- To Change Your Mind - Details Matter
Vyvanse Dosage for ADHD: The Water Titration Recipe
Choosing a Consultant
November 11, 2007Check out CorePsych Books
November 15, 2007
Vyvanse Dosage Matters
Vyvanse Dosage: Use These Water Titration Strategies
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 dialogue, better outcomes, less mystery. Starting slowly makes a big difference for the duration of treatment.
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 dosage, 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 [20 mg, 40 mg, 60 mg] so perhaps we won't have to use these off-label suggestions – offered in the spirit of pharmaceutical precision [off-label = not in the package insert].
- If you do like the possibility of Vyvanse for it's range of effectiveness and efficacy as well as the promise of better compliance with our 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, then put the other into the refrigerator, warn others not to drink it
- Corrected below by FDA approval: 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 a Vyvanse dosage of 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 Vyvanse dosage 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!
——————
Vyvanse Posts At CorePsych
- Vyvanse: Fix The PM Drop [1 of 7 Video Reports]
- Vyvanse And Therapeutic Window
- Vyvanse DOE – Duration of Effectiveness Simplified
- Vyvanse Odd Toxic Reaction – Top of The Therapeutic Window
- Vyvanse Diminishes Memory?
- Vyvanse: Comments On The Exact Therapeutic Window
- Vyvanse: Q&A From Readers – News And Tips
—————–
Video Tutorials: ADHD Medications Playlists
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
ADHD Meds Become Instructive: – Learn from The PM Drop: http://bit.ly/7PMdrops
_____________________
FDA On Water Titration
Addendum – August 2013: The FDA Agrees – General Instructions at Drugs.com, or here under General Instructions at Med Library
_____________________
Intuniv Details
Intuniv Addendum: For Additional Notes Dosing Titration: Intuniv Notes | Or http://corepsych.com/intuniv
_____________________
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
Author: New ADHD Medication Rules – Brain Science & Common Sense
Connect & Subscribe To CorePsych News: This Link
Connect & Subscribe For YouTube Updates: This Link
Complimentary: 23 Special Report: Predictable Solutions For ADHD Medications
90 Comments
Dr. Parker,
Do you have any patients that Vyvanse acts as if it is an immediate-release med?
When I take it the effect comes on within 20 to 45 minutes which contrasts with most saying 2 hours to feel anything. Also it only lasts at most so far 4 hours for me.
I am doing a trial of Vyvanse because I was looking for a longer acting med than the Ritalin IRs (10mg 3-5 times a day) I was taking. My doctor prescribed me the 70mg capsule because he said a man my size would probably need it. But he said I could use this titration method even though he had no experience with it.
I am also taking 10mg Lexapro because I am one of those types.
The first day I tried 5 ounces (50mg) of 7 of water that I used to mix with the capsule and at around the two hour mark I was “hyper-focused” and at 4th hour I crashed (anxiety, irritability, terrible cognition). I drank the rest of the mix and felt better for a few hours then in the evening it felt like my brain was fried.
The next day I dropped down to (35mg) and the hyperfocus was gone but I had some anxiety and irritability and a 4 hour crash. Took another 30mg from the bottle and felt clear and good for a few hours and then the brain-fried feeling again at night.
This led me to today where I decided to start from the bottom (20mg) after reading your blog and seeing that you have seen the top look like the bottom and that Vyvanse is tricky. I had a more positive experience. No anxiety and I was pretty clear headed (my goal) for about 3 hours but in the middle of a class at the University I realized that my cognitive ability was gone. So I went to the restroom in between classes and did 5mg (half an ounce of water) and clarity returned for 3 hours.
So it seems to be working for me more like an instant release medication (fast onset of effect and hard drop). Have you ever seen this problem in your experience with Vyvanse?
Do you think I need to take a larger dose or maybe even the full 70mg to get 12-hours? Tomorrow I was thinking about trying 25mg but I am pretty sure the same thing will happen with the short DOE.
I did enjoy the calming effect of the 20mg Vyvanse compared to Ritalin but if I am going to have to sip half an ounce of water every 3 hours it kind of defeats the purpose of Vyvanse and the higher price.
Jack,
Without asking more specific questions, and simply patently speculating to offer a reasonable set of suggestions: This kind of metabolic challenge is just that: metabolic. We see weird phenomenon like this everyday with problems as simple as food allergies, as complicated as bowel candida, as challenging as CYP450 polymorphisms – all of which can now be measured with modern laboratory tools. Your body likely has some low level, not easily seen biomedical rust that is interfering with your metabolism.
Good for you recognizing that mysterious and often overlooked top of the window. That one is missed more than any other presentation. Talk w your doc, continue to work on your titration schedule, and if it doesn’t get consistent then measurement with some of these tests would likely be helpful: http://corepsych.com/tests14. And see this review for more info as well on Bill Walsh and refractory med reactions: http://corepsych.com/walsh. And if you’re really interested in more Walsh Resources see this page: http://corepsych.com/walsh-resources.
Hang tough, answers are there,
cp
Thank you for responding. I do believe the answer is metabolic as you have said but it will be a few months before I can have any of these tests done. In my past all XR meds have lasted a way shorter duration than they are labeled with me so it makes sense. Actually I can feel SSRI’s affecting me within a few days and they say it takes 4-6 weeks so it isn’t just stimulants.
It would appear my current sweet spot with Vyvanse is 30mg in the morning and 10mg every 3 hours. I know it seems pointless to use it this way since the whole point was to get off of short acting meds but in my experience it seems that amphetamine’s control of ADD is much better than MPH. It seems to provide more quality clarity when dosed properly. Better clarity is worth carrying a bottle around sipping from it 4 times day I guess.
