Using Water Titration Strategies to Effectively Dose Vyvanse: Less than 30mg.
Vyvanse titrations
Some have asked offline about clarification of the *water titration* recipe with Vyvanse,
and this post is a brief clarification on that process:
- Please don’t misunderstand, these directions are not for everyone, less than 5% of individuals – adults [off label at this writing] rarely need to use this option.
- These suggestions apply for those who have a history of unusual sensitivity to medications, especially those young children who the treatment team feels will not tolerate new meds well.
- Refer back to this previous Tips Post introducing Vyvanse to you and this immediately preceding post describing more recent Vyvanse clinical experience
- Vyvanse/Shire will very likely be coming out in this next quarter with half sizes [20mg, 40mg, 60mg] so we won’t have to use these off-label suggestions – offered in the spirit of pharmaceutical precision, not in the package insert.
- If you do like the possibility of Vyvanse for it’s range of effectiveness and efficacy as well as the promise of better compliance with our ADD folk who seem to often forget meds, then consider this option for those special individuals with a very narrow therapeutic window, or an unusually high degree of medication sensitivity, even to small doses of stimulant meds -
- Take the Vyvanse capsule at the lowest dose, 30mg, break it 1/2 and pour the powdered contents into 2 oz of water in a measuring cup. Throw away the gelatin capsule.
- Stir, and don’t worry about the small amount of material at the bottom.
- Give 1 oz in the AM, then put the other into the frig, warn others not to drink it, and -
- Give the other 1 oz the next AM. Saving it is *not recommended by the company,* but is reported to work effectively with a few patients who have used this strategy. Safety is an issue: I do suggest you throw the other half away if you can’t keep it from accidental use by others.
- I was in Roanoke VA last week for a day of presentations to the local docs, and one of the docs [pediatrician] said that she thinks of Vyvanse 30mg as equivalent to 15mg of Adderall XR. That observation does help clarify for some the anticipated superior efficacy of Vyvanse.
- For very sensitive kids I take this one step further, and pour the capsule powder into 4 oz of water, then spread the dosage of the next four days, giving essentially 7.5mg/day – most often those do go up at least to 1/2 cap.
- No, you don’t have to use water, OJ or apple juice will do. Stomach acidity is not an issue with Vyvanse, based upon the prodrug release.
- No, there is no Vyvanse taste problem with touchy, taste sensitive folk, though I’m sure an exception exists out there.
- And in spite of the Vyvanse prodrug action I always give all psych meds with a protein breakfast, and I make that pitch on almost every med check if we don’t have protein breakfast compliance. Protein is an essential precursor for neurotransmitters.
And if these details aren’t sufficient: do click over [for ADD videos and other commentary] to another site I built at Squidoo, – Squidoo is an excellent platform for pulling together more ADD information.
Hope this helps,- please drop a comment so that we can discuss the details if you have a question or remark.
—>Tweet this post below! For ADHD Medications: Download complimentary white paper Precise Solutions now, – and get ready for the complete version of ‘The Patient’s Guide’ details to follow. Get Neurotransmitter Details Here
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Greetings,
I was prescribed Vyvanse to offset the weight gain from Lexapro.
I’m a naturally nervous person by nature and have great fear that the medication may be too activating.
I have 20mg capsules. Would it be appropriate to dilute this and start at perhaps 2.5mg and titrate according to side effects every three days? I am not keen on taking any type of medications and do consider myself sensitive to medications. Thanks so much in advance for any words of wisdom.
34yr male 5′11/240lbs
Hey Jon,
I simply don’t use Vyvanse or any of the AMP products as a weight loss tool – not indicated and wouldn’t work predictably over time, as most get over the appetite suppression at the outset.
Now if you told me you had a significant low grade ADHD that became aggravated with SSRIs, [as we so often see, and have repeatedly written about here] then I would tell you to watch those signs of increased impulsivity secondary to the SSRI, including eating without thinking.
Your dosing strategy will work with the plan outlined on this post – if you are really concerned go on down to 1/4 of the 20 mg with the water titration described herein – yes and 2.5 mg can be done as well, just seems like a bit too careful from my experience, unless you have an extended transit time and associated metabolic problems.
cp
Med Titration:
If you simply Search Vyvanse on this series of posts you will find all the info you need, then if not go over to http://www.squidoo.com/vyvnase
It is the best product out there, you simply have to know how to use it precisely, sign up for my new book for the details of why meds are so challenging.
