- To Change Your Mind - Details Matter
Vyvanse Dosage Strategies For ADHD Medication Accuracy
Casein & Milk Immunity Details Change Minds
December 10, 2013Intuniv For ADHD – Details Updated
December 19, 2013Use Water Titration Strategies to Effectively Correct Vyvanse Dosage
Vyvanse Dosage Matters
CorePsych Signature Posting: Happy Holidays to all! This Vyvanse Dosage post is the most viewed post here at CorePsych over the 7 years I've written these updates. Interestingly, it bears a repeat view, as the information here still works everyday, globally. Our collective theme for ADHD meds: use meds wisely, pay attention to those meds for attention problems.
This post from 2007 spells out Vyvanse dosage details that work, and have recently been approved by the FDA. At CorePsych we use water titration [dosage adjustment] in every patient who has never tried AMP [amphetamine] stimulants. The result: better compliance, patient appreciation, improved medication dialogue, better outcomes, less mystery. Starting slowly makes a big difference for the duration of treatment.
2015 Note: Now the lowest dose, which I've have encouraged in resources like this post from '07, is Vyvanse 10 mg. Use the same principles in this post to further reduce dosage as indicated. Quite honestly, our team rarely sees the need to go below the 5 mg. If problems at 5 mg it's likely a metabolic, CYP 2D6, issue.
How To Take Vyvanse Dosage Down Below 20 mg
For example: less than 20 mg – dosing down to 5 mg/dose:
The bottom line with any stimulant dosage, is precision and accuracy. More specifics are spelled out carefully in my book New ADHD Medication Rules – Brain Science & Common Sense – also now available at this same link in Audio, as well.
Many have asked offline about clarification of my *water titration* recipe with Vyvanse, and this post is a brief clarification on that process – and, by the way, it's easy. Vyvanse water titration works to increase medication predictability.
Why Small Vyvanse Dosage
- Please don't misunderstand, these directions are not for everyone, less than 5% of individuals – adults [off label at this writing -'07] rarely need to use this option. See previous posts here on The Therapeutic Window.
- You know you absolutely have to use this strategy if you previously have experienced problems with stimulant medication reactions.
- 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 – Asperger's, those with food sensitivities, picky eaters, adults with brain injury.
- Refer back to this previous Tips Post introducing Vyvanse that describes more recent Vyvanse clinical experience
- Vyvanse – Shire did recently introduce new sizes [10mg, 20 mg, 40 mg, 60 mg] so perhaps we won't have to use these – offered in the spirit of pharmaceutical precision. When this post was first published in '07 the available doses were 30, 50 and 70 mg.
- 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 ADHD 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.
How To Use Water To Decrease The Vyvanse Dosage
- Take the Vyvanse capsule at the lowest dose, 20 mg, 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, put the other into the refrigerator – warn others not to drink it
- Corrected below by FDA approval '14: Give the other 1 oz the next AM. Saving it was, in '07, *not recommended by Shire,* but works effectively with many 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.
- Dosage equivalence from Adderall to Vyvanse is approximately: Adderall 10 mg = Vyvanse 30 mg, Adderall 20 mg = Vyvanse 50 mg, Adderall 30 mg = Vyvanse 70 mg. I always start lower than expected with a change to Vyvanse, as for about 10-15% that anticipated dose of Vyvanse proves too much. I don't want folks on my watch to experience 10% problems.
How To Take The Vyvanse Dosage Even Smaller
- For very sensitive kids I take this one step further, and pour the 20 mg capsule [powder] into 4 oz of water, then spread the dosage over the next four days, giving essentially 5 mg/day. Titrate slowly as in this Start Slow ADHD Meds video.
- 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 ADHD videos and other commentary] to another site I built at Squidoo, – Squidoo is an excellent platform for pulling together more ADHD information.
Don't Forget: My 8 part easy to watch ADHD Medication Tutorial is available at this link – or up here on the CorePsych Navigation Bar ↑ 😉 Check it out!
ADHD Meds Playlists To Easily Forward
Take a look at all these ADHD Medication Videos – and use the short URLs to forward specific playlists:
ADHD Meds Tutorial – Overview: http://bit.ly/medstutorial
ADHD Meds Dosage: http://bit.ly/dosevids
ADHD Meds Problems – Mind and Gut: http://bit.ly/mindgut
ADHD Meds & Allergies – Milk and Wheat: http://bit.ly/mawimmun
ADHD Meds & Allergies – Street Immunity: http://bit.ly/IorWJs
_____________________
Addendum – August 2013: The FDA Agrees – General Instructions at Drugs.com, or here under General Instructions at Med Library and note, now 2015, the new dosage of Vyvanse 10 mg described above.
_____________________
Intuniv Addendum: For Additional Notes Dosing Titration – 2013: Intuniv Dosage Notes
_____________________
Hope this helps,- please drop a comment so that we can discuss the details if you have a question or remark. Theses useful New Rules will save you hours of confusion!
cp
Dr Charles Parker
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88 Comments
Question: I just did a “mouth to the south” test and found out my transit time seems to be 14 hours (maybe shorter…but at most 14 hours)….So how do I dose Vyvanse/Adderall XR to be more successful? Quick over view of my Vyvanse journey:
Started with 60mg of Vyvanse at 5:00am and another dosage of 30mg at starting at 12:00pm, but eventually settling at 2:00pm. So with that setup and after the initial honey moon phase wore off, I found that the first half of the day was inconsistent (I felt these mini ups and downs during that period of time…maddening…almost worse than the meds not working at all)…but the Vyvanse seem to worked perfectly after the second dosage at 2:00pm. Steady Fredy. As time progressed, it became clearer and clearer that the second dosage seem to work the way it was supposed to but the first dosage was not (and was inconsistent…little ups and downs)… So in an attempt to get the first dosage to work like the second dose (smooth, stable, and consistent), my doctor and I slowly increased the 5:00am Vyvanse dose while leaving the 2:00pm dose the same. We went to 70mg, 80mg, 90mg, and even to 100mg. But even though I felt the increase each time, it still wasn’t consistent and was not like the second dosage. I tried all kinds of other things as well to smooth it out but nothing really worked. So then we tried to 70mg of Vyvanse and 20mg of Adderall XR at 5:00am to see if the the Adderall XR would cover the ups and downs of the first Vyvanse dose. It did to a degree but not like the after the second dose of 30mg of Vyvanse at 2:00pm. I tweaked it a little by taking the Vyvanse at 70mg at 5:00am and then taking 20mg of Adderall XR at 5:30am, and that helped a little, but still, it feels inconsistent. One day I tried to add 100mg of NoDoz around 7:00am, and this made the first dose consistent and only took some away from the second dose (but not much). But I don’t want to rely on caffeine because the meds are not working the way they are supposed to work. To me, that’s like putting a band aid on the real problem.
Also, I am on 50mg of Paxil CR. I know you have told me that this could be blocking the effectiveness of the Vyvanse but I wanted to point out that the second dose of Vyvanse I take always works the same every day. It is consistent. So doesn’t that point to something other than the Paxil causing the inconsistency of the first dose?
[On a side: Of course the Pharmacist freaked out on me and gave me ANOTHER talk about how I was on an extremely large dose of stimulants (which makes me feel great about myself). After thinking it through, however, being on 70mg of Vvanse and 20mg of Adderall XR (around 5:00am) is like me being on 25mg of short acting Adderall for the amount of time the longer meds work (since 70mg of Vyvanse is roughly equivalent to 30mg of Adderall XR which is roughly equivalent to taking two 15mg of instant release Adderall and the 20mg of Adderall XR is like taking two 10mg of instant release Adderall, which comes up to about 25mg of instant release Adderall. They make 30mg pills of instant release Adderall, so why do they have a problem with me being on 25mg of Adderall IR for the length of time the longer meds work. If 25mg of Adderall IR is safe, why wouldn’t it be safe for longer than 3.5 to 4 hours?]
But I am still trying to figure out how to get the first part of my day to be smooth like the second part of my day but I am running out of ideas. I can’t keep on having the first part of each day be like it is, because with the ups and downs come up and down emotions, including depression, and a lot of wrestling with painful thoughts. Overall, I just don’t feel that well most of the first parts of my days so something has got to give.
I am pretty sure that the second dose works so much better because it is sitting on top of the first dose and therefore covers any gaps.
So my current ideas are:
1. Increase the first dose of Adderall XR from 20mg to 30mg at 5:30am and either decrease the 5:00am dose of Vyvanse from 70mg to 60mg or leave that the same.