I don’t see my doctor until a month from now so hopefully he will be fine with this method.
Jack,
Yours is clearly metabolic – trying hard to find that narrow Therapeutic Window through your day. Just back from Walsh Research Institute 5 day training. These issues of methylation directly effect med Windows. For a quick review of his book: http://corepsych.com/walsh – for a more evolved video look at how epigenetics shapes neurotransmitter outcomes: http://corepsych.com/walsh-resources.
See what you think, we have that testing available, scheduled through http://CorePsych.com/services
cp
Dr. Parker,
I notice you mention supplements in your writings and videos. Have you any experience with L-arginine?
The reason I ask is because after a few days of taking Vyvanse the way I described above (30mg in the morning and 10mg every 3-4 hours) after about a week I became toxic. I just became really irritable on the same dose. It got a little scary as if I had too much stimulant in my body. I stopped Vyvanse and went back to Ritalin because of this.
Around this same time, I coincidentally ran out of an L-arginine and AAKG combination supplement I have been taking for working out and I noticed something after not taking it for a week. I noticed my insomnia problems had diminished as well as some bowel troubles I had been having. I never knew this supplement was the cause of these problems as a gastro specialist had told me in the past that it was anxiety that caused these problems for me because he could find anything physically wrong with me. I think it maybe it was this supplement.
After seeing the improvement of the above symptoms, Today I got the idea to try the Vyvanse again because I thought the arginine may have been interfering. Well, I have to say the Vyvanse feels a lot smoother than it did while on the supplement. I have only taken the morning dose and a really small 5mg dose and it seems to be holding steady without a hard crash like before. But strangely it also feels like I could use a higher morning dose now. I will have to experiment and find the right one again I guess. I would love to find that “one morning dose a day” dose if I could.
Do you have any experience with your patients and Arginine supplements?
Jack,
Very interesting posting, much appreciated, but haven’t heard of that from anyone I’ve treated. Have you Googled L-arginine side effects? The main questions, as you had the problems you did in respect to Vyvanse: 1. metabolic pathway interference via 2D6, and 2. enzyme pathway interference encouraging the methylation process. Overmethylation at the synapse could cause accumulation – see this page that covers many posts on methylation, including overmethylation: http://corepsych.com/walsh-resources
Thanks, very interesting, appreciate,
cp
Hello, Thank you for the information. My son is 9 and diagnosed ADHD combined. Adderall was not a good fit. His emotions were gone, stopped eating, and not sleeping. We switched to 20mg of Vyvanse last spring. We took him off for the summer to eat. Boy he did! He grew much taller but still very skinny. We started him back on the 20 mg of Vyvanse a couple weeks ago and now he refuses to take it because he wants to eat and sleep and he says that he can without it. Would water titration work for him?
Joni,
Yes, it might, but the best, first solution is to try protein breakfast before-> http://corepsych.com/ProteinBreakfast
cp
Hi Dr. Parker,
How should I titrate 70mg of Vyvance? I was told by my Dr. to start with 30mg for 7 days then increase by 10mg if needed for another 7 days. Should I dissolve 70mg in 7 ounces of water, and will each ounce then be 10mg?
Thank you in advance.
Leanne,
I can’t even guess what his thoughts were on Vyvanse titration – 1/2 of 70=35? Call me conservative, but I go for low and slow every time. I’m not telling you personally what to do, but I can report w certainty that slower is far more predictable than fast on outcomes. Yes, each oz would be 10mg in that dilution.
cp
My ten year old son was written a rx for Vyvanse 20 mg capsules. After 2 days on the med, he was up all night. Couldn’t go to sleep until maybe 5 am. He was getting 3 or 4 hours of sleep. The doctor’s office advised me to split the capsule in half. Would the water recipe work for him? I had a heck of a time splitting the powder.
Wendy,
I’d shoot for an even lower dose using the water titration strategy here: http://www.corepsych.com/vyvanse – perhaps 5mg/day. If he reacts poorly to that low dose he likely will have a problem with amphetamine products period due to 2D6 genetics [search for 2D6 details here at CorePsych].
cp
Dr. Parker,
I have recently been diagnosed at 36 years-old with ADHD (inattentive) and have found Focalin XR to work best for me so far though I have yet to try Vyvanse.
My issue with the Focalin XR is that it would appear that I can only handle 10mg 3 times a day (morning, noon, night) as opposed to only taking one 30mg for the whole day. The 10mg capsules only last 5-6 hours and I actually sleep better on a stimulant (explaining the night dose). The issue that rises though is with insurance companies not wanting to fill more than 30 caps per month of this medication. So I am hoping I could use your Vyvanse trick with the Focalin XR.
My question is do you think the water titration technique that you describe for Vyvanse would work with Focalin XR? Have you ever used this technique with any of your patients for Focalin XR with any success?
Also, given that I have tried generic Dexedrine and had bad side effects (nervous, sweats, chills, insomnia), do you feel that Vyvanse is worth a trial?
There were positive effects of the Dexedrine on concentration and reversing some of the side effects of my SSRI (Lexapro) so that makes me wonder if Vyvanse would be better given that it is reformulated Dexedrine.
Thank you sir.
Dirk,
Quick answers:
1. Nope, can’t dissolve Focalin for time release as dissolving will make it all immediate release – as it will cut into those time release beads. Vyvanse works because of the prodrug metabolic process… it’s designed to release only by metabolic means.
2. Don’t know on the AMP issue – you could have a 2D6 problem, but w Vyvanse it’s so forgiving you might find that it does work based on those same metabolic principles – even tho Dex is a prob. Our team sees that all the time. Start lower that you would think!
