Lessons Learned About Medication Changes
In my last post I talked about the personal experience of making the decision to change your child’s medications. We talked about the questions you should ask before considering a medication change and how to research and find information about the many possible choices of drug treatments. In this post I will give you a candid look at the lessons I have learned about this whole process. I am hoping that sharing my personal experience will help someone else who is going through the same thing.
Lesson Number One: Know as much about your medication options beforehand as possible.
When we finally had our appointment with my son’s neurologist, we had written down about four choices of medications we had researched for treating his particular symptoms. I am so glad we did because it saved a whole lot of time. Your child’s doctor is going to give professional guidance as to which drugs are safe and effective for your child. That time with the doctor is extremely valuable so you want to make the most of it. Here are some questions you may want to ask:
• How have other children fared on this particular drug?
• What are the potential side effects and when would we begin to see any of these side effects?
• What do we do if the side effects are too adverse?
• How long does this medication take to kick in (so we can tell if it is working)? What should we expect to see as far as changes in mood or behavior?
• At what point do we say it is not working? How much time do we give it?
• What is Plan B if these medications do not work?
• Are there any harmful interactions between these medications and supplements my child is taking? You want to be very up-front and clear about anything your child is taking including other medications, vitamins, or supplements.
Lesson Number Two: Keep a log of what symptoms and behaviors you were seeing before the medication change and after.
It is extremely important that you have a baseline of behaviors to look at in comparison to how your child behaves after the medication takes effect. Otherwise, you may have a difficult time in assessing whether or not the medication is working. Believe me, do not rely upon your subjective memory. Memories are faulty at best and in the case of making a medication change you want to be precise. Your data sheet does not have to be complex. Write down the behaviors your child usually exhibits; this may include hyperactivity, not being able to finish schoolwork, trouble sleeping and so forth. Take this same data sheet and begin to record behaviors after the medication change has begun.
In our case we have data sheets as well as a simple notebook log of how his day goes that we share with all teachers, therapists, and the doctor. You want to make sure everyone is on the same page and is aware of the medication change. These people should be on alert for changes in your child’s behavior.
Lesson Number Three: Make sure that your child is getting his or her medication in a consistent and effective way.
I cannot stress to you how important this is. Everyone who is administering medication to your child needs to be able to give it in the same way. We found this out the hard way when we discovered that my son was not getting his full dosage of medication due to inconsistencies in how it was given.
There are many ways for medication to be dispensed. Sometimes a patch is used. Some medications are in tablet form, some are capsules, and some are liquid. You will want to ask your doctor about what is the best and most effective way to give your child’s medication.
In our case my son will not swallow pills, so we must find a liquid equivalent or be able to crush the medication into a drink. This, of course, makes things a little more difficult. He also likes to drink from a straw so this too makes things more challenging. Then there is the matter of giving half of a pill, as you have to cut it. I have found that some pills are easy to break in half and others split in different places; sometimes you end up giving a larger half than others.
Liquid medicines are easier to give, but sometimes they have an extra added flavor that your child may or may not like.
I have found in my experience that it is best to ask the doctor AND the pharmacist about the best way to give the medication to your child.
Here are some questions to ask both health care professionals:
• What time of day do we give the medication? Does it matter if there is a variance in time and by how much can it vary?
• Does it matter if we give the medication with food or not? Does it matter if we give it with other supplements? I think about the case of my husband who takes medication for his thyroid. For months and months the medication appeared to be ineffective as his thyroid levels remained the same. Upping the dosage did not seem to help. Then the doctor asked how was my husband taking it - here he had been eating and taking a vitamin before taking his thyroid medication and this factor was making it not work. As soon as he changed to eating and taking supplements 30 minutes after his thyroid medication, then the medication was effective. These little things can matter!
• If the medication is given as we do, crushed and placed into a beverage, which drinks are best so he gets the full benefit of the medication? We found out the hard way that mixing my son’s pills with acidic beverages was not a good mix. Changing his drink made all the difference in the effectiveness of his medication. We found this information by asking the pharmacist.
Lesson Number Four: Make one change at a time.
Originally my son’s neurologist wanted us to add two medications to his already-existing medication of Prozac. But when we attempted to do this the problem became deciding which medication was causing what. There was no way to tell and, in discussing this further, we all decided to only make one medication change at a time. This may be a slower route but at least I will be more certain of what each particular medication can do as far as changing my son’s behaviors and which medication causes which side effects.
Lesson Number Five: Consider how to handle withdrawal symptoms from ceasing an old medication.
If you are making a medication change, it may include stopping your child’s existing medication(s). You will definitely want to have a plan in place for this action. It is never a good idea to stop any medication suddenly. A slow tapering is always best in most cases.
In our case my son’s neurologist wanted to stop the Prozac he had been taking and substitute Celexa. The way she wanted to do this was to add a small dosage of Celexa to his normal dose of Prozac to begin with for the first week. The second week we would up the Celexa and decrease the Prozac by the same amount. This would go on for four weeks until he was taking only Celexa and not the Prozac. According to our doctor, it would decrease the chances for withdrawal symptoms to occur.
Ask your child’s doctor about the best way to taper off the older medication so that withdrawal symptoms are kept to a minimum.
Lesson Number Six: Have realistic expectations about how the medication will work.
I guarantee you that there are no magic pills out there. They all have certain side effects and limitations.
Here are some things you should know.
• Most medications take a while to kick in until your child gets the appropriate therapeutic level. This can range from weeks to a couple of months. You will need to be patient and give it time.
• As your child is adjusting to the medication you may see more side effects those first few weeks. In my son’s case, we are seeing a lot more sleepiness during the day from his new medication. But this side effect is gradually wearing off day by day.
• The new medication may not help with all behaviors. What medication can do is decrease the frequency and intensity of certain negative behaviors. You will still need to keep up all other supports including any behavioral programs and strategies.
Lastly, hang in there. This process is not easy by any stretch of the imagination. It may be emotionally difficult to see your child taking medications. It is for me. It is a very hard decision to make, but once you decide that your child needs medication it is essential for you to be committed to the process and not give up.
We hope to hear from other parents who are going through such a medication change with their child. Do you have any pointers or lessons learned that you wish to share? Remember, we want to hear from you. Your input is of great value here.