Tips for Vyvanse a new, third generation stimulant:
You already know our regular CorePsych theme with ADD/ADHD and emerging brain science: the more we know the more we can have a positive impact. Not knowing can bring years of frustration, missed opportunity and unfulfilled dreams. 
-And you know that ADD is one of the most misunderstood clinical conditions, as many in this world consider it a belief system not a proven medical condition.
As you also know from these pages, I advocate for what works, what works best,
and what works with the fewest problems for patients and families. Vyvanse, in the short time on the market has set some very impressive records.
From a launch date July 1, 2007, here in the States, I have written about 100 new scripts for Vyvanse treating ADD, and the results have proven quite remarkable. Simply put: almost 0 complaints to the reps, and coming back to my office after the first visit. Unusual launch. -But a few slight problems can occur – thus this post.
These easy tips will help you understand how it works here so that you can communicate easily with your medical people. [Full disclosure: I do speak for Shire, the company that makes Vyvanse, and have for years made a considerable effort to teach medical colleagues around the country how to use stimulant meds more effectively. I have presented for Adderall since its launch, Adderall XR, Focalin XR, and Daytrana as well as Vyvanse.]
Tips and Treatment Notes for Vyvanse:
- It is a prodrug with a slow and forgiving delivery process: No heavy AM hit, no big drop in the PM
- Both studies and clinical experience show that it is more efficacious [post hoc review] than Adderall XR, and Adderall previously held highest efficacy ratings on comparison studies.
- The prodrug delivery system provides a longer duration of effectiveness, with no need for a PM “kicker” dose to complete homework or home chores.
- Methamphetamine addicts don’t like it: as measured, get this, on a “likability scale.” Because it is a prodrug you can’t snort, chew, or inject it with any buzz success [peak Cmax about 4 hrs post ingestion]. In research they injected Vyvance into a meth addicts arm: their conclusion: this is not “likable” – no fun, no buzz. This is an excellent outcome, not previously reported with any stimulant, and in the package insert. It may be abusable, but it will be nearly impossible.
- Always start at the lower dose: 30mg which roughly equals Adderall XR 10mg. They may be on higher doses, even 40 mg of the Adderall XR, but always go low and slow. It’s more efficacious, and if you start at 50mg which roughly equals 20mg Adderall XR, it can give them an unpleasant feeling. Been there. Go slowly.
- If the duration [DOE] is out at ~ 2PM the dose is one click too low. Move up to the next dose.
- With a medication sensitive child/adult you may want to divide the dose in 1/2 to get started: Take the capsule, pour contents into 2 oz of water in mixing cup, drink 1 oz each of the first 2 – 4 days to start slowly. I have two children perfectly dosed with only 1/2 capsule/AM in this manner.
- All psych meds are better tolerated and more effective with a protein breakfast,- please review my breakfast posts linked here.
- Always remember the ADD 3R’s, discussed in my first post, in reference to medical treatment for ADD: Right Diagnosis, Right Medication/Intervention, Right Dosage.
Please send along any comments: this is an opportunity to work closely together and let people know how this medication can be used most effectively. -Look forward to our discussions.
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I’m 22 years old and was diagnosed with depression at age 15. I’ve tried zoloft, effexor, wellbutrin, wellbutrin with rhisperdal, cymbalta, and pristiq at varying doses. Although they all seemed to temper my emotions for short periods of time, I still had problems with my energy level that was non existant and focus. My dosage of Pristiq was increased from 50mg. to 100mg. but i was quickly brought down to 50mg. again after the change in dose made me extremely depressed and I noticed symptoms like rapid energy loss and anxiety around large groups of people which i never suffered before. I was diagnosed with ADHD Predominantly inattentive and prescribed 70mg of Vyvanse in addition to the 50mg. of Pristiq and Ambien CR 12.4 mg.. This was done during my semester winter break, for two weeks I felt cracked out but I continued taking my medication and every couple of days the uncomfortable side effects began to diminish and i noticed extremely positive results, for the first time I felt like myself and I hadn’t really in over three years. As school started up again and life continued I noticed the motivation and energy I had to complete tasks was diminishing and lasted for about two weeks. When i spoke to my doctor about it he opted to increase the dosage of Pristiq to 100mg and told me I should take it for three weeks after I asked him how long i should deal with side effects. It’s only been 6 days, but I’ve only really been out of bed for 2 out of 6 days, I wake up feeling extremely drowsy and disoriented, following that period i’m extremely exhausted and frustrated with how unproductive I am at the moment, have even less focus than before, and pretty much only have a two hour window in the evening where I feel ok enough to really walk out of my room and eat and interact with my family. Is this a normal reaction? Should I continue taking this dosage in hopes the side effects diminish? Would changing the time I take Pristiq in the morning with my Vyvanse to the evening with Ambien CR make a difference? Thanks.