3. Likely the same positive reaction w Dex for the Lex would work for Vyvanse… but honestly one never knows until you try. Respect the metabolic message, as you already do, and you will find the answer. Side effects are our friends, as they tell us how to get it right.
Best!
cp
Is it ok to use the water titration with more water? I emptied a 70 mg tablet into a litre of water. I drank 1/3 of the mix and felt ok, a little more productive. The next day I felt very sick (although I may be getting a cold) I felt better the 3rd day. I want to drink the remaining water but concerned I may get sick again.
I had previously taken 30 mg with good results for 2 weeks followed by headaches and discontinuation. My doctor is working with me to try to get just the right dose or abandon stimulants. I got very sick from Focalin that I took for only a few days.
Mary,
Absolutely not a problem. Our clients often find good results w dividing a 20 mg in 4 oz of water significantly dropping the dilution to 5mg/dose.
cp
Hey, I take 40 mg of vyvanse and had a couple of questions regarding this titration method. What is wrong with storing a water/vyvanse mixture for a later time? Also, is there any difference between actually putting the contents of the capsule into water and mixing it around, as opposed to just putting the contents in your mouth, and then using water to wash it down like a normal pill?
Jason,
From my experience clinically: when some – quite uncommonly – save it in the refrigerator for even 6-7 days they report no decrease in effectiveness. The only difference between dumping some of the contents directly into your mouth: some decrease in accuracy of dosing, but no apparent challenge with ability to absorb from what I’ve been told. As a practice I encourage precision vs imprecision.
cp
Dr. Charles,
I am 26 yr old female and I was just diagnosed with ADHD. I bought your Kindle book yesterday and I love it. It helped me understood from the very beginning what are the main concerns with ADHD medication and the insights of my condition. I was able to identify myself as being the “Thinking ADHD type” (following your book guidelines). Until I found your book I somehow doubted my MD’s diagnostic of ADHD but now I am certain that I have this condition. I do have some more questions and concerns:
1. I have had, in the past problems with PCOS but ever since I started a 90% vegan raw diet all these problems went away. I had clear face and normal weight. On my 5th day of Vyvance I started to get acne like I never had before. I am following a very strict hygiene with my face. I am eating very healthy, 90% vegan gluten free wheat free raw absolutely unprocessed. I have a protein rich breakfast.(20g) I take my proteins from raw sprouts blends. I drink more than 1 gallon of water every day. Is acne a side effect of stimulants? What can I do to prevent it? . Is Vyvanse influencing my hormones or is unbalancing my body’s chemistry? Even though it is not an official side effect acne seems to be very prevalent between stimulant treated ADHD patients.
2.All my life I suffered from constipation, slow gut, and I think I have a lower metabolism but this issues seemed almost gone with raw diet and daily exercise. I do think I have a longer than 24 hours transition time. How can I fix that? I am eating a lot of fiber and I am never constipated anymore but my transit time is longer than 24h most of the days. Is this a problem? Can I fix it? How?
3. My body feels more hot than the usual. Why is that happening?
4. Vyvanse seemed really effective in the first 3 days. This is my 7th day on Vyvanse 30mg and I feel it is becoming ineffective. I had some side effects in the first couple of days but by day 3 I was side-effect free – beside the acne and the hot flushes. My capacity to concentrate seems almost gone and all the worrying seems to be back. My doctor prescribed me 30 mg Vyvanse and told me to take one pill/day for 7 days and two/day pills from day 8. I am a little scared to take 2 pills. Can I titrate my second pill and just drink half of it? (in that way I get 45mg) Following your book I identified I am at the bottom of the therapeutic window and most probably I need 40mg-50mg. I just think my MD’s recommendation for 60mg is a little to high.
5. Can I take multivitamins in conjunction with this medication? What about Omega complex, L-Thianzim, B complex? I heard that all these are very beneficial for your body when taking stimulants.
Thank you so much. Your book is truly helpful and I think a must for anybody on stimulant medication. I am happy to see somebody understanding the importance of nutrition.
Best Regards,
Connie
I just want to add that I get 8h of sleep every night and I exercise almost daily.
Doing well! Stay w those plans, excellent that you take care of yourself so well.
cp
Connie,
Would go more slowly than recommended and err on the side of too little… talk w your doc and read here about “Vyvanse Water Titration.”
Metabolic challenges with heat and constipation are routine and often pass unless other metabolic challenges supervene. Not likely that hormones are effected, but possible.
Sounds like you’re chasing a Roving Therapeutic Window – further evidence of a metabolic challenge that preceded the meds.
Multivits are not a problem!
Thanks for your kind remarks, hope this helps.
cp
Thank you very much! I appreciate all your support!
Glad to pitch in!
Dr. Charles,
My 8 year old has done the gammut of stim meds over the last 3 years. He has since birth had constipation and bowel issues. He was diagnosed with ADHD, PDD NOS, and also exhibits ODD at times,anxiety, manic(may be the meds), and some asperger’s tendencies.
Of all the meds he’s tried Vyvanse was the best with the least extreme side affects, but still caused moodiness(almost sad or dark or depressed), loss of happy self, and weight loss/no appetite. He was over 8 yrs old and 47 lbs when we stopped it for a summer break. He gained up to 57 lbs by summer end. Yes, it was a rough summer but he also didn’t have to sit still, be still, be quiet and learn so it was doable.
