Post editors interview Rakesh Jain, MD, MPH, Director of Psychiatric Drug Research for R/D Clinical Research at Lake Jackson, Texas, to learn more about the new ADHD drug Intuniv and catch up on latest research findings in the field.
Post: How does Intuniv work?
Dr. Jain: First, let me explain there is a very important chemical in our brains called norepinephine. It has many jobs to do, but one of them is helping us—whether or not we have ADHD—to pay better attention as well as to control our impulsivity and activity. It seems that people develop symptoms that we call ADHD when there are abnormalities in the norepinephrine system.
To answer your question, Intuniv is a selective alpha-2A receptor agonist. In other words, this drug selectively attaches itself to certain “docking stations” on nerve cells, making the brain’s norepiniphrine system work better. Subsequently, this leads to an improvement in the symptoms of ADHD.
Post: Who are the best candidates for Intuniv?
Dr. Jain: Kids from the ages of 6 to 17 who have been diagnosed with ADHD and have impairing symptoms of attentional difficulties, hyperactivity difficulties, and impulsivity difficulties. It appears to be an all-comers-are-welcome kind of drug. In addition, the Intuniv is FDA approved for use with current stimulant therapy—to make the stimulant act even better. This is a uniquely interesting medicine in that it is approved as monotherapy, or as add-on therapy.
Post: What do parents need to know about this medicine?
Dr. Jain: It’s important to know several things, including: 1) Intuniv is an FDA-approved medication. 2) It is not a stimulant. 3) It does not appear to cause weight loss or sleep difficulties such as insomnia.
In addition, parents ought to discuss with their pediatrician, family doctor, or psychiatrist whether Intuniv can be added the child’s current medication that may not be working appropriately or not entirely so.
Post: Might doctors prescribe Intuniv as first line therapy—prior to trying stimulant drugs?
Dr. Jain: In my opinion, it would be appropriate to use Intuniv as first line therapy for a child who already has little appetite, sleeping difficulties perhaps, and some troubles with irritability, impulsivity, hyperactivity, and inattentiveness. In other cases, however, using the stimulants as first line is more appropriate. It’s wonderful to have multiple medications with different mechanisms of action.
We have broadened our ability to help children with ADHD by having a medication that is FDA approved to be added to a stimulant medication that may be partially working but not quite as well as desired.
Post: Are scientists closing in on the cause of ADHD?
Dr. Jain: Absolutely not. We really don’t even have a clue. The most consistent finding in people who have ADHD is norepinephrine and dopamine difficulties in the brain. We know it is highly genetic, it starts early In life, and its ability to impair a person’s life is enormous.
Post: So, people are born with it?
Dr. Jain: It does appear so. Most would say that. The first symptoms may not appear immediately but they do appear before the age of 7, about the time kids start school.
Post: Are you currently involved in any research projects related to ADHD?
Dr. Jain: Yes, in a number of them. We continue to look at the specific roles of Intuniv: should it be taken in the morning, the evening, or does it depend on the particular child? We’re also evaluating other medications to see if we can continue improving treatment options. In addition, we want to see if improving sleep further helps ADHD symptoms.
The field of ADHD is very active. And that’s perhaps something your readers want to know: the medical community is not walking away from ADHD. We are very aggressively continuing to look for ways to help our kids and their parents.
A list of ADHD research trials in the U.S. and around the world is available at ClinicalTrials.gov. The registry also provides information about the study’s purpose, who may participate, locations, and phone numbers for more details.
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