Philip,
Sounds like you have something else going on medically, and I would have to go over you in detail to even guess what it is. Those two meds have no interaction, do take a look at this video and see if it rings any bells, especially the last few mins.
cp
I’m curious if there are other medications that require the same enzyme as Vyvanse that should perhaps not be taken along with Vyvanse… maybe later in the day instead, and if there are substances that may inhibit this enzyme (flavonoids?).
Kim,
None to my knowledge, – interesting question!
cp
I’ve really enjoyed reading through your blog and am learning quite a bit. My youngest daughter (6) was diagnosed with ADHD when she was three. She was considered a danger to herself so despite her age and some reservations I decided to put her on meds. THe doctor first prescribed Focalin XR first, but that caused her to become aggressive and violent. After a month we switched to Adderall XR and she took that for about 7 months, M-F. It worked fine when she was at daycare, but evenings were even more difficult and when I found that she wasn’t gaining any weight I decided to take her off the meds entirely and see how she would do. She ended up being incredibly improved, at least from the behavior that I could measure. She’s been off meds since then, so almost 4 years.
With her diagnosis I started to evaluate myself and finally, after procrastinating forever, I went to see my doctor to be evaluated myself. The result of that is a diagnosis and meds for me. I just started Vyvanse, 30mg, on Monday and the change in my thought process, ability to get things done, and patience with my kids was extraordinary. My DOE right now seems to be about 8 hours and I’ll be following up with my doctor in a few weeks to discuss my dosing. I’m assuming I need an increase to reach my ideal 12 hour coverage.
My questions for you are regarding exercise and how that affects the way the drug is metabolized. I am an amateur triathlete and work out 4-6 days a week depending on the season. Monday was a rest day, Tuesday, Thursday and today I took my dose after leaving the gym but on Wednesday I took it with breakfast then went to the gym. It was a wonderful workout. Instead of grinding out miles on the treadmill I was able to immerse myself in the television and the next thing I knew, my run was done. The particularly notable thing about it was that my heart rate, which I usually struggle to control with breathing, stayed lower and steady through the entire workout. Could that be related to the Vyvanse or is it likely something else? I tried doing the same routine today without the Vyvanse and it was the same old struggle and misery.
The other thing I noted was that on Wednesday it wore off by 4pm. I’d taken my dose at 9am and had expected it to last at least until 5pm and fade away gradually like the other days but instead I had a hard crash. I pushed through it at as much as I could but I fell asleep at 7:30 while putting my son in bed. I’m guessing that the exercise messed with the way my body metabolized the medicine, but I’m not sure why or what, if anything, I should do about that.
I look forward to hearing your thoughts. Also, I’m making an appointment with my daughter’s doc to discuss starting her back on meds again. Her behavior is manageable, but now that I’ve experienced some clarity in my head for the first time in my life I can’t stand the thought of her not having it too.
Allison,
Excellent report, thanks for sharing, – it sounds like you are right on track with both your daughter and yourself.
Yes DOE is the best way to lock Vyvanse dosage down – it’s not exactly the same every day, but on average you can, as an adult, expect in the 12-14 hr range when dialed in correctly – just go slowly as suggested. With an early starter, in the first 2-3 mos of meds, we see more fluctuations in duration, and must regularly counsel folks to hang in there a bit [2 wks] to see if that next click up is correct. With Vyvanse it is almost always locked on well after just 2-3 adjustments. Breakfast is a key variable, and when you make that protein part of your self management package you will evolve even more into the Warrior-Goddess. The Wednesday experience I would write off as getting-used-to-the-meds. These fluctuations in tiredness etc do occur until stabilization with the meds about 1-2 mos out.
The only other item to watch: with a very early challenging onset of ADHD, I always ask even more specifically about bowel habits and anything that sounds like metabolic issues, as those start early and encourage a more unpredictable outcome with meds over time. See this post on Intuniv and Metabolism for some details that work for any meds with kids.
