ADD/ADHD Treatments: Tips for Vyvanse

I have been on 50 mg of Vyvanse for about a week. I am newly diagnosed at 36 (my kids have it as well, I recognized my own symptoms from watching their patterns.) The first day on the med I was a zombie, but I noticed that I felt more calm. Second day, a little bit more motivation, but no change in focus. I have tried taking it later (at 8 or 9 AM now) and still nothing. I know that you're not supposed to feel a "buzz" but I really don't feel any change at all. I am also still drinking way too much coffee, and still "bouncy" (leg bouncing, finger tapping.) I'm going to assume that the dose is too low, but I also take 300 mg Wellbutrin. I know that Wellbutrin inhibits DA uptake, so I tried a day without the Wellbutrin, but no change in the Vyvanse effectiveness. I'm still new at this, and will be talking to the doctor tomorrow. Any suggestions?

Teresa, Just going suddenly off the clonazepam can wake you up, I've seen convulsions on 1mg fast detox, so you could simply be detoxing - see the book: "I'm Dancing As Fast As I Can." Hang in there watch for the DOE on the Vyvanse, dial it in carefully, and no drug interactions there with Zoloft so that's not a prob, nor is the Chantrix. cp

Cheliz, Absolutely, excellent combo - but for some strange reason it comes up as an interaction in the drug stores, but not in the books that address drug interactions, and not seen in my practice. cp

Zoo, So you love the guy... read this and it will put your mind at ease... he probably doesn't have DSM4 ADHD, a diagnosis only for the uninformed, but he likely does have one of the two other types I describe in detail in Rules: Freebies Here: http://www.corepsychblog.com/adhdbook Videos here: http://www.corepsychblog.com/adhd-medication-tutorial/ He's lucky to have someone who cares, and is probably right according the very limited current diagnostic codes. cp

Hi Dr. Parker, Wow, you are brilliant. Wish there were more out there like you. I recently started Vyvanse 40mg and have taken Effexor XR 150mg for close to ten years. So far so good! My question is: My doc's only concern is that combining Effexor and Vyvanse has caused alarming weight loss in SOME patients. Is this likely as I am a recent chemo recipient and their concern is secondary anorexia? Of course, I could afford to lose about 100 lbs., but don't want it done due to meds. God Bless! Bethany

Deb, Highly likely best bet would be to redo Vyvanse, dial it in more effectively and consider comorbid depression with a depressive/anxiety subset that will likely respond to antidepressant meds. If that proves counterproductive she very likely had a metabolically stimulated "roving therapeutic window." http://www.corepsychblog.com/2011/06/psych-meds-time-titration-tachyphylaxis/ cp

Hillsz, Sometimes those symptoms dissipate, but often they don't - see my video on Anxiety and ADHD on YouTube - at about 5 min there you can see some info on the seesaw with depression/anxiety and ADHD. Stimulants can and often do aggravate depressive symptoms that are often there before, but are aggravated by the AMP. Bottom line: easy fix would be low dose antidepressant for a quick fix and measurement of neurotransmitter imbalances for the longer term fix data. cp

My 7 year old daughter has been diagnosed with ADD/ADHD. Doctor has prescribed 20mg of Vyvanse. While drug is helping with school and focus issues, it seems to cause her to be overly emotionally sensitive and weepy. Is this a common side effect and will  it dissipate after she has been on medication for a while?

Darrius, Vyvanse dosage, as is all stimulant dosage, metabolism and genetics related, not based upon size, weight, sex or age, period. There are some studies that encourage a more weight related response with Intuniv [described in detail elsewhere on CorePsych Blog], but with the stimulants, not so. Having said that, Vyvanse, when correctly adjusted, should work for ~ 12 hr in adults, sometime up to 14 hr without side effects, without coming out the top of the Therapeutic Window. Adjustments up or down from 40 mg, in attempt to find that Therapeutic Window, will move most often by 2hr/10mg - meaning 10 mg more = 2 hr longer duration of effectiveness DOE. cp Read more: http://www.corepsychblog.com/2011/05/adhd-medication-dosage/ Under Creative Commons License: Attribution Non-Commercial Share Alike

how long does vyvanse 40mg would last

Dr. Parker, I have a common situation. I have no health insurance. I have been on vyvanse for 4 years. I have been diagnosed 2x for add/adhd. My situation is that even psychiatrist has problem with giving over 70mg. I am 31 years old. I have patient assisstance through shire to cover cost of vyvanse. Switching me to other meds is a concern due to cost. Even trials done on adults for vyvanse is a joke. They were given max dose of 70 mg. The child trials were given at 30, 50 and 70 mg and titrated by 20 mg until reaching assigned dose at four weeks. Help please. Amberstarted at 30,50 s

Dr. Parker, I ordered your book and I really love it. I have a couple questions about drug interactions. I have fibromyalgia along with cronic infections on top of the ADD and high anxiety. I got off of my Vyvanse for about 4 months when I was first diagnosed with the fibro. because I am on so many medications I was scared. Now, my concentration is so bad I started it again, but instead of the 20mg I was on before I started out with 5 and am working up that way. My question is they have me on strong pain medications Norco and Percocet (when the pain gets to bad) and Clonazapan for anxiety. I have also been on and off of Steroids, anti-biotics and hydroxyzine for all the Sinus Infections. My doctor says that these drugs do not interact, but after reading your book I am not so sure. Should I be concerned?