We just took him off Adderall because of anger/violent outbursts within two weeks at only 5mg. Not his happy self at all. The doc is trying to go without stim meds and is doubling Intuniv to 2mg. Plus I am starting him on Probiotics, Omega-3s, MultiVitamins, and garlic because I heard it could help with bacteria in his gut. I am going on a hunch that some of his life long behavior issues are tied to his gut, but also may be habits by now too.Please, any advice is appreciated. It’s all taking a toll on me and the family, not to mention this sweet, smart little guy living inside it all.
Thank you
Connie,
Short answer w the press of time: do take a look at the video playlist on Mind and Gut at YouTube. IgG testing, not quantitative but yes, qualitative for food allergies is the place to start. We like Great Plains Labs in our offices. Much more spelled out in my book, free for Kindle until this weekend – link to Kindle apps at that link as well.
cp
[…] took the FDA 6 full years to recently approve the simple Vyvanse Water Titration Recipe I encouraged soon after production in 2007… so expect that you may discover Approved ADHD, […]
Thank you, Dr. Charles.
Yes I learned about the Narrow Therapeutic Window in your book. But I was confused as to why I am going over the top of the therapeutic window when I am barely taking 20mg and my metabolism and bowl movement seemed ok.
I suspected that it might have to do with liver ineffectiveness and IgG. It seems that you are confirming my suspicions but it’s hard to know exactly what it might be without testing.
I will contact Desiree.
Thank you for your help.
David,
Good, look forward to talking to you… Yes, even at that very small amount the metabolic markers still tell the tale – thus so many treatment failures.
Talk soon,
cp
Over the top on 20mg Vyvance?
I just read “The New ADHD Medication Rules”, I wish I read this a long time ago! Such a wonderful book.
I was diagnosed 3 times with ADHD and prescribed 20mg of Vyvance.
The first day is usually perfect. I am extremely sharp, motivated yet still myself.
The second day is not as good but not bad either. I can sense that I am tired and mentally exhausted.
The third day and on things go down hill I start feeling the following symptoms:
The stoned effect
Hyper-focus
When talking to people I am so hyper-focused I can no longer relate to the subtleties of the story
Lack of empathy (not tuned it, not present in the moment)
Headache
Sensitivity to light
Not able to articulate eloquently in writing
I don’t take any other medication and sleep 8 hours a day. I’m 31 years old.
I have tried this titration technique and took half a dose of Vyvance 10mg but that it’s simply not effective to treat my ADHD.
I am very frustrated; 3 days ago I stopped Vyvance because my head felt like it was going to explode. I am starting a company and so I really need to stay sharp.
I have previously taken 20mg of Vyvance with great results but I am not sure why lately its been different.
My next step is to try high protein breakfast and diet and eat well generally. I will also exercise more regularly and try again with Vyvance.
Any advice would be so greatly appreciated.
My bowl movements are 3 times a day.
I have acid reflux but I believe that that doesn’t matter with Vyvance.
David,
Don’t really worry about the frequency… because it might inaccurately tell the tale. Check out your real Transit time, – measure it accurately. It’s likely w the acid reflux that you do have IgG issues.
cp
David,
Since you read New Rules you now know how that Narrow Therapeutic Window works… that’s what you’re talking about here. Then, when coupled w your other question above, it’s now more clear that you do have significant metabolic problems w an 80% chance they are created by IgG immunity issues. We can get you tested easily long distance, do it all the time thru Desiree at Services..
When you talk to Desiree add on the Tissue Mineral Analysis for faster results when you add the meds back on. My best guess at this moment: your liver is working ineffectively secondary to these immune challenges.
cp
[…] ADHD Meds aggravate comorbid TBI: – Unless the meds are set up in sequence with full regard for the specific brain issues present in the brain injury. Numerous citations in the literature agree that stimulants may be used with brain injury, but they must be used with caution. [Vyvanse water titration.] […]
I have a weird mix of anxiety, add, tics, and night terrors. I have tried numerous meds. Vyvanse was the only med that allowed me to stop constantly fidgeting (arm smelling, hair twiddling, nailbiting) and allow my physical self to actually sit still. But at the end of the night I had terrible anxiety and would bite my nails till they bled. It also made my days feel like they went too quickly. I have been reading more and realize my head fracture when I was 18 may play a factor into me not being able to figure out the proper way to medicate. Would this vyvanse water method work for me? I found that a lower dose worked well but the anxiety was so unbearable at the end of the day. My current pysch thinks the vyvanse was a bad fit…but it seriously was the only thing that could make me feel clear and calm. :[
Teresa,
Without an eval it sounds from this distant perspective that you have a mix of affective and cognitive anxiety – the affective is treated better with SSRI products, the cog. w Vyvanse. If Vyvanse works stay w that, and then the next step is to get a better review of the post TBI possibilities.
Yes the water titration will work for diminishing the doses, changing the doses carefully w your docs approval.
cp
My son who is 7 yrs old is on 20 mg Vyvanse and he has a strange tic with his mouth and fingers (he has to strech his mouth and fingers every 30 seconds)the problem is he has had this with Concerta xr and Adderall XR. Its so distracting for him and because of it hes unable to stay focused on anything. We tried Intuniv and that made him very angry and explosive. The docs said we have to make a choice to put up with the tics or his ADHD. Its so frustrating and we dont know what to do?
Renee,
I don’t agree that you simply must put up with these challenging medical presentations, even tho complexity of intervention strategies is often confusing. This type of presentation almost always arises from IgG issues and combined trace element challenges downstream from GI issues – often dating from earliest childhood/infancy. From a neurotransmitter perspective you’ve hit three of the four neurotransmitters predominantly involved with ADHD: Glutamate [Intuniv], Dopamine [Adderall and Concerta], Norepinephrine [Adderall], but hasn’t touched PEA.