2. Kind of a crazy idea: Take 30mg of Vyvanse at 9:00pm (if I can sleep) and see if that makes the 70mg of Vyvanse I take at 5:00am work like the 30mg of Vyvanse at 2:00pm. In that scenario, I wouldn’t take any Adderall XR since the 30mg of Vyvanse I took at 9:00pm would theoretically accomplish what that 20mg of Adderall XR is currently trying to accomplish – to stabilize my first part of the day medicine-wise).
3. Take 100mg of Nodoz every day at 7:00am in addition to my current regime.
4. Switch medications.
So now that I have learned that my transit time is 14 hours at the most, I am trying to figure out were to go from here. Thanks for listening.
Chad,
Very interesting and, BTW, characteristic problem we see at least x1/week at CorePsych.
1. My humble opinion on this brief amount of info: you are on too much. The consistency in the pm I can’t fully explain, but in my experience the PM dose appears to have dissipated the toxicity of the left over blood levels from the previous day.
2. Adding more on again in the AM: take you out the top of the Therapeutic Window: Video here – http://corepsych.com/tw and in this case the top looks like the bottom because you are clinically cycling into lack of focus from toxicity not paucity.
3. The additional culprit without doubt is Paxil: see this vid – http://corepsych.com/2d6-video That one IMHO is a serious must change w your doc. Note the references in the description there for their review.
4. Strong recommendations:
Change Paxil to Effexor for 2D6 issues,
Plan on 4-6 days to clear from toxicity, not 1 or 2
Lower your dose after clear and retitrate from the beginning. Video playlist: http://corepsych.com/dose
My take on this question: You’re smart, fixable, and on too much.
My rec: start over.
cp
Thanks for the reply but I have a few questions and additional information about your opinion:
1, If I am on too much Vyvanse, why did I feel even more inconsistent when I was at lower levels of Vyvanse (like at 60mg and no Adderall)? Are you saying that you even think 60mg of Vyvanse was too much? From there, we went up very, very slowly and the inconsistency actually improved but not to the extent of the second dose. I am currently back down to 70mg of Vyvanse with 20mg of Adderall XR which has gotten me as consistent as I have been able to get with the first part of the day so far, but it hasn’t been quite as consistent as the second dose.
2. Breaking News: I have also been taking allergy shots (immunotherapy) and no one told me that this could make you feel the effects of the allergens. I was also not told that I could take allergy medicine with the shots to help deal with some of the symptoms from the allergens without it lessening the effects of immunotherapy. So yesterday and today I took some Zyrtek. Yesterday seemed like one of the most consistent first part of the days I have had. Today, so far, the same, but its only 10:35am. So one possibility is that I could have been mistaking the effects of the allergens as the Vyvanse/Adderall XR not working consistently. I am not sure if that is the case yet nor am I sure why the second dose seemed to rise above these possible allergen reactions. But again, today, so far, so good. (Now its 11:21pm and I have very focused all day so far)…
3. What is a scientific way to determine whether inconsistency is from toxicity versus paucity? For example, is it possible that my metabolism eats through the dexedrine before the amino acid produces it in it’s usable a form? (I am not sure how metabolism plays a role in how long it takes the amino acid to produce usable dexedrine). You didn’t say anything about my 14 hour mouth to the south transit time. Looking back to when I just took Adderall XR (for many, many, years), it worked great but would only last 5.5 hours or so. That is why I was on 120mg of it. It wasn’t because I kept needing to push up any individual dose to get it to work well, it was just that each dosage would only last 5.5 hours so in order to keep me at an even level, I had to take 3 dosages of 40mg Adderall XR (which is like 20mg of Adderall IR throughout the day). I was actually quite excited yesterday (after following your instructions about finding out transit times from the mouth to the south) that I learned that mine was at most 14 hours (maybe even less if I would have gone earlier). I saw dinner in the morning if you know what I mean (which in the video you said would show 8 hours but I think you did the math wrong). This explained to me why the Adderall XR only lasted 5.5 hours for me. It also seemed to point to something about the first dosage of Vyvanse not working as well as the second dose (but you don’t seem to think so?). But to me, that explained why I needed a lot of Adderall XR. Since it was consistent for many, many, years (it never become inconsistent) while I was on the same amount of Paxil CR that I am on now, it just doesn’t make logical sense to me that the Paxil CR is the main culprit in my current situation. If the Adderall XR was way inconsistent like the Vyvanse has been, I would see how the Paxil could likely be the culprit but since the Adderall XR worked great (just shorter than it was supposed to) and I was on it for years, and years, and years, it doesn’t make logical sense to conclude with much probability that the Paxil is currently the problem with the Vyvanse. If I attempt to switch from Paxil to Effexor, I need way more evidence than we have thus far. I have been on Paxil CR for 20 years and it great assists me with my OCD and when I have made even the tinitest changes to Paxil, I went through emotional hell (something I am not ready to go through right now unless I know for sure what I am accomplishing.)
4. Why did the little bit of caffeine seem to make it more smooth?
5. What about switching to something like Focalin XR? Would it be wiser to switch to that class of drugs rather than swith Paxil (which has worked for me for 20 years)?
Chad,
The bottom line on all of these questions is that you do need a better workup. I don’t have the time to directly answer each one of these except to say that underlying metabolic challenges always make meds unpredictable. Coffee and MPH come up thru a different path than 2D6 – you could have a 2D6 polymorphism as outlined under genetics on the second page here: http://corepsych.com/tests.
Immunity issues always create unpredictable outcomes, and if you’re taking Benadryl it significantly interferes w AMP metabolism thru 2D6 – just SEARCH here at CorePsych for a past article on that interaction.
Hope this helps,
cp
See the image to see the results of my genetic tests as it pertains to the 2D6: https://drive.google.com/file/d/0B9uOSjM8jRSQTUVzbnBiMzdhVEk/view?usp=sharing
Chad,
Reassuring news: yes, your 2D6 & COMT are not a problem, and if you use an alpha 2 agonist [Intuniv, Tenex, Clonidine] you are also quite clean with no anticipated challenges genetically from those paths.
This information encourages that next set of previous recommendations: see what’s up with other likely metabolic impediments by testing.
cp
That’s encouraging. Here is something else I just discovered: My mouth to south transit time seems to be 11.5 hours or less. I ate something at 7:00pm and saw it at 6:23am! This could really explain a lot?
Chad,
It clearly is a bit fast on Mayo Clinic terms. Quite fast on the 18-24 Hour TT [ http://corepsych.com/ttt ] subset who have a longer target for fast. This finding isn’t in itself diagnostic, but does encourage more careful review.
cp
Thanks. The link takes me to a 404 error? http://corepsych.com/ttt%5D
Chad,
I missed the space after ttt – before the ] – if you don’t space you get that weird other thing: This is the link: http://corepsych.com/ttt
No spacer needed now…
cp
It is around 1:48 and I had another very smooth day. So does your opinion change about me being on too much if I keep having smooth days like the last couple of days?
Chad,
Smooth days come and go with interactions. I’m rigid about the Paxil and that 2D6 interaction, have created that problem for patients hundreds of times before I recognized the interaction in ’96.
cp
Hello!
I’m sorry if this was covered in another comment- I’ve literally been researching this for the past few hours on many, many different websites and forums and have yet to find an answer. Here’s my situation/question-
I’m 32 years old- (female/5’7″/135lbs/ in good shape- if that matters). I was diagnosed with ADD way back in 5th or 6th grade when I was not doing too well in school. At the time, it was suggested to my parents that I start taking meds but my parents wanted nothing to do with that. They tried the “natural” methods such as coffee or tea in the mornings. Those methods didn’t have much effect, so I just did the best I could and made it through. I took a few college classes after high school and it just wasn’t working out. In classroom situation, I tend to “zone out” and my mind is everywhere but focusing on the subject (thinking about everything else going on). I then joined the military instead of continuing with college.
Fast forward to present time- I’m at the point in my life where I’d like to go back to school and continue my education. About a year ago I started a new position at work (a “desk” job- I was an aircraft mechanic before) and I’ve been involved in a lot of training with this new position. I’ve always thought my lack of attention and getting sidetracked/distracted so easily was just how I was (for example- when I’m sitting in a training class, even though I’m interested in the subject, my mind is thinking about other things like what I need to get at the store on the way home, whats going on for the weekend…etc.) However, after talking to a few co-workers that have been on medication for ADD, they said being on medication was a life changer. I’m the kind of person that tries to avoid medication if I don’t feel its really necessary. I’ll take Tylenol/Advil occasionally, but that’s about it. So after many hours of research, I made an appointment and was prescribed Vyvanse 20mg. After not noticing much of a difference, I’ve was bumped to 40mg, and now 60mg (a month + at a time). The thing is, I’m still not really getting the effect I was expecting. I researched Vyvanse A LOT before I tried it and I’m not getting the “this changed my life” feeling from it. In fact, I’ve actually felt more lazy while I’ve been on it. I’ve honestly spent my whole Sunday on my computer looking up why this isn’t working for me. I feel like I have no motivation to do anything. I should have spent the day cleaning up around the house, being outside (it was a really nice day today) or at least doing something productive! but I haven’t left my couch! They say Adderall is like a Rx “speed”. Maybe I should try that? although, my doc said he tries to stay away from that, the reason he prescribed Vyvanse. The only difference I’ve noticed while being on Vyvanse (20,40, and 60mg) was dry mouth and lack of appetite- which is actually a plus because I’ve been eating more healthy and not snacking on junk like I used to.