Best of luck with the next visits, – do keep us posted, your insights will be helpful to others on the path.
cp
Dear Dr. Parker,
I started using Vyvanse 40mg about a week ago. I’ve been taking one every morning as prescribed by my doctor. I notice it helps me feel more energetic, and focused throughout the morning and early afternoon, but I start feeling sluggish around and after 4pm. I begin feeling what I can best describe as a hangover. I notice Adderall XR 10mg doesn’t give me this “crash” feeling by the end of the day, but it doesn’t last as long as Vyvanse 40mg. Adderall does give me a slight sense of dizziness once in a while, but it definitely doesn’t feel like being hungover. Is there anything I can do to help reduce these Vyvanse side effects, or should I ask my doctor to prescribe me a different drug? Thanks…
Rafael,
Please take a look at all the DOE materials I have on almost every post on Vyvanse, including this one. Your dose sounds like it is simply too low, assuming you take it about 7AM your DOE would be only 9 hr, way under the projected 12 hr DOE.
Talk to your doc about first going to 50 mg for an extra 2 hr, then look at the possibility of one more 10 mg click if the same situation occurs. Adult studies take Vyvanse to 12-14 hrs DOE, so might as well give that a shot before you and your team call it a day.
cp
Dr. Parker,
I started 3 months ago on vyvanse at 60mg and was taking 30mg Prozac. I told my doctor i had read there was an interaction between the two drugs and she pulled out the pdr and it was not listed. I did fine for about almost 2 months, things were great, the vyvanse was wonderful it had helped me to completely turn my life around, but then i started to experience confusion, difficulty focusing, so I went back in and said are you sure it is not an interaction. She said no, so she increased the vyvanse to 70mg. Things got so bad, severe aggitation, confusion, severe muscle pain in my upper back, i could have lost my job!,
So I found you, best info i have had in months!!! I printed info out and went into the doctor again and said ok, now i know there is an interaction between prozac and vyvanse. Again She did not agree, I gave her the info, I told her i did not agree with her anymore and i refuse to take the prozac, but of course I have to ween off. I requested Pristiq cause I do have the depression with the ADHD and she agreed. So we dialed back the vyvanse to 50mg and Pristiq at 50mg, Prozac is done with, but now it seems that vyvanse doesn’t seem to be as effective like it was.
My problem is that I like the vyvanse, but with all that I have been through, what do I do now. at 70mg of V I was out the top of the Window but that was with Prozac, and now at 50mg of V I am at the bottom of the Window with Pristiq. I have to be more knowledgable than my doctor at this point! I will be changing doctors but until this happens I have to get things straight to function. I also notice that the V tapers off at 3pm which is at 10hours DOE for me It took me a long time to be able to notice when the V tapered off. I feel I need a short acting med for 3pm to 9pm, other wise I feel the adhd and some depression phase back in on me and cannot finish the rest of my day with out it becomming a struggle again.
I don’t want to be toxic again, that was soooo horrible! My doctor did not listen to me and that just makes things all that much worse. Can you give me a little direction so I can share it with my doctor until I can find some one else to treat me?
Thank you
Tonya,
Now we enter the realm of considerable hesitation on my part, because I haven’t seen you, and don’t know you – so the following is to run by your doc as possibilities – I am telling you my experience relative to this pattern, not giving you medical advice, and would make no changes without seeing your doc, period.
With ADHD meds there are too many variables, but you did hit and cover one with her – the Prozac/Vyvanse combo.
My best guesses and these are guesses:
1. that you are still flipping a bit with residual interaction from Prozac, as it can take even two weeks to get out of your system.
2. you became significantly overdosed, and acclimated to too high a dose of AMP and are seeking a harder hit than you should get with Vyvanse
3. your dose of Vyvanse is too low, and needs to go up to 60
4. you are having an atypical reaction to Pristiq
5. you have other comorbid problems not listed in your note
The complexity and options need to be discussed with her – all have their obvious recommendations tied with each observation. You may wish to simply wait a bit and get your 10 hr by taking it later in the AM as some do.
Please get back with her, any of these [and others may come to light with her] could be the problem.
Be well,
cp
One more point Tonya:
Reference for my Prozac/Vyvanse interaction is the Concise Guide to Drug Interaction Principles for Medical Practice – Cozza, et al.
Hope this helps,
cp
I am in my late 30’s and have been on Vyvanse 50mg for over 6 months> Like some previous posters I experience some unsettling memory problems even though I have great focus. I can’t remember simple things like my childrens teachers names or the name of a store. My word retrieval skills are terrible, or I will reverse words thought, example.. I am going to the bananas to get the store. This is quite common and it is only after I utter this nonsense that I notice the error. My children even pick up on it sometimes. Also, for several months I experienced a shortness of breath that seemed similar to my asthma symptoms as a child. This seems to come and go now, but is bizarre. Do you think these could be related to the Vyvanse.
