Vyvanse Dosage for ADHD: Finding the Safe Top of the Window

Cheryl, Wellbutrin can block the pathway for Dex, only moderate, but if the person is s slow burner that moderate blockage of 2D6 could spell the difference. With the other symptoms is sounds much like you have an associated metabolic imbalance that would require further investigation in careful interview and history. cp

Not a problem from anything in my experience or reading. cp

I have a problem with the comment under point number 1- "or you very likely will loose [justifiably so] their medical support". From what Daisy shared, she doesn't HAVE medical support! Her doctor sounds like he thinks treating ADHD is optional. Would he treat other medical conditions the same way? The fact that she FEARS he may withdraw helping her with any meds tells me this doc is way over his head and shouldn't be dabbling in this treatment. He is NOT justified in withdrawing his "support". He should be asking himself why she feels it is necessary to take her treatment into her own hands in the first place- and then refer her to someone who is more exprienced in this area.

Colin, I think, it's late now, I answered this on another posting... bottom line, hang tough, get to the pharmacy the tide is turning! cp

Star, Right on the same track... the therapeutic window is alive and well in every med check with every practitioner in our offices. Look for 12 hr DOE no matter the dose, and watch the details at the end of the day cognitively to see when your dose burns out. cp

AN UPDATE & A FEW QUESTIONS (5 to be precise; although some include sub-questions. I counted them after writing this!) 1st question: is there a need to wean off of any of the stimulant meds before switching to a new one? Obviously I know that with the new, you start low and slow again. Does how slow depend on the stimulant? Other questions are interspersed below... (After writing all this, I just counted them -- there are 4 more questions, basically one per section). Update: Per drs orders, I am now taking adderall w/o the vyvanse to be able to see more clearly its effects. Although initially I was opposed to this, I can definitely say that it is easier to see the differences! I had thought that the vyvanse plus 20 IR wasn't making much of a difference (at least the morning dose), so when I took the 30 mg IR by itself I was expecting that it would be about right. Nope! It was way too much. I had not been tired before, and shortly after I was completely tired and unable to do anything at all! It was awful. I then slept and worked on not dwelling on my negative thoughts for the next 6 hours. After that, I felt normal for me again. Then I took 10 mg because I did not want to repeat! It also occurred to me that day that the adderall plus the vyvanse previously had likely been too much. Even though I didn't think I'd noticed any changes, upon reflecting, I had been irritable all week. External events, that normally, although probably distracting would not be aggravating, were. Onset for adderall has been about 25-30 minutes. It's been 20 mg and I've felt good, but also able to concentrate, be less restless, and not have so many thoughts swirling in my mind. DOE has pretty much been exactly 4 hrs as far as I can tell, which I believe is within typical range? (I know you cite 6, but every where else I see 4 - why is that?) Another question: that first night after taking the 10 mg (which did not have much benefit) leading into about the 5th hour, I was pretty tired. By the 6th hour I was fine. Why is that? Similarly on another day, the 20 mg second dose of the day, I felt tired for that first hour or so (which again is the 5th hour of the first dose and the onset of the second one). I'm confident that the aspect of up/down is part of these shorter acting stimulants, but what I don't understand is why I feel tired when it's coming off and then fine afterwards, even if I don't take any more medicine (like in the evening). Then again, this regimen is pretty new. On a side note, we would not be sticking with the IR as a general rule...it's what I have currently filled and is serving as a sort of test before deciding to switch to XR I guess. Isn't there one other amphetemine formulation besides Adderall and Vyvanse? I can't recall off the top of my head. Suppose I wind up taking 20 mg adderall IR 3 times a day (or 4 at the most depending on when I started it) and it works well....what would be the normal switch if going to adderall XR? Because 20 mg adderall 3x is 60 and 4 is 80, but I didn't think XR came in those doses. Is that how it works or no? I do have your book on adhd meds, thank goodness - that's how I knew that the first 30 of adderall was too much and subsequently figured out the other problem too. But it doesn't answer these questions, most of which seem to me to be pretty straightforward! So my 5 questions (extracted from the paragraphs) are: 1) Is there a need to wean off of any of the stimulant meds before switching to a new one? Does how slow when starting a new one depend on the stimulant? 2) Typical DOE range for Adderall IR is 4-5 hrs? I know you cite 6, but every where else I see 4 - why is that? 3) Why was I tired roughly the 5th hour into the dose when I had not been previously? The 6th hour I was good. 4) Isn't there one other amphetemine formulation besides Adderall and Vyvanse? 5) What's the switch from Adderall IR to Adderall XR if someone is taking 20 mg IR 3 or 4 times daily? Every now and then I want to completely give all this med stuff up because it's frustrating and takes a while, but right when I'm about to do that, I see a glimpse of how things can be and so I just try again. Thanks for your assistance asap. This website and the information is invaluable!