Being that this is the first medication I’ve ever tried for ADD, I’m not sure where to go from here. Ive tried the other suggested methods to cope with ADD without meds such as taking notes, keeping a planner, using reminder on my phone…and i use post-its like crazy… I’m going to start taking classes soon to finish my degree, and I’m at the point that if it takes a medication to absorb and retain information better, I’m willing to try it. I’ve read so much about Adderall being the “study drug”, though I’m not into “drugs” whatsoever… if it honestly helps me in my everyday life to be more focused and productive- that’s what I need! I give in! I should also add that in my current job position, have to be careful about my medications due to my security clearance. I’ve made sure my Rx was ok, and reported before I started.
Any information or suggestions would greatly be appreciated!
Brooke,
Security is always OK unless you require a specific license to operate specific vehicles: planes, long haul trucks etc. I live in a military town and we see Top Secret clearance folks, not a prob.
Re your dose: I does sound like you have a metabolic problem in spite of your good shape. Several more comprehensive vids that can break this down more effectively are here:
Dosage Measurement Video Playlist: http://corepsych.com/dose
Mind and Gut Playlist: http://bit.ly/mindgut
How to Assess Your PM Drop: http://corepsych.com/drop
And to check out your Transit Time more effectively use this inexpensive Transit Time Tool: http://corepsych.com/ttt
Hope this helps!
cp
Hello again Dr. Parker,
Reading through some of the new comments here, I have a few more questions concerning Vyvanse.
My doctor recently, and very surprisingly, agreed to up my dosage to 80 mg. But he still thinks that is an unusually high dosage and will definitely not go any higher. And every single pharmacist at my pharmacy freaked out the first time they filled the prescription and questioned it and told me how that is a very high dose.
So I guess my question is, if dosages of 100 mg or more are ” not that usual”, why is everyone is freaking out? And also, would you recommend a higher dose? Is is really healthy to take that much, or would I be better off trying a different approach? (I understand you can’t really give a specific response not knowing me or my history. I just mean in general, do you think high doses of Vyvanse are safe.)
I still can’t really tell if the Vyvanse is working or not, which is making me think maybe it just isn’t right for me. And the cost is outweighing the benefit at this point. So I mentioned the possibility of switching to Ritalin to my doctor, since I had some success with it in the past and it’s dirt cheap in comparison to Vyvanse. He flat out refused and said that Ritalin is all generic now and… I forget, but basically he was saying it doesn’t work. He said the only alternative to Vyvanse would be Biphentin.
So, would Biphentin be a good alternative if I decide to switch? Or is there something better? I personally thought that Adderal would be the logical choice, but I have avoided even mentioning Adderal up until now out of fear of having him come to the conclusion that I am just looking for drugs and cut me off altogether. (I have no history of drug abuse, but I have sensed that he is thinking along those lines regardless.) I suggested Ritalin thinking that, since he is very “old school”, he would be more comfortable with that. In fact, just a few months ago, he suggested Ritalin himself.
I’m starting to wonder if he has Alzheimer’s….
Kaylee,
The bias against AMP amphetamines is pervasive, and as your comments reveal, often significantly misinformed. 80 mg of Vyvanse is roughly equivalent to 35mg of Adderall every day and while they “freak out” about 80 of Vyvanse they have no problem with Adderall 30 mg two times a day, roughly equivalent to 140 mg Vyvanse. Go figure. Medicine is guided now by the misinformed NYT and public opinion, not specific medical facts.
Hysteria rules over critical thinking.
I don’t get into the debate about specific meds as they absolutely vary according to each persons biochemistry: Biphentin, quite simply, is methylphenidate [MPH, Concetta, Ritalin] – not an AMP.
cp
LOL- You got that right. One of my biggest pet peeves and a great source of anxiety- people who just refuse to learn or listen to reason and would rather go by what they read on Facebook, or in the NYT.
I just found out that Biphentin is Methylphenidate. I guess I never looked it up before, or I did and I forgot. I’m not doing well right now and I’m confused about a lot of things and just have too many things going through my mind. So I appreciate you taking the time to answer questions because it makes my life a lot easier, to not have to take the time to look it up and do the research myself. Thank you.
I realize now that you can’t comment on how effective one medication will be compared to another. Silly of me to ask. Just shows how fried my brain is.
Thank you.
No problem, always happy to pitch in, especially with those clearly looking for improved answers,
cp
i am still having trouble figuring out if I should increase my first dose to 90 at 5:00am because I clearly feel better after taking the second dose of 30 at 2:00pm than I do with the entire time of the first dose. My Psychiatrist is fine with it but I am having trouble figuring out how I should feel.How do I determine which of the two doses feel the way it is supposed to feel?
Chad – Best to reconsider your target of feeling, and stay with a target of watchful cognition… metacognition. Feelings too often seduce one into the ‘upness direction – energy correction’ when the real functional targets, from my experience, embrace ‘getting things done and thinking things through in an organized way – more purely cognition.’ Feeling too often becomes a solution for comorbid adrenal/metabolic issues that must be addressed from a different perspective as they, more frequently than not, arise from somatic concerns that look ‘mental.’
cp
Kaylee, I can completely relate to what you are going through. I am currently on 80mg of Vyvanse that I take at 5:00am and then I take another 30mg of Vyvanse at 3:00pm. The second dose works better than the first but the first dose is working…just not as well the second dose. I can totally relate too to pharmacies freaking out, I have dealt with that for 15 or so years now because I also required high doses of Adderall. Here is some advice that will change your life: Go to a pyschiatrist who specializes in ADHD. I don’t know if your current doctor is a psychiatrist specializing in ADD but it doesn’t sound like it. General doctors are simply ill equipped to prescribe the correct dosages of stimulants for ADHD (in my opinion). A psychiatrist who is trained in ADHD will be able to get you on the right dose of the right medicine.
Hope this helps!
Chad
On it Chad – experience spells the difference.
cp
And be sure to get a psychiatrist who specializes in ADULT ADHD as well (instead of just children).
Hey again Dr. Parker. I am still working with Dr Winer to get the right dosage of Vyvanse. I had been on a high dosage of Adderall for years and years. It worked fine for short periods of time but my body would burn through the dosages faster than normal so I had to take three dosages (3 dosages of 40mg Adderall XR about 6.5 hours spread apart to cover the day…and caffeine to help where the Adderall left off). So a good while ago, we switched to Vyvanse. He started me on 60 mg Vyvanse in the morning and then for the first week I would take an additional 20mg of Adderall XR at about 5pm (I took the first Vyvanse and 5:00am). Surprisingly that 20mg of Adderall XR I took 12 hours after the 60mg of Vyvanse worked better than the 40mg of Adderall XR I used to take by itself. Dr Winer suggested I only take the 20mg of Adderall XR because he knew there would still be some Vyvanse working after the 12-14 hours. He was right! So to keep me on only one medicine (and to avoid some of the side effects that Adderall XR has that Vyvanse doesn’t have) we extended the DOE by adding a second dosage of 30mg later on in the day. I had to adjust the time I took the second dosage. At first, Dr. Winder had me take the second dosage at 10:00pm, 5 hours after my first dosage, but I felt it was too much so he and I kept pushing it back to get it where it felt right (and lasted the entire evening). So for a while, I was on 60mg of Vyvanse at 5:00am and then 30mg of Vyvanse at noon. So what I noticed was that after the second dosage kicked in, I felt the medicine was working much better than the dosage from 5:00am to noon seemed to be working. So Dr. Winer increased the first dosage to 70mg and kept me on the second dosage of 30mg at noon. After about about a week, I felt the second dosage needed to be pushed back an hour to 1:00pm because I felt really tired in the evening and pushing it back helped that. So I tried that for 6 to 8 weeks. So at this point, the second dosage really felt optimal and that really showed me that my first dosage still didn’t seem optimal. So I asked if we could go up another 10mg in the morning and he said he was fine with that. So since last Friday, I have been taking 80mg of Vyvanse at 5:00am and then another 30mg at 1:00pm. (The insurance covered the entire 110mg). So the first half of my day definitely improved this past week but the second dosage effects seem to be a little inconsistent. The first day, I kind of felt like the second dosage was too high because I experienced some tiny bouts of tiredness in the first couple hours after taking it but then felt great all day. The second day, I felt excellent after the second dosage, and the rest of the day. After the second day, I have felt some tiredness this week that concerned me. Today, for instance, I had a couple tiny little spouts of extreme tiredness after taking the second dosage but they were very short periods of time. I was still focused, and not agitated or anything but I just felt this quick overwhelming tiredness for a minute or so and then I was ok. So I say all of this to say:
1. I feel guilty for being on so much Vyvanse because 110mg is more than many take. The pharmacists made sure to point out to me that that was an extremely high dosage (I love when they say that because it makes me feel so good about myself…not!).