Lara,
Do look very carefully at your DOE, and assess if it is in the 14 hr range. While not always the accurate barometer [having only misrepresented Vyvanse dosage efficacy with careful questioning only 2x in my experience], it will often tell the tale. The phenomenon of decreased memory can be related to several different issues, the most frequent, and the reason for measuring the DOE, is simply too much Vyvanse leading to an excessively long DOE [somewhere over 12 hr with some folks]. Said another way, sounds like you are coming out of the Top of the Therapeutic Window.
Another possibility, quite likely, is that your ADHD is simply caused by a dysregulation with a different neurotransmitter, for example PEA. Phenylethylamine, PEA, is not commonly appreciated by the current ADHD psychopharmacology practitioners simply because we haven’t had a medication to address levels.
Measuring PEA, as I do now in every challenging presentation, saves months of speculation and trial and error, and real dollars as the evidence will tell the practitioner exactly what to do.
As you may know from these pages I am a strong advocate of science and measurement, and disparage the Missouri Turkey Shoot concept – such as taking a blurb like this one from the Internet and running out to find the amino acid precursor for PEA, phenylalanine.
However if you are interested in PEA do take a look at this article [PEA noted on pg 269] in this article from Psychiatry and Clinical Neurosciences, for verification of this possible targeted amino acid neurotransmitter precursor intervention.
Neurotransmitter measurement possibilities discussed in detail on the Neuroscience page here.
Interesting question, thanks,
cp
I started 20 Vyvanse 2 weeks ago and about 2 pm it starts to wear off and I start to feel very flat or emotionally blank, almost like a depression. I do not want to be around others and I hide in my home. I told my doctor he said he could up the Vyvyanse or add Adderral at 2 pm to get me through the rest of the day. I was reading a lot of blogs about Vyvanse and it seems alot of people are having that same reaction when the medication wears off.. What are your suggestions??
I was previously prescribed 30 mg Vyvanse with 400 mg Provigil. Taking 200 mg Provigil with 30mg Vyvanse in the morning and the other 200 mg Provigil at lunch time. This was absolutely the best I have felt in years with regard to ADD management. After a recent job change, and with that a change in insurance, I could not longer justify spending over $600 a month on my medication. My GP changed my prescription to 20 mg of generic Adderall XR. This worked okay, but didn’t seem to be as efficacious as the Vyvanse+Provigil Combo… so at my next med-check, we switched my medication to 40mg Vyvanse alone once in the morning. I am now taking the 40mg, but find that everyday I am needing something more to control my energy and concentration; I typically drink 3-4 cups of coffee throughout the day in addition to an energy drink first thing in the morning… and if I didn’t fear putting too much caffeine into my body, I would probably opt for another energy drink after lunch. All that to preface my question: What dose of Vyvanse, or generic Adderall, would be the equivalent of the 400mg Provigil + 30 or Vyvanse? Would another medication be better? I should also note that I have MVP, and take Toprol in the evenings for that. Many thanks in advance.
Krissie,
Sounds like dosing for the Vyvanse is not correct yet – shoot for 12 hr DOE, even 14 hr DOE for adults, and I’ll wager you will come much closer to the mark without all the additional cost of Provigil.
I have several other posts on the details, and check the many comments here on the process – and discuss with your doc – don’t forget the free White Paper at the book sign up on the top right hand corner – details there.
cp
My son is 15 and has been taking vyvance on and off for about one year. He takes a 30mg pill each week day at 7:00 a.m. and does not take the pill on week ends. He says that the pill does help him focus but he feels the focus is to intese and he says he just doesn’t feel good when taking the nedication. He doesn’t feel like eating until 8:00 p.m. although he does try to force some food down at lunch and drinks some fluid. I was reading that you can cut the dose by putting it in water. Is the effect the same as taking the capsul? Can vyvance be perscribed in a lower does.
Thanks
Lynda,
Yes, sounds like slightly too much – two easy options with docs approval:
1. Directions for splitting the dose are on several other posts here at CorePsych Blog and here at Squidoo, – and you can give him 15 mg in AM or actually any dose by the water titration recipe
2. Easy other solution: just ask your doc for the small 20 mg capsule, probably will be nearly perfect with one exception… some are simply slow burners and need only a small dose for the 12hr DOE.
