Comments on: ADD/ADHD Treatments: Tips for Vyvanse http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/ Dr. Charles Parker Reports on Core Brain and Body Evidence: Psychiatry and the Mind Evolve Thu, 11 Mar 2010 12:41:02 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: Dr Charles Parker http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-6888 Dr Charles Parker Thu, 11 Mar 2010 12:32:32 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-6888 Kim, If you have no cardiac problems, none previously identified, you are clear according to the standard of care. No one recommends that every adult have cardiac screening. If you have high BP, do watch your numbers, but even then it is not contraindicated, and I have seen BP problems improve with carefully adjusted doses of Vyvanse. cp Kim,
If you have no cardiac problems, none previously identified, you are clear according to the standard of care. No one recommends that every adult have cardiac screening. If you have high BP, do watch your numbers, but even then it is not contraindicated, and I have seen BP problems improve with carefully adjusted doses of Vyvanse.
cp

]]> By: KIm P http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-6594 KIm P Wed, 10 Mar 2010 03:36:25 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-6594 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 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

]]> By: Dr Charles Parker http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-5785 Dr Charles Parker Fri, 05 Mar 2010 11:43:51 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-5785 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, <a href="http://www.youtube.com/watch?v=fu0mN68rkEs">do take a look at this video </a>and see if it rings any bells, especially the last few mins. cp 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

]]> By: Philip http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-5704 Philip Thu, 04 Mar 2010 00:29:44 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-5704 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 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.

]]> By: Dr Charles Parker http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-4910 Dr Charles Parker Sat, 27 Feb 2010 18:04:07 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-4910 Kim, None to my knowledge, - interesting question! cp Kim,
None to my knowledge, – interesting question!
cp

]]> By: Kim http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-4744 Kim Fri, 26 Feb 2010 20:55:04 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-4744 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?). 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?).

]]> By: Dr Charles Parker http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-4092 Dr Charles Parker Sat, 13 Feb 2010 11:26:35 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-4092 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 <a href="http://www.corepsychblog.com/2010/02/intuniv-for-adhd-metabolic-challeges/">Intuniv and Metabolism</a> 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 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

]]> By: Allison http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-4088 Allison Fri, 12 Feb 2010 22:03:42 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-4088 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. 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.

]]> By: Dr Charles Parker http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-3013 Dr Charles Parker Fri, 04 Dec 2009 01:43:39 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-3013 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 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

]]> By: Rafael http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-3012 Rafael Thu, 03 Dec 2009 23:32:36 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-3012 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... 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…

]]>