2. I am thinking about pushing the second dosage back to 2:00pm but I am wavering. I can’t tell if the tiredness is because I am toxic or if it is just the adjustment. Dr. Winer said not to change anything for at least a week so we can tell what is doing what (we don’t want to have more than one variable change at a time so we can know what is causing what). The problem is it will be 7 days this Friday, and I still can’t figure out if the second dosage is too much or not (based on the tiredness). So how do I determine if bouts of tiredness are because of the adjustments or because I am toxic?
* Note: I also take 100mg of Trazadone at night and so I have no problem falling asleep even when taking the second Vyvanse dosage at 1:00pm. As you know, I am also on 50mg of Paxil for OCD.
Thoughts?
Chad,
It’s inappropriate for me to get into the details except for the fact that left to these plans you very likely will come completely out the top of therapeutic window over time for 2 reasons:
1. Paxil is bound to back up those AMP amphetamine compounds and you will become toxic and can become far worse.
2. You clearly suffer with metabolic challenges that ultimately will further encourage you to feel like you are chasing your tail with the meds.
Those two global predictions are all I feel are reasonable at this time… just sit tight and see if I’m right – or, change the Paxil out to a clean-on-2D6 antidepressant – and follow up w a metabolic review as found in links here: http://corepsych.com/tests14
cp
What I am finding a bit puzzling about your reply is that the last time I asked you what you thought (the only difference was I was taking 60mg of Vyvanse in the morning instead of 80) you said we looked like we were on the right course. The tiredness thing and the 20 extra mg make you think differently?
As far as the Paxil thing, we also discussed that last time and you said it was very likely I was the exception to that rule. It has been a good while since I have been on Vyvanse and it works, and doesn’t stop working. I just realized that the morning dosage didn’t seem to being working as well as the second dose?
I just said I was feeling like I was chasing my tail this past week, not the whole time…It has been consistent other than this week and just with the second dosage (but for the most part works great with the exception of those bouts of tiredness).
“You clearly suffer with metabolic challenges” So what kind of metabolic challenges could there be an are they correctable?
cg
Chad,
I do still expect that Paxil is a problem and, quite reasonably, can’t make a full assessment with brief comments here – I am trying to offer some help in a limited way. Read and watch the videos here if I haven’t already recommended previously for ‘metabolic challenges:’ http://corepsych.com/walsh-resources
cp
I think do have a high metabolism (so you are right about metabolism challenges) but as far as th Paxil goes, I was on Paxil and took Adderall IR or XR for at least 12 years with no problems. No toxicity. The only problems were that my body would burn through the Adderall Xr faster than most (not the IR though). They never stopped working. They never led me to a place where I was agitated and all of that. The Vyvanse is working great at the higher doses. For now, all I am going to do is push the second dosage back to 2:00 pm and I have a hunch that that will take care of the tiredness. I’ll let you know though.
Another question. I am not understanding why the dosing of Vyvanse is the way it is. What I mean is that if 70mg of Vyvanse is like 30mg of Adderall XR, than its like 15mg of Adderall IR. 15mg of Adderall IR was never enough for me, even the first time I took it. So theoretically, if I take 70mg of Vyvanse a day, its like I am on 15mg of IR Adderall for 12 hours. How would I expect that to be sufficient when 15mg of IR Adderall wasn’t sufficient? So 80 in the morning would be a little more than 15, like 20mg of IR Adderall. Adderall IR comes in 30mg tablets and so 30mg of Adderall IR is not considered out of the ordinary for someone to take (since they make the pill 30mgs)……
Chad,
Folks do have atypical metabolic patters that create unpredictable dissimilarities – no answer for that one, except to say that my first 2 questions for that problem is to review the Walsh Resources and ask about Candida: http://corepsych.com/candida
cp
Last thoughts, I just did some research, and it seems that many people are on more 100mg of Vyvnase (as prescribed by their doctors). Also, the fact that my insurance company covered the 110mg with out a hitch tells me this is not that unusual?
Chad,
Dosage: Not that unusual. The fact that insurance covered: quite unusual. Higher doses of meds 90% of the time have to do with metabolic disarray over and above 2D6 Polymorphisms – and require further investigation to understand causality.
cp
Hi Chad,
I just wanted to say, I’m only on 80 mg of Vyvanse and the pharmacists have all pointed out to me “that is a very high dose”, their eyes wide with shock as they say it. So I know how you feel.
I found it interesting to read about your experiences with taking two doses of Vyvanse a day. I actually tried that when I went up to 80, taking 60 in. the morning and 20 in the afternoon. It was completely by accident at first, because I kept forgetting to take the 20 mg capsule in the morning. But I discovered I liked it that way. I noticed I wasn’t sleepy in the afternoon anymore and I was able to concentrate much better into the evening.
I’m back down to 60 mg at the moment because I got really sick right before Christmas and missed my meds for a couple of weeks, so I had to start back at 20 again. I also take 300 mg of Welbutrin XL everyday, which I always think isn’t doing anything, until I miss a few doses. The difference becomes obvious when I start taking it again.
And thank you for mentioning the Trazadone! I have been trying to remember that name for years. I had a psychiatrist who prescribed it once and I loved it. Never slept so well or woke up so refreshed. But then he had a hissy fit at the next appointment because I I had only been taking it for 4-5 days, and he had wanted me to take it for 10 days. I explained I wasn’t able to get to the pharmacy to fill the prescription right away, and I told him it was really working well, but because I hadn’t taken it for 10 days he refused to listen and refused to prescribe more. I don’t know why it is that I always seem to get doctors like him…. Just my luck I guess.
Anyway, good luck with your exams and I hope you find the right balance with your meds.
Kaylee,
Thanks for weighing in, you need a doc that understands the pharmacology and you. They are out there, but the folks you write about don’t understand the variables.
cp
I shouldn’t have mentioned it but it just came to mind. It was actually 12 years ago and my first assessment for ADD. I have had a lot of trouble getting proper treatment, both for ADHD and and depression/anxiety. I don’t understand why my experience has been so bad compared to others but its partly due to the extreme lack of psychiatrists here (here being ontario, Canada). It takes at least six months to get in, four if it’s deemed to be urgent, and most will only do one 10 or 15 minute session, maybe a couple more. Unless you can pay. Mental health services are bad all around. I was referred for grief counselling after ny dad died and it was over a year before I got in. So I’m planning on going to see my doctor next week to ask for another referral so maybe I’ll be able to actually get some help when I need it if my mom dies, which it looks like might happen soon. Or I might just have to pay for therapy whether I can afford it or not.
Thanks again and sorry for venting here. I know it’s not really the appropriate place but it’s kind of hard not to right now my filters just arent working at all.
Thanks again.
Kaylee,
It’s not so bad here in the US, but with public opinion and misinformation becoming the standard of care treatment objectives often remain murky and misinterpreted, even by professionals.
cp
Kaylee. I am so sorry for all the hardships you are going through!! I will put you on my daily prayer list. Do you have any specific prayer requests I can shoot up to God?
Also, where do you live in Canada and do you got a church you go to? God has saved my life through the churches I have been a part over the last 20 years and I bet you there is one near you.
Hang in there man. Again, I am so sorry for your loss.
Are you on facebook? I would love to befriend you if so.
Thanks for the encourage Kaylee!
I would get a new doctor if I were you. A psychiatrist. Doctors won’t usually get it right because they are greatly limited. You should not be made to feel like a drug abuser just because you are trying to find a dosage that actually works for you. Why take a dosage of medicine that doesn’t work? What’s the point?
I think I am at a good place now, I just backed the 30mg of Vyvanse to 2:00pm instead of 1:00pm and it seems I have hit the sweet spot (for now). (I take 80mg at 5:00am). I have smooth coverage from the morning until I go to bed. The trazadone really helps me fall asleep pretty much immediately and I think also helps a little with my OCD the following days. (I am also on 50 mg of Paxil for that and yet my OCD and still kick my booty some days).
I also took some iron today and yesterday, and my energy level seems to be better too. I wasn’t taken iron during the beginning of the week and I am wondering if that contributed to my tiredness (and I may have been fighting off a cold or something).