And: If he is not eating a protein breakfast before the dose, start there, it may solve the entire riddle.
Thanks,
cp
I stumbled upon this website — I have had some wierd side effects that I am attributing to this drug and I wanted to get your opinion.
I started Vyvanse in about January of this year — I am 26 years old and I took Ritalin when I was younger and Adderall though high school and college with good results. I recently started seeing a marked deterioration in my ability to focus and spoke with a local doctor who recommended Vyvanse 40mg. I started taking it and I noticed marked changes in the way I acted and sexual appetite. I also noticed that after a few days of taking it I had a shortness of breath (never felt like I could take in enough air, and there was what I can only describe as a “cool pain” when I tried to breathe deeply, similar to when I had to get a shot of Benadryl when I was younger) and my mouth was always really dry.
I spoke with my doctor about some of the side effects and he dropped me down to 30mg — which I never took. I have been off of the medication for about 2-3 months and have noticed that the feeling of being short of breath hasn’t gone away (neither have any of the other side effects), and I am starting to feel depressed and sluggish during the day — symptoms that I never had prior. Until I got off Vyvanse, I was doing very well and was very successful at managing and running my own business, and I’m noticing that I lack the energy to do anything (not just scatterbrained like I was before) now and a general funk has descended since I stopped Vyvanse. I never had these issues with Adderall.
Rob,
The breathing problem is not likely due to the Vyvanse, as it remains after stopping. Vyvanse, from my experience, does not cause long term side effects after usage – and therefore would discount that thought.
It does sound like you have significant ADHD problems with a positive response to stimulants and these are some suggestions to run by your doc for consideration when you check back with them:
1. You could always try the Adderall again, and will likely rule that option out as creating the shortness of breath [SOB]. – This after the med evaluation next.
2. I would really take a hard look at yourself medically with SOB – from celiac and gluten sensitivity to more obvious problems with some serious medical consequences outlined here.
3. Given the complexity of your presentation I would suggest the medical workup before jumping back on the stimulants.
cp
Is there any link between Vyvanse and sleepwalking/sleep terrors. My 7 year old son started on Vyvanse 5 weeks ago and the last 3 nights he has had what seems to be sleep terrors while sleep walking. He runs around the house screaming and crying like he’s fleeing from someone/something but there is nothing there. He’s obviously not awake during these episodes and it happens on and off throughout the night – not just once.
Thanks!
Crystal,
Vyvanse and the symptoms you describe may be related as follows:
1. All stimulant meds, MPH or AMP can significantly create problems when dosed excessively, even slightly. Bigger problems like this often occur with significantly too much. See my article: The Top of the Window here and the other articles at EzineArticles associated with titration to understand this important phenomenon. In a word: look at the dose, likely not ‘just the Vyvanse.’
2. Yes, on and off thru the nite can still be ‘dose related,’ – and that dosing problem is often associated with appetite decrease, wt loss, and hyper-focus during the day, and irritability.
3. Suggest speaking with your doc and adjusting the dose downward, as noted in detail on a site that I built here at Squidoo, when Vyvanse first came out.
4. Often the dose is increased to cover a drop in the PM, an emotional challenge with depressive features, based on comorbid depression, another subject to review with your doc, covered in detail in my new book.
Hope this helps,
cp
My son, now 15, developed tics on focalin a year ago. The medicine was stopped at that time. Would trying another stimulant like Vyvanse cause the same thing? Also, what type of medication works best for inattention. My son has ADHD inattentive type. He is not hyperactive.
Thanks,
N Aikens
N Aikens,
Tics are quite unpredictable. Sometimes a different [e.g. AMP] stimulant will work without creating tics, when a MPH stimulant, like Focalin, created a problem in the first place. But traditional psych colleagues and myself have regularly seen tics go either way, more with an AMP product, more with a MPH product, or simply can’t get away, the tics arrive with ‘any’ stimulant product, – and thus you might need to try Strattera. No one has been able to directly pin the *how and why* tail on that donkey to my knowledge.
It has been my experience that I do see fewer tics with Vyvanse than any of the other MPH or AMP stimulants – but I await full consensus from my colleagues on that one – a bit to early to tell, but looks promising.
Two other axioms we follow in our office:
1. First of all we have seen some excellent response to tics with Neurofeedback [NFB], I have written several posts over the years on that subject, so please type “tic” or “NFB” into the search box, I hope the URL’s will come up after the transfer from TypePad.