My strong recommendation: IgG testing, Tissue Mineral Analysis, Neurotransmitter Testing to start, and Neurofeedback with an experienced NFB has often proven significantly helpful in our practice with refractory Tic Disorder and these obvious metabolic problems.
cp
[…] For Additional Dosing Titration Notes on Vyvanse See This Link […]
I forgot to mention it is Vyvanse. 😉
My son is on 20mg but needs a higher dosage. He complains of leg cramps when we go up to 30. I believe 25mg will be just right. How do I use titration to get to 25mg? Dilute a 20mg in 2 oz and add an extra tablespoon of water/juice?
Kira,
Narrow Therapeutic window, often associated with metabolic challenges, yes dose related but mitigated by other background noises like magnesium imbalance. See this page fro more on Narrow Therapeutic Windows. If you take the 1 oz for 10 mg, .5 oz = 5mg, and you can add. I think that’s way too much trouble to regularly address and strongly recommend a more careful workup re: IgG issues.
cp
@drcharlesparker:disqus I’m prescribed to 40 mg of vyvanse and want to try splitting the dose because it feels like too much. Will it be safe to drink the other half of the titration the next day? I’d really hate to waste it if is still usable.
Jennifer,
Quite simply, yes without question. We’ve been recommending this water titration for years now, and some mothers with ASD children using minimal dosing strategies keep it in the frig even 4 days, and report excellent response at the end of each titration. Brief video on the details here: http://www.corepsych.com/2012/09/adhd-insights-start-stimulants-slowly/
cp
PS you can divide the 40 into 4 oz of water and carefully check out the DOE for 20 or 30 mg – which covers your day the best.
[…] Vyvanse dosing strategies explained in fact here: http://www.corepsychblog.com/2007/11/vyvanse-for-addadhd-the-water-titration-… Yes, and critical subject given Vyvanse initial came out, and this is a *single many visited post […]
[…] Vyvanse dosing strategies explained in fact here: http://www.corepsychblog.com/2007/11/vyvanse-for-addadhd-the-water-titration-… Yes, and critical subject given Vyvanse initial came out, and this is a *single many visited post […]
[…] Vyvanse dosing strategies explained in fact here: http://www.corepsychblog.com/2007/11/vyvanse-for-addadhd-the-water-titration-… Yes, and critical subject given Vyvanse initial came out, and this is a *single many visited post […]
[…] Vyvanse dosing strategies explained in fact here: http://www.corepsychblog.com/2007/11/vyvanse-for-addadhd-the-water-titration-… Yes, and critical subject given Vyvanse initial came out, and this is a *single many visited post […]
When doing the water Titration. Does one have to place it in the frige? I have been taking 30 mg Vyvanse for 6 days and been feeling nervous and think I need to go to 15. I place my vyvanse next to my alarm clock to as it helps to wake me up early as well. So would it be ok to leave it in the water next to me over night in the titration?
@ShaneChapman Yep not a problem. I have a pt in LA who carries it in his car, in a small drink container – not precise, but no apparent deterioration even in CA heat according to his report.
Hello there!
1) Thank you for you suggestions to give to my doc last time — I’ve definitely noticed a better difference in that I think we found the right dose. yay 🙂
2) except it’s IR, is there another way? Also, since there is no 25 mg dosage sold, I would either need 2 scrips which I’m not sure would go over w/ my insurance but it would also cost me 2x as much; or just keep doing what I have been (cutting 20 mg tablets) which is a pain and not perfectly precise.
Current — 25 mg Adderall IR: 3x day (6:15 AM, 11:30-12 PM, 4:30-5 PM)
*this DOE is definitely 5 hrs, approaching 5 1/2
*only problem with this is when I take it in the AM….I have to get myself moving enough to take it at 6 so that I have enough time to not be effective while it’s taking effect….if that makes any sense. I try a lot, but that’s basically what happened this morning (took it at 6:30 and needed to be getting ready by 6:40, but instead wound up doing something until 7, when I was able to force myself to save and go get ready — except that all made me a little late)
Previous — 40 mg Adderall XR in AM ~6, 20 mg IR in PM ~6
*the 40 would last about 9 hrs at the best, the 20 was 4- but the last 30 minutes was always poor
*also tried moving the IR up earlier in the afternoon; still didn’t make the difference w/ the transition. Basically, I can’t take something between 3 and 4:30 (5 depending on day). It either has to be before or after, as those times are among the trickiest.
Previous — 20 mg Adderall IR 4x daily
*huge improvement over what had been before, but I forgot often in the middle of the day to take it at the right time
Previous — 70 mg Vyvanse
*especially helpful the first three days, but not after that….this had been titrated up from 30 over the course of at least a month.
*DOE was 9-10 hrs
3) I also was wondering about what I could do in the next day or so – I will call my dr asap; I just didn’t have the chance today.
Here’s why: since we were adjusting the 20 to 25, I have no more IR. I have XR 20 mg (for the whole month) and Vyvanse 70 mg (from before).
????
4) Just wanted to share my gladness at finding what seems to be the right dose and my dismay as to what it should be converted to, if anything. The only things it doesn’t help with are the intensity of my emotional reactions (though they don’t happen quite as quickly; it’s like I have more time to do the CBT stuff and it’s easier to do it) and time management (which is a no brainer…I have to learn that one).
5) The only (and I mean ONLY) other complication is that it’s not perfect, haha 🙂 There are days/times when I don’t feel as well, so instead of focusing on what I need to, I’m focused on how I feel and obsessing over whether it’s a result of the medication. Or there are days/times when, for whatever unknown reason, the medication is not having the same effect even though it should be. But all in all, it’s not that often (maybe a handful of times a week? or less).