As far as people freaking out, I am thinking about writing a book about my experiences with that. I think I am emotionally damaged because of how pharmacists and others have responded to the high dosages of AMPS my body tends to need to be effective. I feel a great sense of guilt often and being that I am a Christian and want to be right with God more than anything else on the planet, I am especially vulnerable to feeling guilty in this area. I pray often that God puts me on the exact medications, the exact dosages, and that I take them at the exact times He wants me to take them. I think it is a shame, that like Dr. Parker said, ignorance can cause so much damage. Like Dr. Parker said, the dosage of Vyvanse is strange to me because using the Adderall XR to Vyvanse conversion charts, many people could be way below an effective dosage.
Good luck!
Thank you very much Chad.
Unfortunately, I can’t just get a psychiatrist. Not enough of them to go around here and unless you can afford to pay $400 a session you just have to take whatever the government will pay for, which isn’t much. But I am working on getting a little support, at least from some online forums and pretty much anywhere I can because I am really seriously not doing well right now. I may have to just pay for a therapist and hope I get a good one who is compassionate and willing to give me a break on the fees. I’m looking into free resources too, like support groups, but it’s hard for me to get out to them and I’m not really a people person, I am also very stubborn and resistant to therapy, so it’s partly my fault. I just find CBT to be so shallow and meaningless, at least it was for me. In a nutshell it was just “hey, who cares if your life sucks, just smile anyway” which is not very helpful.
I wish my faith was stronger it might help. But I have practically been screaming at God for the past few days, sometimes several times a day, so I’m sure He has heard me. I just can’t tell if I’m getting any answers. Or maybe the lack of an answer is my answer. Maybe I’m just asking too much.
Just relax and don’t let the judgement of others bother you. You know the truth, God knows the truth, and that is all that matters. And remember, excessive guilt is a part of ADHD, as well as depression, I dont think you have anything to feel guilty about. But if writing a book about it will help you then by all means do it. I have spent the past 24 hours writing almost nonstop to get down all the thoughts and feelings racing through my head. I am planning to use the notes to help me explain to my doctor because it’s so hard for me to talk to people and I always forget things or just say I’m fine when I’m really not. I finally made myself stop and watch a movie with my mom but it didn’t hold my attention long enough so now I’m here. Going to try to go back to the movie now.
Kaylee,
Hang in there!! Keep searching. Even Canada you can find the right person, you just have to keep cold calling until you find your right person.
cp
Thanks so much Kaylee! I’ll start praying for you! Any specific prayer requests?
This makes me feel like a drug addict even telling the story but I actually had one pharmacist refuse to fill my Adderall prescription because of “ethical objections” because of the high amount! I was able to get it filled at another pharmacy but that made me feel great about myself! (That pharmacy later went out of business).
cg
Carol,
I would have to look at the results and fully understand what you’ve done pharmacologically. Next step: Organic acid testing, OATS, as outlined in this PDF on the second page: http://corepsych.com/tests14
Then take a look at Walsh Protocols there on the top of that page. Those two tests will help with a number of other contributory issues. I would expect possible Candida, based only upon the brewer’s yeast finding, and one or two of the other Walsh issues are very likely at play. Yesterday I reviewed findings w a mom from Boston and her son has 1. Pyrrole challenges, 2. Overmethylation, 3. Copper excess… all three. No wonder he isn’t getting better!
cp
Chad,
The is the sad state of public opinion vs conscientious neuroscience.
cp
Thanks Dr. Parker!
Peace be with you both…
cp
Hi Dr Parker
i took 20 mg of vyvanse last year for a few weeks and was so overstimulated i couldnt tolerate it. I did like how it upped my mood and focus so i played with smaller doses. 5 mg worked for me and ive been using it for 2 months and doing well on it. I recently lowered my dose of xanax from 2-3 mg a day to 1 mg and the vyvanse isnt working the same. Ive read where xanax withdrawal causes fatigue. Im sleepy and unmotivated Does it make sense that the xanax was helping the vyvanse work? I have panic and high anxiety. Im also underweight and have malabsorption/hashimotos/lyme. I took 10 mg vyvanse today and my mood is better but no motivation
Thanks!
Kay,
Metabolic issues are clearly at play with your immunity challenges. Your several medical conditions will narrow your therapeutic window. See this playlist to understand and evaluate the possibility of associated depression: http://www.corepsych.com/7videosPMDrop
Then look at this series to understand immunity that could be corrected and improve your outcome if other immunity issues do contribute. http://www.corepsych.com/immunity-playlist
Sorry, your complexity provides no quick draw solutions without improved evaluation – these are available tests. http://corepsych.com/tests14
cp
[…] Vyvanse Dosage Strategies For ADHD Medication Accuracy […]
Answers Needed Please Respond
So I have been taking Vyavance for about 4 months now everyday due to my ADHD and I’m a college student. I take 60 mgs in the morning in a glass of water I put the powder in and stir. Then in the afternoons I take a 10 mg Adderral booster. I am urgently seeking advice how different vitamins I can take to replace the nutrition this medication takes from my body, along with if there is any vitamins i can take that will cause this medicine to work more effectively. If you could please get back to me I would really appreciate it I am in the middle of the first set of Exams in all of my courses, some informed information would be extremely appreciated.
Thank You,
Max
Maximus,
Take a look at this book for tests, supplements and improved interventions: http://corepsych.com/walsh
And look at this post: http://corepsych.com/ProteinBreakfast2
cp
[…] Vyvanse Dosage Strategies For ADHD Medication Accuracy […]
Hello fellow inquirers,
I NEED AN ANSWER AND FAST!!!!!
I am very glad i found this page, out of the other 14 pages iv looked about to find out some information about my Vyvance and the questions and concerns I have about my tolerance and whats going on with me, this website has had the best quality info. So I am prescribed to 60 mg Vyvance once a day, and I have been taking the medication AS PRESCRIBED ONCE A DAY for about a month and a half now and it has literally turned my life around in a positive way! I am a college student and Im a full time student for this summer 1 semester. Therefore I have a lot of homework, studying, essays, presentations, and school work in general to get done. I have had my fair share of experience with addiction to pain medications, but i have never been attracted to Vyvance as a matter of face I hated it the first week i began to take it. Although I have found Vyvance to hep me out a lot. And yes the euphoric happy feeling that I get in the beginning of the day is a definite added benefit considering I suffer from depression. SO MY CONCERN AND QUESTION IS…. all the sudden since yesterday and not today I am not feeling the effect of my 60mg Vyvance nearly as much as i was less than 48 hours ago. This has me concerned considering I have so much school work to do and making good grades is extremely important to me! It is almost like it came out of nowhere all the sudden the Euphoric feeling went away along with the great concentration and work ethic has diminished greatly and I’m talking about within a mater of 48 hours! So this morning I took my Vyvance along with two 30 mg (Adderral salts the amphetamine/dextroamphetamine type of Adderral) well I am concerned and scared to realize that this action of taking the two extra Adderall in hopes it would bounce my usual effect back into order. Well it didn’t I almost feel as if today the Vyvance & Adderall don’t even have me as focused and driven as it had me yesterday even when i was starting to feel less of the effect. Of course i like the buzz feeling in the morning, but who doesn’t its a good feeling to be happy, energetic, and social! My main question is why all the sudden the loss in the medications effectiveness? Also how come when i took an EXRA 2 Aderral with my vyavance this morning I found it to have no effect on me, I feel as if I’m sitting here right now without have taken my vyavance at all today! What could be the cause of this sudden lost effect of medication… of course the first thing that comes to mind is tolerance, but like I said i have only been taking my 60mg Vyvance for a about a month and a half now! I also only take it on a monday – saturday basis, usually taking Sundays off unless i have a big exam to study for. Please will someone tell me what is going on, and how come when i took the two 30mg adderral this morning along with my vyvance it had no effect on the effectiveness of my vyvance? Like I said I feel as if i have taken no Vyvance or Adderall at all today! Plus i got a god 7 hours of sleep last night and i ate breakfast like i do every morning today too. So why all the sudden has my medication started to have little effect on me? I have read that I need to make sure to drink water with the medication and I drink a gatorade or Dr. Pepper every morning with my medication so I know that I’m staying hydrated, also i made sure today to make myself drink to full cups of water which was about 18 Oz of water. I would deeply appreciate if someone can give me and answer as to what is going on or some insight to my situation! Also if there is something I need to change in my medication or dosage? I am not addicted to my Vyvance I could stop taking it as of now and I wouldn’t have any urges or addictive symptoms towards it, although my grades would probably suffer badly. Please if your reading this and you know whats going on resound and let me know. My dad passed away a little over 7 months ago and I have been through a lot along with had to learn some things the hard way. I busted my ass to get accepted into the HUGE AMAZING DIVISION 1 college I’m now a student at, this is my second chance in life to make something great of myself and I have put my all into it i currently have straight A’s and I don’t want this sudden change in the effectiveness of my medication to affect my school work. So once again if you would have any idea or insight as to why all the sudden my 60mg Vyvance has lost almost its full effect within the past 48 hours? The day before yesterday the 11 my Vyvance had its usual effect on me, it put me in a happy state of mind and determined state of mind for the first half of the day and continued to help me concentrate for the remainder! All the sudden since yesterday it feels as if the medication is having little to no affect on me. I know iv repeated myself many times, i just want to make sure i get my question across to whom ever reads this and has a answer or insight! What is going on and what are some suggested solutions?