It isn’t for everyone, but the numbers that can’t take it are less than 5% if taken correctly.
cp
I’ve tried several different approaches to handle my ADHD in the past and keep running across different styles or methods of how to handle it. I went the medication route as well as the psychologist route and found both to be mildly effective. I’m very curious about the effects of Vyvanse now and whether or not the product is similar to adderall in nature or if its from a different part of the amphetamine family.
Leighann,
Glad it worked for you-
If interested you may want to review the several full articles I have posted on med titration over here:
http://ezinearticles.com/?expert_bio=Dr_Charles_Parker
Bottom of the page,
Have a great Holiday,
cp
Thanks doc, all good. talked with my doc and he upped my dose of vyvanse to 120 mgs, tons better, thanks for the confident chat I needed to nip this in the arse.
peace, leighanne
Leighann,
With the dramatic changes everyday in everyone’s life, a single day at school or work can become a turning point. Naturally I don’t know the treatment options, but would encourage you to call around, ask for some help during your docs vacation – but do go back and give him a run at this new understanding.
Finding your own dose is a two edged sword, yes it is correct, but medical folk prefer to manage controlled substances more closely and he could reasonably have a problem with the changes you have made. All that should be explored with him.
The last chapter in my new book addresses the many problems with medical team communication – and offers some resolutions for challenges like this.
I hope you do get the team play ironed out for the Holidays,
cp
Dear Dr cp,
I would like to thank you for such a quick and thorough response. I had no idea I would get answers so fast. I planned on making an appointment with my dr. for tommorrow yet when I called I was notified he would be on vacation for another week or so. Since I feel as if work would be almost immposible without any meds, yes I ran out as of today from dosing one and a half, I’m wondering if going to an urgent care center would be an option? I realize you only answer questions pertaining to certain topics so I’m certain my question is a bit nuts, but since I feel half way there I thought I would give it a try.
Once again I thank you,
Leighann Foley
Leighann,
From speaking with 100s of colleagues and watching the internet I can report that I have often heard much larger numbers than yours, – and while the package insert suggests top of 70, it’s only because no formal research has been presented regarding safety etc – I am very careful over 100 mg, see below.
If you do the AMP math and round off your Vyvanse to 100 = 2×50 = 40mg Adderall/day [according to the dosage equivalency of the Harvard study] you are well within standard of practice for safe AMP dosage of 1.5mg/kg tops for Adderall toxicity.
Now, some will argue, quite reasonably, that all AMP are not specifically the same. No argument, but clinically they do appear to carry the same relevant dosage for the most part in the office as seen in the study.
My recourse in the office: stay with very precise DOE, watch for adverse events, good breakfast, no more than 14 hr DOE, watch the top of the window, and then do the following:
At higher doses [anything over 100mg] work hard at following up carefully with a complete metabolic review: hormones, liver function, etc as encouraged elsewhere in these posts. Consider comorbid conditions in detail.
Your doc is the final path, – I suggest trying to work with him on the math above 1kg = 2.2lbs, therefore 145lbs= top dose of Adderall 98.863mg, far above the dosage 105 mg of Vyvanse.
Again, I am clearly not recommending a top bar here, just doing the math, and do have very few [1-4] of my entire practice 120 mg or over. Identifying comorbid conditions will almost always lower the top dose requirement – evidence makes the difference.
cp
Hello,
I’m very curious as to what is the highest recommended dose of Vyvanse is for a 35 yr old female at 145 lbs? Currently I am supposed to take 70 mg/daily yet in reality it’s more like 105 mg daily. I bumped up my dose obviously without my doctors knowledge, stupid I know, yet at the lower dose I am worthless. Unmotivated, unable to focus on one particular thing, mind racing, etc…..I am not certain how to explain my dose to my doc due to him being a bit conservative and fairly new to me as a patient. I do not want any lies or questions coming bewteen my doctor and myself It’s just I’m uncertain as to how to ask for an increase or if an increase is even an option? Please help if your able,
SIncerly, Leighann Foley
Mike,
Interesting comment and thanks for the interesting site… I just haven’t seen any problems with Vyvanse on the pH side of matters, but do look forward to spending more time over at that site you sent.
I appreciate that you are thinking on this level and especially appreciate your sharing with our team over here.