Please, feel free to comment and answer my questions insofar as possible. Thanks again for a wonderful source of information with all these articles.
m82
m82,
Only comment is off label – you and your doc got the drill down on the DOE, and, if your insurance covers it, the only prob is not going just a tad higher on the Vyvanse for the effortless 12-14 hr DOE. I know 70 is the package insert top, but docs around the nation are going higher, and you likely wouldn’t need much, probably would reside at 80-90 depending on your burn. You might see if your doc is willing to try one of those, as you would then have the increased compliance and smooth on and off that most often accompanies the Vyvanse.
cp
I just lost my entire reply….!!
1) Thanks; I’ll ask him and see. It’s been a while since I was on the vyvanse (and that was a different prescriber) so I’m a little hesitant to go back to it. I had noticed some change at 30 and then nothing new until I’d hit 70, which only lasted for 3 days — which was unbelievably frustrating and perplexing! Adderall overall has been more effective – more changes, and sooner. But your take is that the dosage of vyvanse just wasn’t correct and that I should see these same changes if the dose were adjusted better. I wonder though, because the drugs do have differences chemically…
2) These last few days of just taking the Adderall XR 40 mg in the morning have been absolutely awful after about 7-8 hrs. I think I’d actually overestimated the DOE on it because it’s harder for me to tell when others are demanding my attention and I’m busy rather than on the weekend when I’m left to my own devices (that whole context issue: less structure = >difficulty). I know I’m not going to get anything else useful done today….but that won’t keep me from trying. I need to go grocery shopping which I hate (at least I finally finished my list) and then the gym. Maybe I’ll do the gym first though, since it just keeps getting later…
I have been a little concerned about my HR too: since being on Adderall, it’s been in 80s on average (sitting, moving around, work etc…) with a resting of 63-70. Before any meds it was in the 70s with a resting in the mid to upper 50s.
3) If my doc were to agree to this (which is possible because it’s a new one), would I have to start all over at 30? What about the remaining doses of 70 that I still have? Why might my insurance have a problem with a scrip that says to do 40 2x/day? The only problem I’ve ever had is if I’ve tried to pick up before 80% used; and I’d imagine there might be a problem if I had two different scrips for the exact same drug (like 10 and 15 mg for adderall ir, let’s say)
3a) What if going back to they vyvanse is a no-go?
4) I guess I am feeling more confident and generally happy because I can see the differences so much more clearly now. I’ve figured it out. It’s not the effect of the medication that’s the problem, but the absence of it. Every time I felt something was off, I worried that it was a result of the medication. Rather it’s that I’m back to how I was before and I had forgotten what that was like. Yet being on it has not changed me into a different person, I don’t feel like a zombie as some people report — I still feel like I’m myself, but I guess just much better able to handle changes and accomplish the tasks that are difficult for me. On it, I definitely still worry and have very quick, strong emotional reactions; but it seems to be not so much maybe.
5) Most importantly, I can’t wait until this finally really figured out – for good. I’m so tired of changing things around!!
time for the gym I guess…then the store (I hope I actually go afterwards!!)
Thanks again. This really can be better….right?
m82,
You are on the right path… tweaks can best be done with your doc at hand.
cp
i am currently taking 120mg of vyvanse and am interested in trying focalin xr. what would be a comparable starting dose?
Alisha,
If you are using 120 mg of Vyvanse I would first ask the deeper question: Just what is the metabolic background noise coming from? Higher doses almost always have a metabolic contribution, thereby making the drug itself work unpredictably and ineffectively – and encouraging changes to other meds repeatedly – been there, done that. Ask yourself the key question about transit time to start. Brain and bowel function do significantly harmonize for the better or worse. Transit time more than 24 hr will show you need to test for IgG food allergies to get started. Fix that problem and your effective DOE sweet spot improves significantly. And, BTW, you can use simple meal of corn, and don’t have to bother with activated charcoal to discover your time from: The Mouth To The South.
cp
Hi,
After 46 yrs, i’ve just been diagnosed with ADHD. I experience myself as the energier bunny who goes in circles and never really gets anything done, always reved up and have a hard time relaxing. Also, my mind is always thinking, unforntunately negative, because of past invalidations. I just got a perscription for 60 MG of Vyvanse. My greatest hope is that I will have some relief from my constant thinking, the motivation and ability to stay on task, and most of all the feeling like I can relax and chill in the moment. I am so wired that I cannot sit still and then when I do, my mind is like, “do something”
you mentioned something about taking SSRI’s. I found that when I took Lexapro it made me feel manic, more reved up and on top of the world. is this the effect you were referring to.
Thank you lisa
Lisa,
Lexapro will often make anyone appear emotionally dysregulated/manic if they have comorbid ADHD that is left untreated. See this Anxiety and ADHD CorePsych video, start at 4.45 min for the neurotransmitter balance info relevant to your question.
cp
Dear Dr.,
My son is 8 and has a hard time swollowing pills. He was just prescribed 20mg Vybanse. Can I open the capsule and mix it in his daily glass of orange juice? Every morning is a battle and it is not getting any better.
Thank You,
Jim
James,
No problem at all. Vyvanse will mix with anything and you don’t have to worry about the acid base balance, acidity of the juice, etc.
cp
Greetings,
I was prescribed Vyvanse to offset the weight gain from Lexapro.
I’m a naturally nervous person by nature and have great fear that the medication may be too activating.
I have 20mg capsules. Would it be appropriate to dilute this and start at perhaps 2.5mg and titrate according to side effects every three days? I am not keen on taking any type of medications and do consider myself sensitive to medications. Thanks so much in advance for any words of wisdom.
