run late. Families fight despite the best intentions. When kids finally get out of the door, homework or needed materials are often forgotten. Self esteem is impaired with these daily struggles.

Many parents ask for help with morning struggles

Some kids have benefited from a non-stimulant for this purpose. Non-stimulants, such as guanfacine, clonidine, and atomoxetine, can be effective upon waking. Guanfacine and clonidine can help kids sleep as well, which is an added bonus to kids with ADHD, since many struggle with sleep issues. These medicines can be used alone or with stimulant medicines, but they aren't effective for everyone.

Other parents have snuck into bedrooms to put a methyphenidate patch on their child so it starts to work before the child wakes. While this works well for kids that respond well to methylphenidate, they are very expensive and many families cannot afford them. Some kids don't like wearing a patch or they get skin irritation from them.

How does this work?

Jornay PM uses a delivery system called DELEXIS. In this system the beads with medication inside resist water and dissolving.

The beads do not release any medicine immediately. They travel through the small intestine without dissolving for about 10 hours. When they reach a part of our intestine called the ileum, they are able to start dissolving.

The medicine will be effective for many hours once it starts to be released. The delayed release layer starts to provide medicine about 10 hours after ingestion. Specific timing is affected by foods and drinks taken in the evening. It is recommended to be consistent with eating and drinking when taking this medicine.

Inside the bead deeper than the delayed release layer is an extended release layer. This releases the medication even later than the delayed release layer, to provide for many hours of benefit.

About 14 hours after ingestion starts the maximum concentration of medication levels. Absorption of the medication continues through the early evening.

Will it be right for your child?

All of this sounds great for the kids who need help from the first thing in the morning until later in the evening, but I will wait to see how it really works. We'll all have to wait to see if it works as stated or not.

Will this new medication delivery system benefit your child?