2. The other important perspective, shared by my functional colleagues for years: metabolic challenges are almost always found with tic disturbances – I don’t at this moment have enough pure evidence to say definitively what we have measured and corrected, but I can tell you correcting metabolic issues in general, form bowel frequency to supplements and proper nutrition does seem to help – could be nutritional, could be toxic, could be immune dysfunction, could be all three.
Hope this helps a bit, – as always, check with your doc for their experience.
cp
I’m a junior in college majoring in math, and am prescribed 70 mg of Vyvanse which I take at 8am every weekday and by 3:30pm I am back to my normal scatterbrained self. But I’m not here to complain about the DOE…
I plan to start working out regularly again (to get prepared for extensive summer beach action!) and ordered a big tub of a very popular whey protein product which contains Aminogen, a patented blend of proteolytic enzymes, but realized after receiving the order that Aminogen may cleave off the lysine in lisdexamfetamine and negate the sustained-release effect. Is this a rational fear, or do you think it’ll be okay to take the whey protein with Aminogen during the the DOE window?
Also, how long can I store Vyvanse mixed in water before having to worry about it breaking down or losing effectiveness?
Thanks in advance for your answers, doc.
Vyvansified -
Great questions, and I doubt anyone can give you a well substantiated answer on the proteolytic side of matters… my guess is that it likely will not create a problem, but will be interested to see what you think, would suggest trying Aminogen without modification of Vyvanse dose – and then run back here and comment for all of us.
Storage in water… no evidence to show any deterioration from office reports. Haven’t had anyone report longer than 4-6 days – and they all report no problems with dose or DOE changes.
Do stay with the working out… excellent for all aspects of recovery and do read the excellent book Spark by John Ratey MD is available here at Amazon: He is a superior writer, and one of the most well informed about exercise and ADD.
Final note: sounds like the DOE is a bit off for your dosage, just using the 12-14 hr burn rate objective – the math on your dose is only 7.5 hr, so you might want to talk to your medical team about that one before finals.
Remember your sun block!
cp
Hello Dr. Parker,
I have three questions for you:
1st question.
I am a 46 yr old woman and I have ADD. I have been on Effexor XR for about three years. I am now taking Vyvanse at 30mg a day (just started yesterday). Now that sometime has passed since you first started this web page in 2007, do you still feel that Effexor and Vyvanse is a good combo?
2nd.
Also, on the Effexor at 187.5mg (two 75mg and one 37.5mg) I noticed that I too am having problems with thinking of the right word to say. And I feel very sluggish and always tired not sleepy. Also my memory (short term) is terrible these days. Does Effexor cause the symptoms?
3rd
When I was a child I was on Ritalin and it work well and there was not anxiety and depression when I was taking it. I’m thinking (with my Dr’s help) of discontinuing the Effexor and sticking with the Vyvanse if it works will for me. Are you finding that this is the case with other patients that had been on antidepressants and once the ADD was addressed the no longer needed the antidepressants. I’m really thinking that my anxiety and depression was a result of the ADD.
I wanted to let you know that your website has been a great help to me.
Rita,
Thanks for your kind remarks!
1. Still love Effexor XR and combo with Vyvanse, but am even more pleased with the daughter of Effexor, Pristiq – less sedation and less titration challenge with super efficacy. Pristiq, more in a later post, skips the 2D6 pathway needed to metabolize ~ 60% of Effexor… easier metabolism = faster assimilation and fewer side effects.
2. Thinking of the right word can be related to insufficient stimulant, as serotonin frequently aggravates ADD symptoms – or simply too much Eff. Watch your DOE and see if the word search occurs in the PM after drop off. ‘Sluggish’ occurs in about 15-20% of those taking Effexor, is much less common with Pristiq and solved by giving the Eff. at bedtime in most situations – Also look for all the other possible metabolic issues such as slow GI transit time and other conditions like thyroid etc. often under appreciated.
3. Sure, go with the minimum that you and your doc decide. My experience: often the stimulant will aggravate a less obvious depression if the depression co-exists with the ADD. If the depression is secondary to the ADD, it will resolve, and no antidepressant is needed.
Thanks again, hope this helps you pull some of the details together with your med team.
cp
So you are saying you like the Pristiq/Vyvanse combo? I currently take 50mg of Pristiq and feel nausous a lot. I also have had a really hard time sleeping. I have been diagnosed with ADD and just heard about Vyvanse.
Hillary,
Make sure you take the Pristiq with food even tho they may tell you no problem – best if protein.
