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Daytrana

ADHD: Vyvanse and Duration – DOE Simplified

by Dr Charles Parker on June 9, 2009 · 6 comments

DOE = Duration of Effectiveness An Essential Tool
This brief video requires your immediate attention: The ADHD medication mess can be significantly corrected by regularly paying attention to the specifics of each individual DOE, – is it too much, or too little? Basic!

Do we really have to pay attention to treating paying attention? Oh yeah…

DOE is the acronym that absolutely should be on every medication progress note with every stimulant medication, period. Why am I so dogmatic? Take a look at this video and see what you think about the value of this kind of precise thinking.

DOE would cut out all this flap about what’s wrong about psych meds and much of the noise about side effects.  It’s a simple matter of respecting, paying attention to the basic science of:

  1. The medication delivery process [how it is made by the company to be released in the body] will set the hours of DOE for each product if the dosage is adjusted for best DOE effect [less is too little, more is too much]
  • Immediate Release [IR], [Ritalin IR-4Hr, Dexedrine IR-5Hr, Adderall IR-6Hr]
  • Extended Release [Adderall-XR -10/12hr, Ritalin LA -8Hr, Concerta 8-10Hr, , Metadate CD -8Hr],
  • Daytrana Patch 10-12 Hr, or
  • [in a separate DOE league]: Vyvanse – the benefit: 12-14 Hr, by peer-reviewed findings and in my office.

2. The metabolic individuality of that specific person will set the individuality of that metabolic process-

  • Determined by genetics [CYP 450], CYP 2D6 has multiple genetic variations see this CorePsych post – 4 most measurable
  • liver function and adhd-medications-ssri-amphetamine-interactions-cause-serious-problems/”>drug interactions – see this previous CorePsych post,
  • inflammation
  • nutrition
  • bowel function [fast or slow transit],
  • metabolic disorders,
  • immune dysregulation

Each one of these variables can effect DOE, and the more challenged the liver, the more metabolic problems, the narrower the window, the greater the difficulty finding the right dose. I will send out a specific video on the Narrow Therapeutic Window soon – stay tuned. [You can subscribe to my YouTube Channel [to stay informed via email.]

Or sign up for the blog email updates here if not already hooked up.

Drop a comment to let me know if this DOE video note is useful for you and yours.

Think DOE!

cp

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—>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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ADHD Meds are Predictable: Use The Therapeutic Window For Best Results
Tune in to CorePsych Radio Thursday 4PM EDT and download the Program Outline here.

If you simply pay attention to these basic details the possibility of the biggest two problems with ADHD medications are almost naturally corrected – no more frustration, no more fear of adverse effects. This program is a summary of several articles already published at EzineArticles on the Therapeutic Window

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I Overview: Sides, Top, Bottom: The big picture.

7 Tips To Recognize The Window at the Outset

1. The Sides: The Entire Problem with Stimulant Meds can be summarized in two ways- Too Much, or Not Enough – the Therapeutic Window is the correct dosage, not too much, not too little, lasting exactly the right duration through the day. Stimulant meds don’t last all day, thus the problem with timing. Everybody is built different metabolically, thus the problems with dosage.
2. The Therapeutic Window is specific for each individual adult or child
3. Stay away from the Top of the Window:
4. Watch for the Bottom of the Therapeutic Window: 5. Watch for the Sides to find the DOE, Duration of Effectiveness: Each stimulant medication lasts only a specific duration. If you are under that expected duration and the sides do not cover it properly as noted in the “Sides” article, you are underdosed. If you go past that expected DOE, you are on too much.
6. Drug Interactions do occur and may cause unpredictable diminishing. – More here on 2D6, an important metabolic pathway.
7. Denial of the Importance of The Window: If you don’t think about it, if you don’t know it’s there, you simply cannot target it. If you don’t target the ‘Window’ you are either shooting geese at night, or simply throwing cans of paint at the barn door.

________________________________________________________________

II The Insufficient Bottom:
Often ADD/ADHD medications aren’t targeted, or dialed carefully in, for the Entire Day, but rather set for an inadequate objective to just “get through work or school.” This problem has been with us since much before the 1960s – is Paleolithic – and simply does not address the ‘bewitching hours’ of 4-8 PM.