Thanks
cp
along with vitamin C, it’s important to remember that foods can affect how ADD medication works depending on their PH.
http://adultadd.info/QuestionsAnswers.htm#Can_food_affect_how_well_amphetamines_work_
This is a good site on which foods are which. Orange juice is interesting because it’s acid in your stomach but alkalinizing after your body metabolizes it, so it could reduce the effect of Adderall and increase the effects of Vyvanse.
My son is currently on 5mg of Focalin XR once daily. It is not lasting the full school day and he has been switched to Vyvanse. He was prescribed 20mg of Vyvanse and his doctor said to give him one fourth of the dose – equal to 5 mg of Vyvanse. It seems to me that 5mg of Focalin XR is not the same as 5MG of Vyvanse. Is there a conversion chart? my son is 8 years old, 53.5 inches and 78 pounds. I am thinking that he will be okay with the 20mg dose and that I should not give him one fourth. Any advice?
Stephen,
Interesting comment on the Vit C… I just haven’t seen it with the Vyvanse as I did with the Adderall – but with your comment will watch even more carefully. We use a significant amount of buffered [not straight ascorbic acid] Vit C [specifically calibrated to each person] – in the AM with chronic metabolic issues such as with fibromyalgia, and those will be the folks I will ask again.
Thanks for your comment,
cp
You can also take Vitamin c with your dose, most people experience a reduced effectiveness of Vyvanse when they take Vitamin C
Royal,
No prob, no damage done… have seen many have problems, much more significant than this, with multiple drug interactions and clear “out the top of the window” toxicity – [not so subtle as your issues] and they turn around with no problem, once the underlying issues are directly addressed.
cp
Thanks for the advice; it’s a great service to all of us. I plan on basically using the titration method to ensure I get a consistent 15mg/day, at least until 20mg doses come out and I can try that. Reading back on your “therapeutic window” posts, it strikes a bell with me, because there are some days where I will have problems sleeping, and then one day I will just crash for 10 hours or so to make up the sleep. Hopefully with a halved dosage I can get rid of some of these side effects; I just hope no long-term damage has been done by me taking too much.
Crown Royal:Temperature
Sorry I answered your temperature machinations under the Jay inquiry…
Your plan sounds quite workable – unusual, and not typical, but not a medical problem – except with the sleep issue [if occurring], and the inconsistency issue if you use it too irregularly.
Vyvanse [and all psychostims] should be used conservatively, so the dosage patterns preclude significant side effects, and the delivery system, the prodrug action and the consistency with metabolic pathways, has sufficient time to stabilize in each individual.
Using it irregularly will almost always lead to significant dissatisfaction with drug performance… it isn’t designed to be used that way – and everybody from the street docs to the guys at Harvard completely agree on that point.
Tnx
cp
Jay::Temperature
No, temperature isn’t a variable here, as you will note in my previous comment to the other Jay. Just watch, if you do that, for PM problems.
Sounds like you are on a bit *too much* as well with the 24 hr problems… If it is keeping you awake you are either taking it too late, or the dose is incorrectly adjusted.
Please see the CorePsychBlog and Vyvanse/Squidoo URL’s listed above for more info.
cp
Jay::Neuroscience -
First things first: Please do read my extensive post on the *therapeutic window* here:
http://www.corepsychblog.com/2008/01/tips-on-medicat.html
-in this list of comments regarding the “top of the window” [or Google "window" on CorePsychBlog] and read that post carefully.
My first guess without evaluating you, but reasoning based upon the clinical evidence reported re excessive concentration for both stimulants, – I think you are out the *top of the window,* with likely *too much* on both meds, whatever your actual mg dose, and can see why you intuitively are trying to cut it down.
If you/your doc push the dose for too much intensity [most often requested by the patient] so that the drug pushes you harder, more aggressively, you overdose ever so slightly – with consequence that, just as before, once again, you can’t concentrate.
In point of fact, when “out the top” you will often have periods of massive concentration, [over concentration], mixed with brain fog and too much inefficiency with your time – the switch will go off and on about every 2-3 hrs. This up and down phenomenon is almost always associated with too much and is often called Bipolar Disorder.
The concept of “IMMEDIATELY” is not mine. Just sitting in the refrigerator does not activate any proteolytic enzyme system, so dexedrine is not slowly released through that mechanism.
You can keep it in your car, I have some people that do it that way, against my own directions, and swear that works for them… but they have to completely cut off that process early in the day as the half life will keep you/them up at night.