Dr. Parker, I'm a 28 yr old female who'd thought about an evaluation for ADHD etc. for several years but never had actually followed through on it until a few months ago - mostly because I've always managed and been successful. But some relatives and others close to me told me to go to a psychiatrist. It took them 3-4 weeks of convincing me I should go before I even considered making an appointment. I did not go with the idea of being evaluated specifically for adhd though, said as little as I could about it, and answered the questions on as low of a scale as possible yet still being honest. I'm somewhat knowledgeable in the area and had debated this many times. I own a copy of your e-book on adhd medication and have read it several times; I've also read/watched almost all of the information posted on your site. I have some questions regarding the top of the window and effectiveness in general. I started with 30 mg Vyvanse, noticed a difference with project avoidance but not other differences. It took about an hour to an hour and a half to set in, from what I could tell. Increased dose weekly by 10 mg; all with no other changes. No side effects either during this time. I went to 70 mg and was physically and mentally less impulsive/hyperactive (most notably when I was really making an effort to do only one thing that was quiet & not involving the computer - thus able to focus better) with still less project avoidance. That lasted for at least 3-4 days, maybe as much as a full week and then went away. Time of onset stayed the same - roughly an hour to an hour and a half. DOE from time of taking it was 10 hours, sometimes 11. Objectives I was looking for to change but still did not notice even with the 70 were: remembering what/how to say things, remembering where I put things, being able to stop doing something when I need to and have already reminded myself several times, being able to listen in conversations more easily, being less confused with overload of information or choosing what to do first (even when I already have a list broken into steps). If any of these are not specific enough objectives or reasonable to expect changes with medication, please tell me. There are other issues too, but I don't know how to state them clearly. I'm wondering about the top of the window because I had read in one of your comments to someone else that the long onset could indicate that they were on too much. Is that only true if onset changes as you increase? I'm also wondering again about the top of the window (or basically just getting it right) because now what I am taking is: 70 mg vyvanse and 20 mg adderall ir together in the morning, and another 20 mg adderall in the afternoon. This is very new to me; I didn't notice any drop off with the adderall and I'm not sure about the onset. I'm supposed to take it in the afternoon, but haven't yet because I'd gotten sick and was trying to rest up that afternoon. The next day I was trying to sleep all day and drink water so I didn't take either...but normally, I would stick to what the dr says. I have yet to be on this regimen (70 mg vyvanse + 20 mg adderall 2x) for any length of time, but should I expect to see those other changes with my objectives? Should I just do exactly this regimen for a week or so to see and then maybe change? I was thinking to do 10 mg adderall 2x instead of 20 at first, or 20 mg in am with vyvanse and only 10 in afternoon...I just don't want to be on too much. With taking the adderall, would I maybe need less of the vyvanse? I keep thinking of all these possibilities and I' m not sure what I should actually do. I'm making careful notes about when I take these medicines, other medicines I'm taking (i.e. antibiotic for being sick), breakfast, and notice of symptoms as best I can. I was glad to not have to switch from vyvanse all together, because it was helping in at least one regard and I had no negative side effects. I just want to be sure about not doing too much and basically knowing when I've found what's right. Two other quick questions -- how long for onset with adderall ir typically? And, can I use that typical time or should I add to it since I was longer with vyvanse? I know DOE for adderall ranges from 4-6 hours. As far as the necessity of a protein breakfast: I do make sure I get it and I've been taking the medicine right along with it or shortly after I've started eating, but I was wondering how much protein is enough? Some of the things I've done include: 1-2 C. reg. oatmeal with 1/4 to 1/2 C peanut butter mixed in and a little honey (I'll usually eat half and save the rest for the next day), a cereal w/ @ least 2-3 g protein per serving plus either spoonful of peanut butter or handful of nuts both with milk, one day I didn't have anything so I just ate a half piece of chicken breast. I'm thinking about maybe waking up earlier than I need to, having an easy protein thing - like a shake, taking the adderall, and going back to bed for a bit. Then when I actually get up, get ready, eat something (either w/ or w/o much protein), and take the vyvanse on my way to work or right before I leave. The mornings have always been so hard for me (at least since adolescence)- even when I get enough sleep I rarely feel rested. When I do feel rested, it can still be hard! I have always been one of those people who really needs sleep (childhood and on) and a lot of it. If I'm healthy (no cold/other illness), exercising, and eating...9 hours is what I aim for, although 8 is just fine. 7 or less I can manage for a few days at a time, but then I really struggle with everything a lot more. Anything less than 6, I'm miserable later in the day or I get sick. Anyways, I got sidetracked. If you can let me know about the objectives, the vyvanse and adderall, and how much protein is enough I would really appreciate it. Thanks so much!!