Any information will be deeply appreciated!
Thank you
Max,
You’re very likely coming out the top of the window, dosing inappropriately too much, and when toxic it’s like you have taken nothing. 60 mg of Adderall + 70 mg Vyvanse – not good at all, very likely associated with toxicity.
For you the next important question is Why? Some possibilities to consider w your doc.
1. You mention several times you are depressed and seeking help with depression from the Vyvanse. It’s not for depression: Serotonin is different than Dopamine. Consider an antidepressant and treat the associated depression/vulnerability condition correctly.
2. Your mention of pain meds: If you experienced the same overall ineffectiveness over time w pain meds you very likely have an associated metabolic problem no matter how athletic or smart you are.
3. Identify and treat that condition.
4. Stop thinking buzz and get to the objective of balanced cognitive support, not buzz.
Look at these vids for more explanations: ADHD Meds Dosage: http://bit.ly/dosevids & ADHD Meds Problems – Mind and Gut: http://bit.ly/mindgut
cp
I am 53 and have been taking meds for ADD since I was 40. As It turns out, what was called “Hyper Active” in the 70’s was really ADD and it hurt me in a lot I did.
One of my children also has been diagnosed with ADD. She’s been on many different med’s and Vyvanese seems to work the best for her. The problem I see is the amount she’s taking; 2 40mg pills a day as prescribed.
Let me give you some background on me. You might say I’m an experienced drug taker. When I was a kid 30+ years ago, I took a lot of speed for a 1-2 year stretch. We used to call them Black Mollies and Black Beauty’s. I remember well the little tingle you got in the back of your head.
Fast forward to 14 years ago. I was finally diagnosed with ADD and several drugs were tried, and failed, until I took Adderol. At first it was 30mg, but I knew that was too high. I was told you should not feel the “Tingle” in the back of your head, just be more alert and be able to concentrate. I soon figured between 10-20mg was where I needed to be where I wouldn’t feel the Tingle, but stayed alert. Let me also add I have been in the 300-350lb range.
After 8 years on Adderol, I started reading, and hearing, about the long term affects. Mood swings, lethargic and lazy when not taking(I would skip Sundays), and most importantly the rage. Uncontrollable rage, at times. What I noticed most about this rage in hindsight, is the after affects the next day. When someone has rage, they usually think about their actions the next day, or sometime after the incident, realize they were out of control, and apologize to all affected. On Adderol; what ever ticked you off to fly off the handle, was totally justified in your head; even after a cooling down period. You still felt you did nothing wrong. It took a friend of mine, who started taking Adderol because of me, to have the same “Rage Attack” on me,for me to see what others had been saying. He was totally, and uncharacteristically, unjustified in his rage, and the next morning felt totally justified in his pathetic display. Like a light hitting me I knew I had to get off. A lot easier said than done.
I literally went through withdrawal. This was as bad a withdrawal as I went through in the late 70’s and 80’s on those recreational drugs I mentioned in the beginning. I had severe headaches for 3-4 weeks. Advil, Tylenol, and nothing else could help, as my body got rid of this dependency on this drug. It was awful. In addition to that, I couldn’t get any help for my ADD. I was a mess, but knew I had to get off for my wife and four children’s sake.
At the same time, I lost my insurance and ended up with VA insurance being a 30% disabled Vet. The VA does not prescribe anything but “Old School Riddalin(Sp?). What a difference. I was prescribed 2 10mgxt per day, but took only one for the majority of the last 5 years. Lately I did bump myself up to 2. I’m still a big guy, about 320Lbs. I get the attention and concentration I need, without the “Buzz” or “Tingle” as most describe here. I no longer have the uncontrollable Rage either. Everyone around me notices the difference.
Recently, I found out my Daughter is being prescribed, what I consider, a high dose. She has been irrational and confrontational, as most 17 year old girls, but lately it’s gotten out of control. When I heard of this dose I thought it was too high for 120lb girl, but I’m not the doctor. She’s also prescribed something for anxiety(Forgot the name, but its popular) along with Xanax(Sp?. It seems to me some of her behavior could be caused by this constant up and down cycle. Last week, the VA screwed up my order of Rittalin and I ran out yesterday. This morning I took one of her 40mg Vyvanese to see if it would help. Wow! You gotta be kidding me! This is speed, pure and simple. As I stated earlier, I am well aware of amphetamines, both recreationally in the 70’s and 80’s, and later as prescribed for my severe ADD, but this seems like a lot of drug. As I write this, I have the Tingle in the back of my head and have been drinking water all day. I know I’m not used to this particular drug, but I’m a huge guy, experienced in these kind of drugs, and know what to expect. How can anyone prescribe 40-70mg of this to children 2 1/2-3 times smaller than me. Something is not right. With all due respect, does anyone think this is waaaay too high a dose and we may be losing perspective on this? If you go off adrug and go through what we used to call “Frying” and persistent headaches, isn’t this our bodies telling us to take a step back?
I’d be interested if any Dr.s out there agree with me, or any “Users” or family of “Users” recognize what I’m talking about.
Colorado,
Most likely your drug challenges aren’t as much directly related to your size per se, but to your likely metabolic imbalances that create your size situation. The same underlying metabolic challenges cause mercurial results with ADHD meds, no matter which – either MPH or AMP. Even w/o your size the same findings apply to those with mixed reactions such as you specifically delineate here.
I think the dose is too high, but I don’t condemn it, I think you and your daughter should use it as a teaching opportunity. and chase down that inevitable underlying metabolic cause. The cause could be genetic w the size of CYP 450 2D6, it could be immunity related, it could be liver and/or enzyme related, and it could be related to underlying autonomic issues as well. My policy, having seen many folks with these presentations: hold conjecture, and chase down the data lurking there right out of range, begging for measurement.
cp
Hi Colorado,
I would like to answer your question as well, though I am not a doctor or an expert of any kind.
I have been taking Vyvanse for about 6 months now and I am up to 60 mg/day. I also take 300 mg/day of Welbutrin XL. I have almost no side effects at all. Just a bit of a dry mouth and slightly reduced appetite, which is fine because I need to lose weight anyway. I have no history of drug use at all and I have only taken good old fashioned Ritalin in the past, for a very short time in my late 20’s.
After a month on the 60 mg dose I am just beginning to feel the full effects and it’s pretty good. I am so much more alert and everything seems easier. I was interested in becoming an artist when I was in my teens but have never been able to focus long enough to do any real work. Now I am sketching and painting and sculpting again, better than ever. And I have learned more new crafts in the past month than I did in the last 20 years.
I am planning to try increasing to 70-80 mg next month. The reason I want to do this is because I don’t know yet if 60 mg is my optimum dosage or not. If I increase it and begin having negative effects then I will know it’s too much and I can drop back to 60.
Unfortunately this sort of trial and error method is necessary to find the right medication and the right dosage. There really is no way to tell until you try because everyone is different. And although it may seem like the medications are all the same, they really aren’t.
As for your experience with Vyvanse, I don’t think it was really typical and I don’t think you can go by that. First of all, 40 mg is too high for a first dose. Secondly, suddenly switching from one drug to another like that is not good. I believe (though I may be wrong) that the Ritalin was probably still in your system from the day before.
You also can’t judge how your daughter is responding to the medication by your own experience. She may possibly react completely differently from you. As Dr. Parker said, metabolism plays a very important part in how the medications work, and many other things as well. And each of us has our own unique bag of ADHD characteristics. Some do well with little or no medication, some need more than the usual amount. Just for comparison, I have one friend who takes 120 mg/day of Vyvanse. (not that I recommend it) You have to get to the bottom of it, find out why you and your daughter respond the way you do to different drugs and different dosages. Like Dr. Parker said, it could be a lot of things.
No one can really tell except for your daughter because only she knows how she is feeling. You mentioned that she also takes medication for depression and anxiety, so she’s got a lot going on. It may be that there are some better options to explore. Of course, getting to the bottom of it is easier said than done. But I would suggest you start by talking to your doctor, and your pharmacist too because they have more in depth knowledge of the medications.