Those two are my favorites if they work – no interactions, and excellent efficacy, but may not work with everyone.
Give them a try with the protein breakfast, if you doc is OK with that plan.
cp
I am a 33 year old back in school and working full time. 8 weeks ago I had a baby and started on Vyvanse 2 weeks after for adult ADD re-diagnosed from childhood. I am healthy and fit. I eat protein breakfast and incorporate protein in small meals throughout the day (as well as at least 64 oz water). I have lost 30 lbs since starting. I used to have crash and migraine at 1pm on 30Vyvanse and now on 50, do not get it. I am experiencing intense lack of memory recall and word retreival (verbally only-written word retrieval is far above average). I assume much of the recall and word retrieval is related to sleep deprivation (colicky baby) and work/school(??). My questions are:
1) does the word retrieval/memory recall get better with sleep or are there other contributing factors?
2) If I do not take my Vyvanse one day, I feel very depressed (emotionally not physically). I did not have issues with this before. Is there a way to prevent this come down? (I take C every night to attempt the “shut down” off the drug.)
3) Will continual use of Vyvanse harm dopamine receptors so that use is required (and increased) to maintain stable result: focus, good sense of reality, etc.?
Thanks
Ashley,
Sounds a bit like too much, just because you are having the problems with memory, and possibly weight. Sleep is a big, big factor in compromised memory, no doubt about it. Hope you aren’t breast feeding…
Regarding the ‘come down’ – I always use caution dosing with those under big stress as the Vyvanse can help, but can also create problems taking you past your ordinary energy and then, because it is solving an energy problem, the drop is profound. Sleep is a big issue with all of these pressures and can create the fall in the PM.
No harm to dopamine receptors, just not in the literature or the experience of those who work daily with this medication in the approved dosages.
Congratulations – my grandson is now 13 mos and a great guy who already has a sense of humor!
cp
Wendy,
Shortness of breath is not a typical side effect, and the fact that it persists suggests strongly that you should seek specific medical attention and review as soon as possible – might be something more serious.
If it is just a very unusual side effect, about 24-48 hrs.
cp
I have been off of the vyvanse for about 24 hours now and am still very short of breath. how long can I expect this to last?
Kristin-
Your comments from the front will help others who share your same concerns. On of the biggest problems I am seeing every day is the downstream effect of not thinking carefully about stimulant medications – not using a clear system for intervention.
- Glad Vyvanse is working for you and your son.
One the ‘challenge’ side, the ‘problematic’ side of these matters, you may be interested in this article on how we physicians can contribute to ADHD non-recovery:
http://ezinearticles.com/?ADHD-Denial—Medical-Ambiguity-Creates-Significant-Problems&id=1843156
Without a specific treatment structure problems abound.
Tnx
cp
You are right on the money about the “not being able to control” the effects of the high, and “looking high”, if a person attempts to abuse Vyvanse. My experience in viewing this individual was he was extremely red, hot, heart racing, and eyes were glazed. Everyone noticed. I want to make myself clear that I am a strong advocate of Vyvanse. My son has been on several ADHD meds, all of them had terrible side effects which were the sole cause of why they did not work for him. We are having succuss with this one! I could not be happier or more hopeful. Parents with children who struggle, know what I mean. He has made it through an entire week of school without one “checkmark” for the first time all year, since he began the Vyvanse. And homework is completed without tantrums or tears. Thank you for your valuable advice.
Kristin,
Sleep walking is seen when the dose it too high. We always watch for sleep changes in the DOE process outlined here. If the DOE objective is followed no sleep issues should be occurring – if they are, we recommend dosage changes for our patients – decrease.
And yes, I have heard occasional abuse of the Vyvanse, but far fewer than Adderall, and not consistent abuse, because the buzz is too hard to achieve and completely troublesome… they can’t control it – and look like they are high, creating discovery of the abuse.
My resources who are those most likely to abuse, the college kids, – and they affirm these findings with their friends and associates. Just home from Christmas break they are quite enthusiastic about the improvements they have experienced in this regard, and the positive reports on Vyvanse at the schools.
cp
Wendy,
Those side effects are common if the dose is not correct, or if breakfast is sporadic. Protein breakfast is a must, then what appears to be missing is an appreciation of the specific DOE objectives. Please read the Elusive Top of the Window at the EzineArticles button here, if you are near or at 12 hr you should not be having these problems unless no breakfast or on paxil or prozac – sometimes Wellbutrin.
cp
I was just reading through more of the past blogs and saw that you were interested in hearing information on abuse of Vyvanse. I get the medication for my teen son, and have personally seen it’s abuse. His pills were stolen at one point by an individual. We all realized who had done it when we saw the behavior (we knew this person). He was “wired”. For a period of three days, this individual was bouncing off the walls, and then crashed very hard. I have no idea how many pills he took at one time, or each day. But he undoubtably had a buzz. I had to fight hard to get the Rx refilled again, as the Dr. explained that theft of these meds is very common, and often abused. I now keep the Vyvanse in a combination locked box.