7 Tips to Find and Correct Insufficient Dosage

1. Look for that longer objective: It may sound simple, but with the new drugs we can significantly change our PM objectives. The new drugs such as Vyvanse and Daytrana will last 13-14 hrs easily, but just take some time to ask the questions carefully and then adjust the dosage.
2. DOE, ‘Duration of Effectiveness,’ evaluation must come up at every medication check. If your doctor doesn’t ask about it, you must think about it anyway to encourage the discussion.
3. Know The Characteristic Subsets of the PM Drop: – Each medication reviewed in detail for DOE and characteristic drop in PM.
4. How Vyvanse covers 12-14 hr: Increase it carefully with 10 mg increase in the AM will add about 2-4 hrs on the PM bewitching hours.
5. How Daytrana can cover 12- 14 hr: I like both of these medications because compliance goes up with less afternoon dosing, and there is no need to remember that PM dose.
6. Other Meds: Adderall XR, Concerta, Focalin XR, Metadate CR Durations:
7. Teach the children at the outset: It is harder for them to know what to look for setting these PM treatment objectives. Spending just a little time at the front end will help them feel like part of the team.
_______________________________________________________________________

III The Toxic Top

Simply stated: The Top is too much, the Bottom is too little.

7 Tips to Find and Correct The Toxic Top

1. The Reasonable Objective – No side effects
2. Recognize Too Much
3. Toxicity Timing: All Day Problems – Toxicity may appear as absolute: All day buzzing.
4. Toxicity Timing: On and Off Problems -Toxicity may appear as cyclical, mercurial — off and on — with hyperfocus and subsequent inability to focus.
5. “Drugged” Is Too Much: Simply feels like you are toxic; it’s just too much. You shouldn’t feel stoned or drugged.
6. More Symptoms at the Top: Confusion, disorientation, cognitive stress, anxiety, are all increased, while self-expression diminishes.
7. Different Stimulant, Different Tops: Stimulants Adjusted Incorrectly: If you feel these kind of symptoms for the first couple of days after starting a new med, usually no problem. ____________________________________________________________________

III The Understandable Sides

The 7 Tips For The Sides of The Therapeutic Window

1. The Sides of the Window Are Based Upon Time: The Expected DOE – Duration of Effectiveness
2. Know the Medication DOE Expectations from the Outset:
3. Measure Precisely the Time DOE At Every Meeting: Easy questions: “When did you take it and when does it stop working?”
4. The First Side Objective – AM Onset: All meds should be working in 30-45 min after taking the medication.
5. Regulating the AM Onset: Protein Breakfast is Essential
6. The Second Side Objective – The PM Release - When They Stop Working:
7. The Mystery Objective: The PM Release with Vyvanse

See ya there!
cp

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—>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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CorePsych Radio Update

February 22, 2009 Beyond ADHD

CorePsych Radio: How to Connect Each Week: As a side activity I have been also putting together a 1 hr live radio program, and the details are on this page: CorePsych Radio.

1 comment Read the full article here →

ADD, ADHD Stimulant Medication Dosage: The ‘Bottom Bewitching Hours’

November 17, 2008 Beyond ADHD

New ADD/ADHD stimulant meds can cover the entire day, school and work alone are no longer the only objectives. Family life, the evening, and overall cognitive management throughout the day, have become important treatment objectives with the new medication alternatives.

6 comments Read the full article here →

ADD, ADHD Medications: Time is of the Essence

November 10, 2008 Beyond ADHD

If we don’t dose medications correctly based upon there expected pharmacology, we simply are not paying attention to the details. Time is of the essence, and must be measure, just as would measure a fix if sailing off the New England Coast.

4 comments Read the full article here →

ADD/ADHD Treatments: Tips for Vyvanse

August 29, 2007 Beyond ADHD

You already know our regular CorePsych theme with ADD/ADHD and emerging brain science: the more we know the more we can have a positive impact. Vyvanse is a surprisingly forgiving stimulant medication.

135 comments Read the full article here →

ADD 2: The Media, the Meds and the Madness

January 27, 2007 Beyond ADHD

ADD 2: New podcast up on how to make the meds work better for ADD.
Over at CorePsychPodcast
Seems like so many of the basics are so often overlooked.

Why a stimulant in the first place? They do work best if used correctly, listen to the how.
What do they actually do in layman’s terms? See what you think.
Are [...]

0 comments Read the full article here →