I hope this is helpful. Or at least makes sense. I really shouldn’t have tried to write it now, when my meds are wearing off. Good luck to both of you. 🙂
Kaylee,
Very well said, my own experience confirms your cautionary and supportive comments. Well said! It takes a team, glad you’re turning the corner and on it!
cp
Thank you. I appreciate the compliment.
But please, don’t encourage me. I spend far too much time doing this as it is.
😉 copy on the compliments!
cp
Thanx for both responses. Unfortunately, with the current state of the over crowded beurocratic VA, I really can’t consult with a “Team”. I cant even talk directly with my Doctor, unless it is in my appointment scheduled 3-6 ,months out. The VA Pharmacist is 20 miles away in Denver and really just a department of 30-50 people. I took the 40mg of Vyvanse everyday since, because my Ritalin has not come from the VA yet. Today I started downsizing and only took 20mg. I must admit I did get a lot more done in the last week. The “Speed” affect, although still there, is not as bad as when I originally started; which is what I expected would happen.
My problem with these amphetamines is the long term affect. I’ve seen what it did to me personally, and others that took these drugs. It was a subtle change and took 2-3 years to mannifest; but it definitely happened. If you catch yourself in a rage, recognize what it may be.
As far as I’m concerned. I’m going to have to figure out my own medication. My VA Dr. is too busy, and probably does not have the expertise of what Dr. Parker seems to have. My son also has a fairly renowned ADHD Doctor(In Denver Metro) in this field he goes to, Dr. Kaplan. Dr. Kaplan tried to get in touch with the VA also, with no luck. He also thinks I should get on Vyvanse. There is no doubt these drugs help, I just personally think they are prescribed in too high amounts. It seems people start low, get that tingle high from the original shock of taking the drug, and then chase that tingle, rather than let the low dosage work thru their body. They use the tingle high as a litmus test as to whether or not the drug is working, rather than the ability to concentrate. This in turn, leads to higher and higher dosages. I realize this is very unscientific observation, but I have witnessed it in myself, in stories online, and time and time again with people I meet.
Because of their own problems and beurocracy, the VA basically forced me to stick with a low dosage. I found this to be better in the long run, while still helping me to concentrate. I wonder if there are others that would be better off going this route too.
Colorado,
The folks on too much bubble up as trouble. Overlooked is the considerable trouble, without side effects, of inaccurate dosing strategies at the lower end of the Therapeutic Window. The Reality: Dosing strategies must become more precise period – too high or too low. People suffer at both ends, often in silence. Accuracy is possible with clear treatment objectives and an abiding interest in carefully looking at the multiple biomedical details.
Thanks for weighing in and contributing to this important conversation.
cp
[…] Vyvanse Dosage Strategies For ADHD Medication Accuracy […]
Hello Dr Parker,
Im so happy to have found your website! Its been a great help so far but I wanted to personally write to you in hopes of more answers for my personal issues with Vyvanse.
A little history:
I’m currently prescribed 40mg of Vyvanse. After about 3 months of being on 30mg, my doctor and I decided to bump up the script because I could no longer feel the effects of my 30mg. (just wouldn’t last as long)
Soon after receiving the 40mg I could feel the effects wear off sooner as well. I am still taking my current 40mg script.
The problem:
When I was taking the 30mg I decided to open the capsule and self adjust the medication without my doctors consulting ( yes, very bad, i know) but since I don’t take the medication every day I have several left after the 30 days, which allowed me to bump up my dosages myself. Sometimes I took one and a half capsules of 30mg (about 50mg) and other times I just took 2 straight on (60mg) in the am.
Shortly after, I began to do more research on Vyvanse (of course all my reading was done on the days I took Vyvanse because I was so buzzed I could “conquer the world”) I came across forums of people taking 2 doses of Vyvanse but during separate times of the day. So, like every other early twenties college student taking advice from the internet, I began to do the same. I began to take the vyvanse so sporadically (30mg in the morning, 15mg-half about six hours through my day, OR 30mg in the morning and 30 mg again six hours through the day. or sometimes I would just take half of one-15mg randomly in the pm if I need to study after work for a quick buzz)
Like I said, COMPLETELY sporadic. As you probably can guess now that I’ve had several pills of 40mg left over from extra each month Ive done the exact same thing with these. I used to have extremely negative side affects (headaches out of this world, muscle aches, extremely nauseous, and VERY frequent urination) but the last month has been pretty smooth. Now i just get a bit of anxiety as the buzz from the 2nd does wears off. I take the vyvanse only 4 days a week however on those days I ALWAYS take at least 2 doses- One 40mg about 5 Am and another 20-40mg at about 12pm to keep that amazing motivational kick it gives for the duration of all my classes.
So here are my questions:
1. Is there really a “perfect dose” for me? A dose that I can take everyday and will last 10 hours or longer?
– will i always have to keep bumping up my dose as time goes on?
2. How can I rewind this process without totally feeling a million negative effects of decreasing my doses. Finals are coming up and I need the meds help desperately.
3. Finally, Am I possibly just chasing a buzz? Are the meds still working correctly by keeping me focused and I just cant feel that “amazing kick, pleasant, conquer the world” feeling so I think the I need a higher dosage??
Please help!!
Thank you so much for your time,
Terese
Teresa,
One can’t ever speculate about a specific person, as we are all different and each metabolic rate encourages different precise strategies.
Some generalizations about your circumstance:
1. See this Overview Tutorial on ADHD Meds in General: http://bit.ly/medstutorial
2. Talk to your doc about raising the dose as your DOE is too short. See this playlist on Dosage: http://bit.ly/dosevids
3. You do have a narrow Therapeutic Window and it appears to be moving secondary to metabolic issues: Videos: http://bit.ly/mindgut
4. More on the Buzz issue and PM Drop, up and down issues stimulants in general, but covering Vyvanse: http://bit.ly/7PMdrops
5. You should find a steady state, and if you don’t, metabolic issues are the cause, – so modifying the dosage shouldn’t be necessary. If you are chasing dosage get worked up for metabolic issues as described in the series of instructional videos in detail.
Some people need 70 mg, some need more. Most insurances and docs follow cookie cutter dosing strategies because they don’t have a set of rules to follow. To do more than 70, if you need to ask for immediate release Adderall to cover your evening studies. If you are in college, in a college town your doc should be quite familiar with these simple, standard of care strategies. If he hesitates find someone with more experience – they do exist.
Hope this helps!
cp
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Dr. Parker,
I’m thankful I’ve found your site and hope that you can help me understand a bit better where I’m at in my therapeutic window. The more I read and research the more I feel my symptoms are a result of too high a dosage.
4 months ago my Dr prescribed me 30 mg of vyvanse. It was like the world became brighter, I was able to focus, play with my daughter, keep up the house, help my kids with homework, and have dinner ready. The weight that had been holding me back and causing me to feel overwhelmed and unattentive was released. After the first week of relief 30 mg was still helping, but felt like there was rm for improvement and my doctor had told me that he expected me to need to double my dose and at my initial prescription appointment told me I could begin taking 60 mg after 2 wks. I did. I felt like this was the perfect dosage for me and continued it for the rest of the month until my next appointment.
At my following monthly appointment I discussed with my doctor that I was feeling so much better and felt finally capable of taking on everyday activities. At the appointment he suggested maybe trying 70 and that it was normal for someone to take that dose. I accepted assuming it could only make me even better! It didn’t! I felt like I was “high”, major anxiety, twice stayed up over 24 hrs with no need to catch up after; simply went back to my normal sleeping schedule; was able to finish a million things a day but really wasn’t mentally available to anyone like I was “floating” all of the time. I waited the recommended 2 wks that every site I found suggested and at that point almost felt a bit like I was going crazy. Another major side effect I began having was at about 2pm every day I would crash for about 45 min and wake up with an intense second wind, and then couldn’t fall asleep. I have to be up a 5:30 everyday to begin getting my children up and take the vyvanse along with my other meds (300 mg lamictal and 300 mg Wellbutrin) around that same time.
Fast forward those 2 weeks of waiting, I went back to my Dr and explained that I felt like it was too much and how it was causing the middle of the day crash so he lowered it back to 60 mg. I began taking it the following day and for a month after, every day it felt less and less effective and my energy has depleted significantly. I’m stuck on the couch, want to do nothing, I don’t even feel it “kick in”, and I’ve started avoiding social interaction again. Last month at my appointment my Dr upped my dose back to 70 mg and there is absolutely no change. As I sit here writing this I’m exhausted, my eyes just want to close, and I have no motivation.