Dr. Parker, Have you had patients become diabetic after using vyvanse? Do Adhd medications increase blood glucose levels? I am confused...do I stop vyvanse? My Dr. called and scheduled a glucose tolerance test due to labs indicating high numbers. Never had this problem until after using vyvanse. Any thought are appreciated. Thanks, ry

Dr. Parker, My 15 yr old son has been on Vyvanse for a few months at his request due to the longer duration. He seems to be less moody and his grades have improved but some days are just better than others. On the "good" days he's more motivated, gets things done more effectively and is just plain happier. On the "off" days he still gets work done but he doesn't take much initiative and he doesn't have the joy that he does on the "good" days. He is pleased with Vyvanse as compared with the Adderall. He does try to eat a protein breakfast but he skipped breakfast this morning yet it was still a "good" day. Thanks for your insights. Susan

Why don’t MDs combine stimulant types? I have tried Concerta, Ritalin IR, and Vyvanse. Each type (methyl. v. amph) affected me very differently! Both positively, both helped with major ADD symptoms, but completely different ones: methyl. with internal processing and obsessiveness; Vyvanse with doing tasks, maintaining focus, and getting my brain ‘up to speed’ for quick activities like driving. Neither on its own really ‘cuts it.’ I don’t think it’s a dose-level issue, as my doc is willing to go notably above FDA regs, with careful consideration and monitoring. My MD believes my ADD underlies other comorbid concerns, but won’t consider combining stimulants. I trust her, but I don’t really understand why! Why don’t MDs combine the two? (I wish they would! ) Thank you, B-Philadelphia