Dr. Parker, I am finding that Vyvanse has been much better than the other AMP meds I have tried in the past. It doesn't exacerbate my impulsiveness or cause such emotional disconnectedness. My question is I still experience low frustration and impatience, along with anxiety. My wife and I just listened to your blog on drug interactions, particularly Prozac and Paxil. I would like to know if you find that the Effexor XR, Lexapro etc, can help with anxiety and low frustration? I want to be able to address these other issues and my psychiatrist doesn't want to interrupt with my therapeautic window by increasing the Vyvanse as I am on 50mgs and she feels an increase would only lead to more problems, not solutions. I would greatly appreciate your thoughts. Sincerely, Matt Picardo

Happy First Official Day of Winter Dr. Parker, Dr Parker, Dec 11, 2010 was my first day on Vyvanase. I had taken too much that first day (10mg) You are probably right that I have a slow metabolism even though I thought I had a fast one since I walk and talk fast and can eat like a horse and remain fairly thin. I do have low blood pressure. Anyway, what I've been doing is I titrated one capsule of 20 mg in 8-9 oz of water - just a little over one cup. I take 3-4 Tablespoons in the morning, This equals about 1.5 to not quite 2 oz per day. I keep the medicine in a bottle in the refrigerator. I shake it up and pour 1 T. and then shake it again and pour another and so on because I notice that the medicine falls to the bottom of the water quickly. So far, I have no side effects other than increased irritability towards the end of 8 hours. The irritability seems to be declining. I'm going to stay on a low dose for a while until my body gets used to it. I feel a little more focused. In addition I think it's important to note that I have been experiencing increased stress in my life and I believe this can affect medication. So, I"m going slow and paying attention to how I feel all day. I am saving up my pennies and nickels to purchase your Rules of Medication Book and to have a phone consultation with you. Of ALL the Doctors and literature I've experienced, You are the ONLY ONE right on target with my ADD life experience. I am telling everyone, including Doctors about you and your website. I really believe the time is now for a Campaign on educating the public and health care providers on ADD. Can we start by changing the Acronym? AAD is much more accurate - Attention Abundance Disorder. Thanks again Dr. Parker for all you do. Your website has helped me start life anew!

Dr. Parker, I have been taking Vyvanse for rhe past two months and am happy to report that it is helping my ADHD w/o the horrific side effects that I experienced with Adderall and Ritalin. Issues of anxiety and low frustration continue to be problematic and my doctor has prescribed Buspar for the anxiety. My wife is still convinced that these issues are related to serotonin defeciences and has asked the doctor to look into an SSRI in combination with the Vyvanse. Though the doctor is open to this combination, she has stated that SSRI's like Prozac can exacerbate symptoms. I would like to hear your experience in dealing with ADHD and issues surrounding the need for SSRI's. Thanks again Matt Picardo

Dr Parker, Thank you for this website. I just started on Vyvanse yesterday. I titrated 20 mg and drank only about 1/2. I was flying high all day. I noticed at the exact 8 hour mark the vice on/in my head, my rapid heartbeat and my sweating (I usually never sweat) ceased. I am very sensitive to medication. I was paying attention to how I was feeling all day. When the medication kicked in, I noticed I could focus, there was less resistance to stop and pick up something on the floor - I felt I could actually stop and organize without the usual fear and resistance. Because my job does not require a lot of organizing and focus I probably did not need to take medication at work yesterday. I did not like the rapid heartbeat and head vice feeling which lasted almost the entire 8 hours. It felt like I had overdosed. Intuitively, I feel I should try about 3 mg in the morning and maybe 3 in the afternoon, I will see how I feel. Maybe I only need the 3mg in the morning for the entire day. Any thoughts? Again, thank you for your weath of info. I look forward to reading all the great info on your website over the next few days. Happy Holidays. Blessings to you and your family. Adele

Dr. Parker, My daughter who is 6 yrs old was diagnosed with ADHD this summer and the doctor put her on 20mg of Vyvanse to try out first. She did pretty well on it and it seems to work while at school, but she gets VERY emotional in the evenings and cries uncontrollably. We thought bumping her up to 40mg would help and that night it was the worst I've seen it. I have since removed her from Vyvanse and researched different meds but they all seem to have this after affect and my daughter already is a little emotional/sensitive. I am curious if us thinking she was under-dosed is incorrect and she is actually getting too much on the 20mg... do you think decreasing her to 1/2 a pill to get 10mg diluted in water might help the emotional wreck she becomes in the evening?

Hi, I am a 41 yr old woman in decent health. I have been on Pristiq 50mg for the past six months and was just prescribed Vyvanse 30mg for my ADD symtoms. Was wondering about coffee consumption while on Vyvanse, since I drink 2 big mugs of coffee per day. In addition, I drink one glass (about 6 oz) of red wine after dinner every night. Wanted to know about the possible side effects of taking these 2 medications together along with this amount of coffee & wine daily. Please let me know & thanks so much for your help!