34yr male 5’11/240lbs
Hey Jon,
I simply don’t use Vyvanse or any of the AMP products as a weight loss tool – not indicated and wouldn’t work predictably over time, as most get over the appetite suppression at the outset.
Now if you told me you had a significant low grade ADHD that became aggravated with SSRIs, [as we so often see, and have repeatedly written about here] then I would tell you to watch those signs of increased impulsivity secondary to the SSRI, including eating without thinking.
Your dosing strategy will work with the plan outlined on this post – if you are really concerned go on down to 1/4 of the 20 mg with the water titration described herein – yes and 2.5 mg can be done as well, just seems like a bit too careful from my experience, unless you have an extended transit time and associated metabolic problems.
cp
[…] This post was mentioned on Twitter by drcharlesparker, Lebby. Lebby said: RT Vyvanse for ADHD: The Water Titration Recipe http://bit.ly/4GGDq this one bears review as questions continue (via @drcharlesparker) […]
Med Titration:
If you simply Search Vyvanse on this series of posts you will find all the info you need, then if not go over to http://www.squidoo.com/vyvnase
It is the best product out there, you simply have to know how to use it precisely, sign up for my new book for the details of why meds are so challenging.
It isn’t for everyone, but the numbers that can’t take it are less than 5% if taken correctly.
cp
I’ve tried several different approaches to handle my ADHD in the past and keep running across different styles or methods of how to handle it. I went the medication route as well as the psychologist route and found both to be mildly effective. I’m very curious about the effects of Vyvanse now and whether or not the product is similar to adderall in nature or if its from a different part of the amphetamine family.
Leighann,
Glad it worked for you-
If interested you may want to review the several full articles I have posted on med titration over here:
http://ezinearticles.com/?expert_bio=Dr_Charles_Parker
Bottom of the page,
Have a great Holiday,
cp
Thanks doc, all good. talked with my doc and he upped my dose of vyvanse to 120 mgs, tons better, thanks for the confident chat I needed to nip this in the arse.
peace, leighanne
Leighann,
With the dramatic changes everyday in everyone’s life, a single day at school or work can become a turning point. Naturally I don’t know the treatment options, but would encourage you to call around, ask for some help during your docs vacation – but do go back and give him a run at this new understanding.
Finding your own dose is a two edged sword, yes it is correct, but medical folk prefer to manage controlled substances more closely and he could reasonably have a problem with the changes you have made. All that should be explored with him.
The last chapter in my new book addresses the many problems with medical team communication – and offers some resolutions for challenges like this.
I hope you do get the team play ironed out for the Holidays,
cp
Dear Dr cp,
I would like to thank you for such a quick and thorough response. I had no idea I would get answers so fast. I planned on making an appointment with my dr. for tommorrow yet when I called I was notified he would be on vacation for another week or so. Since I feel as if work would be almost immposible without any meds, yes I ran out as of today from dosing one and a half, I’m wondering if going to an urgent care center would be an option? I realize you only answer questions pertaining to certain topics so I’m certain my question is a bit nuts, but since I feel half way there I thought I would give it a try.
Once again I thank you,
Leighann Foley
Leighann,
From speaking with 100s of colleagues and watching the internet I can report that I have often heard much larger numbers than yours, – and while the package insert suggests top of 70, it’s only because no formal research has been presented regarding safety etc – I am very careful over 100 mg, see below.
If you do the AMP math and round off your Vyvanse to 100 = 2×50 = 40mg Adderall/day [according to the dosage equivalency of the Harvard study] you are well within standard of practice for safe AMP dosage of 1.5mg/kg tops for Adderall toxicity.
Now, some will argue, quite reasonably, that all AMP are not specifically the same. No argument, but clinically they do appear to carry the same relevant dosage for the most part in the office as seen in the study.
My recourse in the office: stay with very precise DOE, watch for adverse events, good breakfast, no more than 14 hr DOE, watch the top of the window, and then do the following:
At higher doses [anything over 100mg] work hard at following up carefully with a complete metabolic review: hormones, liver function, etc as encouraged elsewhere in these posts. Consider comorbid conditions in detail.
Your doc is the final path, – I suggest trying to work with him on the math above 1kg = 2.2lbs, therefore 145lbs= top dose of Adderall 98.863mg, far above the dosage 105 mg of Vyvanse.
Again, I am clearly not recommending a top bar here, just doing the math, and do have very few [1-4] of my entire practice 120 mg or over. Identifying comorbid conditions will almost always lower the top dose requirement – evidence makes the difference.
cp
Hello,
I’m very curious as to what is the highest recommended dose of Vyvanse is for a 35 yr old female at 145 lbs? Currently I am supposed to take 70 mg/daily yet in reality it’s more like 105 mg daily. I bumped up my dose obviously without my doctors knowledge, stupid I know, yet at the lower dose I am worthless. Unmotivated, unable to focus on one particular thing, mind racing, etc…..I am not certain how to explain my dose to my doc due to him being a bit conservative and fairly new to me as a patient. I do not want any lies or questions coming bewteen my doctor and myself It’s just I’m uncertain as to how to ask for an increase or if an increase is even an option? Please help if your able,
SIncerly, Leighann Foley
Mike,
Interesting comment and thanks for the interesting site… I just haven’t seen any problems with Vyvanse on the pH side of matters, but do look forward to spending more time over at that site you sent.
I appreciate that you are thinking on this level and especially appreciate your sharing with our team over here.
Thanks
cp
along with vitamin C, it’s important to remember that foods can affect how ADD medication works depending on their PH.
http://adultadd.info/QuestionsAnswers.htm#Can_food_affect_how_well_amphetamines_work_
This is a good site on which foods are which. Orange juice is interesting because it’s acid in your stomach but alkalinizing after your body metabolizes it, so it could reduce the effect of Adderall and increase the effects of Vyvanse.