And regarding your observable “18-24 experience” that point alone firms up that you are on too much: best target range for DOE is 12-14 hr, and if you burn past that time you are, quite simply out the top of the expected range, and on too much. See this post here on DOE [Duration of Effectiveness]:
http://www.corepsychblog.com/2007/11/addadhd-treatme.html
And this on the same subject:
http://www.corepsychblog.com/2007/11/vyvanse-for-add.html
and further summarized at:
http://www.squidoo.com/vyvanse
Then go back to your doc, ask for less – perhaps the between doses will help you get it more correctly adjusted – when Shire releases them in the July time frame – expected to have the 20, 40, and 60 mg “tweener” doses out at that time.
Good luck with your degree in neuroscience you are right on track with much of your thinking – it’s just that with these stimulant meds even more enhanced precision will often turn the course of the battle.
cp
By the way i just noticed someone else named jay posted right before me; different Jay though; i hope you can see my email address since I assume your an admin of the site. Just in case though, its johnjciii@yahoo.com
I appreciate it.
Sorry, my last post got mixed up, I meant for the last paragraph on my post to be read first, not at the end, sorry/thanks again.
Hello Doctor, I really appreciate the free advice you give here. I got a question and you seem much more knowledgeable about AMPs than my current psychiatrist does.
I recently tried vyvanse rather than Adderall 20mg.
The adderal lets me get work done but I overall don’t enjoy the feeling and can concentrate on nothing ut work or writing or reading the whole day. Oppositely, Adderall makes me less able to focus in class and puts me into a very introspective state. (completely focused on myown inner thoughts but can pay no attention to class/tv/socialization.
I have truly full blown, maximum introspective ADD without physical hyperactivity; but much mental hyperactivity.
The vyvanse however, shocked me by it’s ability to let me maintain external focus on classes/everyday routines.
However I still don’t particularly enjoy taking it everyday, I take it maybe 3 days a week which leaves me kind of lazy/unmotivated when I don’t take it.
Anyways, I feel that dexedrin would be the perfect solution for my particular type of ADD. I’ve never tried dexedrine but I know that it’s just vyvanse with a chemically time released mechanism.
The perfect thing for me would be to take one low dexedrine dose in the morning before class and then not have to feel the AMP feeling for 18-24 hours as it often seems to be for vyvanse.
Sorry, about the length of this. My doctor refuses to give me dexedrine due to it’s ‘abuse potential.’ However I konw that me, as with most true ADD/ADHD people; is that AMPS simply arent recreational for an ADD mind (except when I use it to actually study neuroscience due to my intense interest of the brain.
So, since dexedrine is apparently not an option for me I was wondering something about titration:
It says to drink the titrated vyvanse IMMEDIATELY after liquifying it. My reasoning would lead me to believe that this is for the reason that once the vyvanse becomes aqueous, the lysine groups begin to break off by the friction in the liquid in the same way that it does in your blood.
Therefore it seems possible that I could pour maybe a 4th of a 50 mg capsule into a drink and let it sit for a day or so to allow the lysine to become detached; essentially providing me with non-time released dextroamphetamine (dexedrine). Therefore, I could drink a 4th of a capsule each morning and not have to be on Vyvanse for the next 18 hours.
Does this seem like a potential method to get just a short small dose of Dextro without dealing with the XR mechanism of it?
I’m wondering if my understanding of the lysince group detaches due to liquid friction, or is it some other blood/polar/non-polar reactoin that causes the lysine to detach and leaving me with just a few hour Vyvanse experience rather than a 18-24 hour experience of which is usually completely unnecessary and unsettling for me. All I need them for is class, and then i might take a full 50mg capsule when I really have to do some hardcore Neuropharmacology studying. I struggled like never before in that class due to my incompatibility with regular adderrall, or the XR’s, or vyvanse.
This is kind of an in depth question so I understand if your not sure of how the whole prodrug chemical time releasal works. My psychiatrist knew nothing when I asked her and I had to explain to her the difference between regular XR’s like adderall and the new mexhanism of Vyvanse.
Thanks I’d really appreciate any advice; and I noticed you reccomend people to store liquified vyvanse in the refrigerator so I wanted to bring up this topic just in case you were unaware of this seeming potential to turn vyvanse into dexedrine; which is what some of you patients may be unknowingly doing.
Anyways thanks and sorry about the length but I’ve been trying to fiVure this out all semester but I wanted to hear from a real neurologist like yourself first.