I notice it's been a month or two since anyone has written on this specific blog, i hope I'm not bring up a post from the grave. but... I started vyvanse in march (i was on dexedrine from feb to march and because of a really bad memory issue we changed to vyvanse which I haven't had any issues with my memory on vyvanse). I take 30mg once a day. (i tried taking it in the morning but because I think I was still so sleepy it had no effect (cause i wouldn't notice any) but when i'm up for a few hours (11-1) I take it about 1:30 in the afternoon and it seems to kick in within 3 hours, then at the beginning it would last for a few hours.. take a break then start back up again for an hour.. now it just lasts for about 45mins to 2 hours. I am wondering what i should do.. I guess my main question is.. what is the normal affect of vyvanse.. am I suposed to feel like I do for those few times during the day? or is that a sign of something else where I should be taken off of it? I get to feeling concentrative and where I do chores but when it wears off I'm just like "blah.. *sits down and does something that doesn't take much focus*" Thanks

Hello, My 20-year old daughter was diagnosed with adhd a year ago. She has been on vyvanse for this past year - starting at 50 mg and then 70 mg for the past six months. The last two nights she had very frightening psychotic episodes -extreme paranoia. Both happened around the 11 hour DOE. In retrospect, she has been overanalyzing for the past few months. Her doctor just dropped her dose back to 50 mg. Any thoughts/suggestions?? Thank you.

HI MY CHILD HAS BEEN IN FOCALIN,CONCERTA AND NOW SHE IS ON VYVANCE 30MG. IN FOCALIN AND CONCERTA SHE HAS HAD EVERY MG THAT THERE IS AND MORE THAN TWO PILLS A DAY AND NO SIDE EFFECTS. SHE IS CURENTLY ON VYVANCE 30MG ONE A DAY .I JUST HAVE A QUESTION, HOW LONG DOES ONE PILL LAST BEFORE IT WEARS OUT?

Hi Dr! Great information here. I have been taking Vyvanse for awhile now and I love it. Much better than anything I have been taking. However, I am taking 20mg 3x per day, is that wrong? The reason I have the 3rd one is for when I work late into the evening. Can you tell me if this is actually causing more trouble? Also, have you heard of Prestiq and Vyvanse making you more depressed? I recently added Pristiq to my medication while lowering my Lexapro. I have been feeling really down for the past few days. It has been about 2 weeks since I started the Prestiq.

Hi Dr. Parker, I have bipolar disorder and ADHD. I take Lamictal and Lithium for the bipolar and I was recently put on Vyvanse a few weeks ago after going through a trial of meds. Meds in the Ritalin family made me very irritable and only lasted an hour if at all, adderall and dexedrine made my blood pressure really high so I couldnt handle it. The Vyvanse worked great at first and I'm up to 70mg, but recently I can't take it because it makes my blood pressure way too high. I'm 27 years old and athletic and it's really effecting my workouts. I had gone to the Dr. about an injury sustained in the gym and when they took my blood pressure at 6:30pm it was really, really high and I had taken the Vyvanse at 8am that day. I take 70mg and recently it's just become too much. I'm also on Intuniv but they're just samples and I went to pick up the prescription yesterday and found out it's not covered by my insurance so I have to switch to an alternative. Also, yesterday is the first day I didn't take vyvanse because of the bad side effects and I couldn't focus at work at all. I met with my psychiatrist yesterday and request that I be taken off amphetamines, but now I'm realizing I really need them to do my job. For people like me who are very sensitive to these drugs, do you think it's possible to find a low enough dose that will at least be somewhat effective without shooting up my blood pressure or can some people just not safely take these types of medications? I haven't had a really, really good workout in the last 2 months since all these ADHD med trials and it's really driving me crazy because exercise is part of my way of balancing my life and managing my bipolar. Any suggestions?

Dr Parker, I am a 39 year old female with mitral valve prolapse and am on 30 mg of Vyvanse as of a week ago. I have never been treated for my ADD and feel Vyvanse has changed my life. My concerns are the underlying MVP, and I felt like I was on a drug that was hard on my body....maybe just so many side effects. I Felt like if I had half of the effect that things would be great. Don't know if I am just too sensitive to the drug or if I didn't give it enough time. Do you think the Vyvanse would work if I cut in half? Could you also shed some insight into the mitral valve prolapse. I was told that it wasn't a cardiovascular disease, but I sure would rather be too safe than sorry. Thanks for any thoughts you may have. Robin

I am 42 years old and was recently diagnosed I was actually dx'd with hyperactivity when I was 4 years old), with ADHD and my Psychiatrist is wanting to try me on Vyvanse; however, he is wanting me to get cardiac clearance from my PCP because I have MVP. My PCP is not wanting to give me the clearance because he doesn't know anything about Vyvanse and so I basically cannot go on it because I can't get the clearance. What I am wanting to know is...is there need to be concerned? I am a nurse, but this is not my area of expertise, so I am just curious. Thank you

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.

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?).