I’ve read and researched and searched every key word I can come up with trying to find a solution. I’ve read it’s because I exercise after taking the vyvanse, that I need more, that I need less, that I drink too much water, the list goes on and on. Finding your site has me believing that I am in fact on too high of a dose. If this is the case though, why did 60 mg not affect me the first time as it is now or did before being brought back up to 70 mg? Why did it work even if it was a little too much then and now I can’t keep my eyes open?
I’m beginning to think that going back to 30 is the answer because that was where the relief began. I worry though that it will not help any longer the way it did in that the short time in the beginning. Will I just continue on this constant roller coaster and be stuck waiting even longer for an answer I’ve been trying to get for 4 months; years really, but I never knew any different before the first 30 mg vyvanse prescription?
Any advice and suggestions are very much appreciated.
Thank you in advance for your reply
Jenn,
Yes, understood on everything you’re reporting. The problem was jumping too fast and then staying at the top too long. You quite likely are toxic, sound that way, and what I do is exactly what you said: start over slowly. Your metabolic pathways need time to adjust, and even if you and your doc take 1 mo at each level it sometimes isn’t enough time to stabilize. In our office we usually give each dosage change 2 weeks and never, tho I used to ;-(, double the dose.
Suggest talk to your doc about going back down to 30 or 40 and really learning exactly what your DOE is – as in this specific video: http://youtu.be/S0gir0CPLjo
or this entire dosage playlist: http://bit.ly/dosevids
Take the time to identify your targets, keep an eye on your watch in the PM and do subscribe on my YouTube Channel as I’m sending out 7 new PM Drop [in the Afternoon] videos on this exact subject.
cp
Hi Jenn,
I know EXACTLY the frustration you are going through! I’ve been chasing the therapeutic window for about three years! The vyvanse will go through periods of working, to periods of working AGAINST me.
At times I can accomplish tasks that I wouldn’t even dream about before, then other times it makes me so lazy that I phone in to work sick 2 days in a row. And the migraines are out of this world!
I feel like a drug addict in some ways. Logically, why would I take a medication that gives me headaches almost everyday and is completely unpredictable? Because when it works, it gives life color. It abolishes boredom for me. Things become interesting. I enjoy problem solving and I enjoy work! (never thought I’d hear myself say that!) Without it, life is chronic boredom. Nothing is interesting at all. Fatigue is high and all I look forward to is SLEEP!Total lack of motivation as well.
The latest trick I’ve discovered that seems to help a bit with the side effects is pulling the capsule apart and mixing it with water as well as taking it with food. It seems to gradually feather in and out which, for me, seems to reduce the comedown a little, but it’s not perfect.
If I can’t find a solution to these problems of unpredictability and headaches, I simply have to stop taking it. Unfortunately it doesn’t look like there is any other good meds for me to choose from since my predominant symptom is fatigue (partially caused by my SSRI – escitalopram.
I hope that you find an answer to your stimulant problems. Coming to this site I’m sure is a step in the right direction. I’ve been battling this illness for over twenty years. I’ve learned a lot of stuff in that time and everything that Dr. Parker talks about on his site and videos coincides with everything that I’ve learned. For instance, I’ve been to sites before where everything seems to make sense until the person says, “Then we will try an SSRI like Wellbutrin”. Forget it! They don’t know what they’re talking about.
EVERYTHING Dr. Parker talks about matches what I have learned, so I trust him and continue to become educated from him through his website and links. I’m just preparing myself for that first appointment.
In the meantime, I have a “family tragedy” I have to clean up!(What a mess!)
Mike,
You’re very kind… if you suffer with a Roving Therapeutic Window you may very well live downstream from an internal immunity/metabolic prob. Rarely is the “tired” secondary to an SSRI unless it’s just too high a dose.
Best w your Family issues, excellent comments and obviously helpful!
cp
Dr. Parker,
I followed a link I found somewhere to this because I recently started Vyvanse and I am searching for more information on it, specifically on dosage.
However, my problem is not that I need a lower dosage. My problem is that I need more but my doctor will not increase the dosage. I have been on 20 mg for about 5 weeks already and he wants to keep me on it for another 3 months. I don’t understand why. He is going against the recommendation of the psychiatrist who diagnosed my ADHD, which was to increase to 30, then 40 as soon as it was clear that I would tolerate it. Even my pharmacist questioned it when she saw the prescription.
For the first couple of weeks I felt great. Happier, more focused, more productive, able to deal with all that stuff I just don’t want to deal with (like cleaning and laundry). But then it got to where I couldn’t feel it “kick in” anymore and I felt myself losing motivation again. Now, I might as well swallow a Tic Tac for all the good it’s doing me.
Can you give me any suggestions as to how I can talk to him to get him to understand that I need to start increasing it? I really want to give it a good try, to see if it really is going to work for me. But I can’t do that if he insists on keeping me at such a low dosage. I typically have a very high tolerance for most drugs and I know that it just is not going to work at this level.
Any advice would be appreciated.
Kaylee,
Different docs all have different levels of expertise with stimulant meds. Some have none. Many who have no expertise correctly refuse to write for meds they don’t understand and have no training on. Others, in the spirit of trying to provide help, limit their dosage levels in an effort to remain super-conservative to diminish problems with meds they don’t know.
My recommendation:
1. Go easy on your doc. He is trying to help, but does have limitations on these meds, as many do, based on the complexity and new med information coming out everyday.
2. Give him this video link so he can watch/learn basics on this easy medication tutorial: http://bit.ly/medstutorial
3. If he’s interested and does wish to further understand your questions on dosing strategies: http://bit.ly/dosevids
4. More specific training playlists at: http://bit.ly/utubecp
5. If he’s stuck and doesn’t want to grow this part of his practice: get a second opinion by shopping docs who understand and treat adult ADHD before you go to their practice.
And if you really like your doc, give them my book! 😉
Hope this helps,
cp
Thank you for your response.
I am not sure giving him any links, or books, will help. Might make things worse actually. He likes to think he’s smarter than me. 😉
I will check out all of those resources myself though, to make sure that I am well informed. I have been trying to get your book from the library but someone checked it out in December and hasn’t returned it yet. (Someone with ADHD, no doubt.) I might purchase a copy but in all honesty it would probably just collect dust. I have stacks of books that I have never read.
Shopping around for a doctor is not so easy where I live. They are in short supply. But if I don’t get anywhere with him I will contact the psychiatrist who diagnosed me and see if he can help.
The really funny thing is that 10 years ago this same doctor pressured me to take Ritalin when I didn’t want to. Now, it’s like he doesn’t even believe the diagnosis.
Kaylee,
These challenges occur for you because of the imprecision with diagnosing humans by behavioral activities in the first place. Biomedical challenges require more careful review, and ADHD is, without doubt, far more complex than “hyperactive, inattentive and combined.”
Press on,
cp
We’ll…I said I would “check out all of those resources….” I should have added “someday”. It only took 3 months and an email alerting me to a new comment which brought me back here.
So, I finally got up to 60 mg/day and I can finally feel the effects. I may need to go a little higher but it’s hard to tell right now because my pharmacy switched my Welbutrin to a generic bupropion and I haven’t gotten it straightened out yet. (FYI still some equivalency issues there)
I just wanted to say that I found this water titration method very useful. I first used it when my doctor suddenly switched gears and told me to double up on my 20 mg pills. I didn’t want to jump up by 20 mg all at once so I used the water titration to go up by 5 mg a day over about a two week period.
I recently used it again when I was very sick for a few days (courtesy of the generic bupropion) and forgot to take my Vyvanse. I didn’t want to jump from 0 to 60 so I divided a couple of my capsules into 30 mg doses to start with, then increased by 10 mg every few days back up to 60. I don’t know if it was necessary but I felt safer doing it that way, having no experience with amphetamines. It is nice to have the option of doing that.
Kaylee,
You’re doing it exactly right!
cp
[…] Vyvanse Dosage Strategies For ADHD Medication Accuracy […]
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Dr Parker,
If a patient presents with overwhelming apathy (amotivation or avolition) does this likely point towards Depression or Schizophrenia?
The reason I ask is I am taking Vyvanse which has exacerbated this symptom. Treatment with SSRI’s I am told often makes Apathy worse, and to paint a fuller picture I do not have any kind of sadness (rather emotionless).
ATB
Dougie
Dougie,
Whoever told you that antidepressants make apathy worse hasn’t treated psych patients for 45 years. I can tell you they likely didn’t work in psych for 10 min. That observation takes the cake for what I call the 180 degree advertising theory = Advertize the opposite of what it actually does as it may encourage acceptance!
SSRIs treat apathy and problems of apathy secondary to Vyvanse and stimulants very well 80% of the time. That other 20% is directly related to metabolic challenges we so often address on these pages.
cp
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[…] For Additional Dosing/Titration Notes on Vyvanse See This Link […]