My son, 13yrs old, was recently prescribed Vyvanse 60mg.. He has had the typical side effects I have read about, however, he has just experienced a prolonged sleep walking episode. He actually ran, and took a bath before waking. Do you think this is related to the medication, the dosage, or just lack of sleep? Or have you heard of any links between Vyvanse and sleep walking? Thank you.
Hi,I was diagnosed with adult add and put on vyvanse about 2 months ago. I tried the 30 mg for 2 weeks and tolerated that well. I was then put on 50 and that was good too. I was then moved up to 70 and started to have just the slightest shortness of breath. as suggested, I immediately told my dr about that and he moved me back down to the 50 mg dosage. now I am still having a bit of the shortness of breath when I did not have it at this dosage before. the first 3 pills were normal again and when I got to the 4th I had the shortness of breath. could I still be recouperating form the 70 mg dosage? why am I having the side effects at the same dosage that I did not have them before? I only took 5 of the 70 mg tabs. Also, I do not take my with protein as I just learned was recommended. will that help remove the side effects? how about caffeine? I have not stopped caffeine and with the combination with vyvanse could that be causing the shortness of breath? I really want to continue taking vyvanse, and wonder if the side effects will subside.. I am somewhat concerned because that is a side effect that is considered rare and to call dr immediately. He did not seem that concerned and only lowered the dosage. what do you think?
Mary Ellen,
I do have patients, very few, on 150 mg with good result. You could very well be a fast metabolizer, or you could have, and strongly suggest that you check out, other concomitant metabolic issues. I have not seen a person on the high dosage side of matters that doesn’t have unrecognized immune, hormonal or nutritional contributions.
Best of luck in your nursing career, and do check out any changes first with your doc. In nursing and in medicine, you will soon see that even casual discussion might imply taking responsibility, and I encourage you to keep that in the hands of your specific on-site doc.
Best wishes,
cp
Chels,
Always check with your doctor before changing anything, this forum is not to give specific med advice – but I never have any problems with what you are asking, no withdrawal, and no interaction if not taken together.
cp
Hi, I was actually prescribed vyvanse today but i forgot to mention to the doctor that I had previously been on Wellbutrin 150mg. I haven’t taken the wellbutrin in about a week so do I need to delay starting my vyvanse until it gets completely out of my system? and if so, how long?
Hi,
I’m wondering about high doses of Vyvanse. I am a 37yo female, approx. 160lbs, 5′4, with no other health issues. I am holding @ 100mg of Vyvanse per doctor with an Adderall boost when needed (YUCK). I have requested to move up to 150mg (I have been as high as 130mg prescribed and he decreased it) but he says that I’m just throwing away my $. He says that a persons body can only metabolize a certain amount of this medication & the rest is wasted. I have recorded daily when I lose the 100mg ~ I start to yawn, need a nap, fiddle, ect. around 11:30am (I take my meds @ 6-6:30am. I have very long days I work part time & a full time nursing student, with class ending around 8:30pm. I have used Adderall & XR but hated the rollercoaster feeling! I have been on Vyvanse since July ‘07. Looking for some help!
Thanks,
Mary Ellen
James,
Vyvanse with either Effexor or Pristiq [daughter of Effexor] is IMHO the best combo for depression with ADHD, absolutely no problem, clean on 2D6, and those two are, in my opinion, the two best antidepressants available [stand with Stahl and others on that one] even tho they don’t work for everyone.
Sounds like your DOE is off, shoot for 12 hr DOE, don’t go over 14 hr on dosage, no noon dose on Vyvanse.
More info on this duration article here below, – and then just Google DOE here at CorePsychBlog for more details on many posts. This is a common problem.
http://ezinearticles.com/?ADD—ADHD-Medication-Treatment—7-Tips-on-Finding-the-Challenging-Sides-of-the-Therapeutic-Window&id=1650524
Thanks, hope this helps,
cp
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