ADD/ADHD Medications: Frequently Asked Questions on Vyvanse
A recent ADD/ADHD treatment question came up on another post comment, and I thought to share it with all of you.
So many are wondering how to get Vyvanse correctly titrated – and good news: Shire has the new doses out – just last week. [I have updated the pages at this Squidoo lens on Vyvanse for additional easy reference]
Doses now available 20, 30, 40, 50, 60, 70 mg - may have to wait at the pharmacist for a few days, but they can be ordered. No more messing around with all of the water titration strategies.
This recent question from a reader:
“My 14 yr old son has been on
Vyvanse 70 mg. of about 3 weeks. He was on Adderall xr for a couple of
years and it didn’t seem to be working as well as it used to, so the
dr. switched him to this vyvanse and he has been more irritable and his
sensory issues seem to be more pronounced. I upped the Vyvanse to 100
mg. for a couple of days and he seemed to do better. I called the
doctor and she said to stay at 70 mg. for a little longer, that there
are no studies that have been done over 70 mg., I called Shire and
asked about 100 mg., they also said no studies over 70mg.
Do you think it would effect him in a neg. way, by taking 100 mg.?
There was such a difference in him those couple of days that I had him
on 100 mg., but if it’s not safe, there’s no way. He’s 6 feet and
weighs 128 lbs.”
My Answer:
The description of “isn’t working” sounds like it may be the *bottom of the Therapeutic Window*
For the important answer to the question of *Duration of Effectiveness – DOE* needed to get the dose dialed in most precisely – see this post on DOE
As noted in several posts: weight, age, gender, level of hyperactivity… none of these characteristics will help with the dosage individuation necessary to get the right dose for the specific rate of metabolism with any person. No groups have specific characteristics – so his size and age are truly unimportant. Each person, each dose pattern must be customized.
Important details follow:
What is important:
1. Even though no “studies have been reported” we have experienced in
our office, and heard many reports from colleagues that 100 mg Vyvanse
is not “too high” a dose – if it is titrated correctly, as indicated in
these previous posts. I have several folks on 140 mg, all are adults,
but they are the exception rather than the rule, and only arrived at
that dosage after much care with titration.
2. Your doctor is the final common pathway… I can only report what
is working, and add this common-sense point: 100mg Vyvanse = about 40mg
Adderall XR – 40 mg of XR is well within the standard of practice.
3. Vyvanse tends to work consistently better than Adderall, but
there are some exceptions wherein individuals [for reasons I have not
yet heard reported or understood myself] actually need a bit more
Vyvanse than the expected dose based upon the previous rate of
metabolism with Adderall.
4. Always remember the theme here at CorePsychBlog: ADD is almost
always more than *just ADD.*
Metabolic differences occur for many different medical, nutritional and biological reasons – so if your
medical team is having a problem always look for other factors rather
than simply chalking up problems to the medication itself.
5. With other concurrent *metabolic problems*
the therapeutic window narrows, and until the associated conditions, from gluten sensitivity,
to brain injury, to heavy metal intoxication, will create a situation
wherein “nothing seems to work right.” The only solution: complete
analysis of comorbid conditions.
These new dosage sizes significantly improve the necessary titration strategy, and will make it even easier to “start low and go slow.”
The low and slow idea is timeless in application, specific in time measurement. 
cp
Related articles
- Shire goes after binge-eating disorder with ADHD stimulant, Vyvanse (bipolarsoupkitchen-stephany.blogspot.com)
- Vyvanse Side Effects (mademan.com)
- ADHD Medication Rules Winners (corepsychblog.com)
Digitally available now at Nook, Kindle, Barnes and Noble.
ADHD Medication Rules – PDF For Your Desktop
ADHD Medication Rules | Paying Attention To The Meds For Paying Attention – Kindle Version
Anon, I always look at the DHEA in association with adrenal function, as testosterone lives downstream from DHEA, and DHEA is frequently altered by immunity and issues. Another inquiry: consider a good review of heavy metals and trace elements. We can get this done with a colleague here even long distance - a specialist in heavy metals and minerals including zinc balance. These specifics can contribute to hormone imbalance as well. For much more invest in this excellent book on the Testosterone Syndrome - more than simple testosterone supplementation: http://bit.ly/testsoln cp
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