I think Dr. Parker is one of the most rational doctors I've known save my own, and one would be well to heed his advice. I too have gone through the gambit of ADD medications, save Desoxyn, which though is on occasion the right medication for an individuals brain is far too disorienting for most. The barrel shaped pill Daisy was Concerta, the most ineffective, if least risky towards abuse by far, of the stimulant medications (in my experience.) I spent five years on Adderall XR, from 30 up to 90mg over that time period, and for me, it was the perfect (if one can call any medication with the side effects stimulants can cause perfect) fit for my brain chemistry. My doctor was always willing to listen to me, and never afraid of throwing the PDR out the window if reality spoke louder than paper, so increasing my dosage within reason was fine by him. Then I turned 25, lost my father's insurance, and could no longer afford Adderall XR, and instead switched over to Vyvanse which offers a 12 month free 30 pill fill PAP card. I started off at 60mg with Vyvanse, and I am 100% with you on how it changed my life. I was normal for about 1 week (after three days of feeling little to nothing), and had never felt such peace. It faded as quickly as it came though. Being a prodrug, it functions a bit more like an anti-depressant than the typical stimulant medication - it has to build up a bit in your system, and then should ideally stay at a constant level at all times. Like those happy pills, which make the clouds part for a while, eventually the normality resumes and one finds themselves no longer finding the treatment obvious. I went up to 70mg for a week. Nil once more. Because Vyvanse is so new, the ceiling dose of 70mg preempted the logic of making a single capsule of greater strength (I have no doubt this will change over time, as most of the doctors I know of take it to 100mg before settling into worry over protocol). I, however, was now in a position of having to get one RX for free, and pay for one as well anyway, as I required more than 30 pills monthly. I went to 100mg, then 120, albeit with greater periods in between... finally I was on 140mg, and, again, 2 70mgs a day was the most I could take unless I wanted to pay 350+ out of pocket for the one medication (and I am on a number of them). Always fascinated by psycho pharmacology, I did a lot of reading and thinking, and came up with a solution: I asked to be put on 70mg of Vyvanse once each morning, and another 60mg of immediate release generic Adderall to be taken 20mg at a time from noon until 60pm as I needed it. The Adderall was $22 for 90 20s, the Vyvanse free, and while the latter kept me at a steady level of normal at all times, the former gave me the remaining relief and yet without the peaks and valleys typical of 4 hour dosages - much reduced by the constant 70mg "steady" underneath. I will no doubt need up to 75-90mg of Adderall eventually, but any good doctor who has no reason to fear abuse (because dependence with amphetamine is inevitable, but completely different in nature from addiction) should know the brain is different for all, and the stimulant is always fast on the growth of tolerance, and the combo means having to do what is best for the patient, putting out of mind the decrees set by the FDA (which most likely makes such decisions never having been on or been close to someone on any of the medications they decide about for you.) Most key in what the good doctor said Daisy (I won't approach CYP 450, though it is relatively new to me and voraciously fascinating in most all ways, effecting (pardon my hazy stab here) 60-70% of what goes through your pathways to the perhaps 10-15% the next most influencing CYPs (shrug) will.) Read his lips and mine, do not press the desire for an addictive medication without documentation and a fair understanding of the science behind why it needs to be pressed. Doctors other than the rare Dr. Parker and my own, come in about 3 flavors: Overly flippant, overly cautious, and addiction "specialist." Your doctor, may simply be too cautious, but that he removed you from medication completely (malpractice in my opinion), I fear he may be #3. These are the doctors who will deny severe panic prone patients Klonopin, and when the seizure hits get an injunction to hold you for 72 hours figuring heroin was the cause of the grand-mal. Get a new doctor. Sadist or not, if you do not feel you are being respected in your concerns, he/she is the wrong one to be going to anyway. You have to build trust for both your sake as well as the Psychiatrist, because if he feels he can trust you, he won't fear you're trying to get high when you need a 3 day fill of .5 Xanax because your friend died, but trust you need the respite, while you will get that respite without having to seek alternate means. Last thing: It's been shown many a time that an addictive medication given under the care of a doctor greatly lowers the chance a patient will self medicate and truly ruin their lives. Get help if you feel you need it, because if you know there is something wrong, there is something wrong - no MD can make it go away because of incompetence. Best of luck Daisy, and Dr. Parker, thank you for helping instead of hurting. You are one of the true good doctors, I feel your heart in it.