Thanks again for any help/advice you can give, I greatly appreciate your open kindness in giving free advice to all of us.
If you would rather repond to me with an email that would be completely fine too; as it’s probably best to keep certain information offline due to those who may seek abuse.
Again,Thanks ALOT.
I’m 21, soon to be graduating with a Major in Neuroscience. From my unerstanding the lysine group which is attached to the Dextroamphetamine will not allow the Vyvanse to pass the blood brain barrier until enough slow steady jostling of chemical blood reactions casues the lysine groups to break off thus giving a consistent administration of actual Dextroamphetamine to be
Hello, great blog you have here. Quick question: does temperature matter when using titration? I’m currently on 30mg Vyvanse, and feel the euphoric rush pretty strongly about 4 hours after taking the pill, and I often feel that odd, hard to describe feeling that indicates the medication is working up to 24 hours after the dose. My ADD symptoms are fairly strong without any medication, but I seem to do better with much lower doses of Vyvanse (incidentally I used to need 30mg of adderall XR, but even on 30mg I didn’t feel this amplified of an effect).
I plan on putting the mix in my water bottle, which has markings at the 4 oz and 8 oz mark so I know I’m getting a steady dose, and tossing it in the fridge. Is that advisable, or should I leave it out on the counter? My gut tells me it shouldn’t matter, but I just thought I’d ask to be safe.
Thanks.
C Dickinson,
Sorry I missed your post, it didn’t come up on my blog radar, so I just found it – Your neurologist is right in terms of the literature, but what you have found is what I have experienced in the office.
The symptoms at first don’t make any sense because the dose is as small as it comes, and the specific study is with kids 6-12, with 30mg as the smallest dose – but these symptoms clearly are a manifestation of too much.
Thus this post on water titration: #6 above would be one way to retry the med, but if he were my patient, I would recommend the #11 most conservative route. Further I would stay with 1/4 for awhile, 10-14 days to evaluate duration and any further side effects at this very low dose.
Your guy may have a problem with specific sensitivity to amphetamines discussed at #2 from the bottom in this post:
http://www.corepsychblog.com/2008/01/tips-on-medicat.html
If so, an AMP may not be for him – see the hyperlink on pharmacogenomics at this last post, explaining the whole situation.
Hope this works for him!
cp
I had a colleague who tried out Vyvanse and he said it works well on his ADHD problem. Unfortunately, I won’t be able to verify what his takes are on Vyvanse now because he has since migrated to Australia.
My son has recently been diagnosed with ADD. The physician rescribed him Vyvanse 30mg. About four hours after the first dose, he started talking excessively, licking his lips and scratching his hands and arms. These seem to be very significant side effects and I have not repeated the dose. (His first dose was just yesterday)
In your opinion do you think this is a bad choice of medication for him or is the med perhaps OK and I just need to titrate it? He is 7 years old and weighs about 55lbs. The 30 mg seems like a large dose for him but the physician (a neurologist)assured me it was an appropriate dose.
ADHD Guy,
Obviously I don’t know you, but it sounds like your Vyvanse dose is simply too low. Check with your doc. I do not have an adult or adolescent that has to divide the dose of the 30mg, so am guessing that the dose is too low.
All the water titration material here is for those who are significantly sensitive to meds period. The way to tell if it is too much: side effects will often, tho not always give you the clue. Look for 12-14hr DOE, then it will be closer to correct dosage.
I am always [categorical term!] careful with categorical views such as “universally.” Nothing in medicine is universal. My only purpose with these notes here: to highlight my office observation that in most cases Vyvanse does seem more effective, if adjusted correctly.
Best thought: talk to you doc, and discuss duration of effectiveness with him/her.
Thanks
Chuck
I appreciate your thoughts on Vyvanse. I’ve been taking adderall xr for the past 11 months. My doctor gave me some vyvanse to try out as an alternative. I still haven’t decided which I like better. There are pros and cons of each.
Dr. Parker, are you saying that universally vyvance is better than adderall? Do you find that people get better results with it?
Vyvanse does seem to be “smoother” but does not do as much for my motivation as adderall does. I also seem to be in a better mood with adderall than with vyvanse.
I’ve been splitting the 30mg vyvanse in half, but getting the exact half dosage each day has not been that accurate I don’t think. That could be why there’s inconsistency with my results. I’ve just recently started to try the water method instead of just pouring half of it out. Maybe that will lead to better results.