My son is currently on 5mg of Focalin XR once daily. It is not lasting the full school day and he has been switched to Vyvanse. He was prescribed 20mg of Vyvanse and his doctor said to give him one fourth of the dose – equal to 5 mg of Vyvanse. It seems to me that 5mg of Focalin XR is not the same as 5MG of Vyvanse. Is there a conversion chart? my son is 8 years old, 53.5 inches and 78 pounds. I am thinking that he will be okay with the 20mg dose and that I should not give him one fourth. Any advice?
Stephen,
Interesting comment on the Vit C… I just haven’t seen it with the Vyvanse as I did with the Adderall – but with your comment will watch even more carefully. We use a significant amount of buffered [not straight ascorbic acid] Vit C [specifically calibrated to each person] – in the AM with chronic metabolic issues such as with fibromyalgia, and those will be the folks I will ask again.
Thanks for your comment,
cp
You can also take Vitamin c with your dose, most people experience a reduced effectiveness of Vyvanse when they take Vitamin C
Royal,
No prob, no damage done… have seen many have problems, much more significant than this, with multiple drug interactions and clear “out the top of the window” toxicity – [not so subtle as your issues] and they turn around with no problem, once the underlying issues are directly addressed.
cp
Thanks for the advice; it’s a great service to all of us. I plan on basically using the titration method to ensure I get a consistent 15mg/day, at least until 20mg doses come out and I can try that. Reading back on your “therapeutic window” posts, it strikes a bell with me, because there are some days where I will have problems sleeping, and then one day I will just crash for 10 hours or so to make up the sleep. Hopefully with a halved dosage I can get rid of some of these side effects; I just hope no long-term damage has been done by me taking too much.
Crown Royal:Temperature
Sorry I answered your temperature machinations under the Jay inquiry…
Your plan sounds quite workable – unusual, and not typical, but not a medical problem – except with the sleep issue [if occurring], and the inconsistency issue if you use it too irregularly.
Vyvanse [and all psychostims] should be used conservatively, so the dosage patterns preclude significant side effects, and the delivery system, the prodrug action and the consistency with metabolic pathways, has sufficient time to stabilize in each individual.
Using it irregularly will almost always lead to significant dissatisfaction with drug performance… it isn’t designed to be used that way – and everybody from the street docs to the guys at Harvard completely agree on that point.
Tnx
cp
Jay::Temperature
No, temperature isn’t a variable here, as you will note in my previous comment to the other Jay. Just watch, if you do that, for PM problems.
Sounds like you are on a bit *too much* as well with the 24 hr problems… If it is keeping you awake you are either taking it too late, or the dose is incorrectly adjusted.
Please see the CorePsychBlog and Vyvanse/Squidoo URL’s listed above for more info.
cp
Jay::Neuroscience –
First things first: Please do read my extensive post on the *therapeutic window* here:
-in this list of comments regarding the “top of the window” [or Google “window” on CorePsychBlog] and read that post carefully.
My first guess without evaluating you, but reasoning based upon the clinical evidence reported re excessive concentration for both stimulants, – I think you are out the *top of the window,* with likely *too much* on both meds, whatever your actual mg dose, and can see why you intuitively are trying to cut it down.
If you/your doc push the dose for too much intensity [most often requested by the patient] so that the drug pushes you harder, more aggressively, you overdose ever so slightly – with consequence that, just as before, once again, you can’t concentrate.
In point of fact, when “out the top” you will often have periods of massive concentration, [over concentration], mixed with brain fog and too much inefficiency with your time – the switch will go off and on about every 2-3 hrs. This up and down phenomenon is almost always associated with too much and is often called Bipolar Disorder.
The concept of “IMMEDIATELY” is not mine. Just sitting in the refrigerator does not activate any proteolytic enzyme system, so dexedrine is not slowly released through that mechanism.
You can keep it in your car, I have some people that do it that way, against my own directions, and swear that works for them… but they have to completely cut off that process early in the day as the half life will keep you/them up at night.
And regarding your observable “18-24 experience” that point alone firms up that you are on too much: best target range for DOE is 12-14 hr, and if you burn past that time you are, quite simply out the top of the expected range, and on too much. See this post here on DOE [Duration of Effectiveness]:
And this on the same subject:
http://www.corepsychblog.com/2007/11/vyvanse-for-add.html
and further summarized at:
http://www.squidoo.com/vyvanse
Then go back to your doc, ask for less – perhaps the between doses will help you get it more correctly adjusted – when Shire releases them in the July time frame – expected to have the 20, 40, and 60 mg “tweener” doses out at that time.
Good luck with your degree in neuroscience you are right on track with much of your thinking – it’s just that with these stimulant meds even more enhanced precision will often turn the course of the battle.
cp
By the way i just noticed someone else named jay posted right before me; different Jay though; i hope you can see my email address since I assume your an admin of the site. Just in case though, its johnjciii@yahoo.com
I appreciate it.
Sorry, my last post got mixed up, I meant for the last paragraph on my post to be read first, not at the end, sorry/thanks again.
Hello Doctor, I really appreciate the free advice you give here. I got a question and you seem much more knowledgeable about AMPs than my current psychiatrist does.
I recently tried vyvanse rather than Adderall 20mg.
The adderal lets me get work done but I overall don’t enjoy the feeling and can concentrate on nothing ut work or writing or reading the whole day. Oppositely, Adderall makes me less able to focus in class and puts me into a very introspective state. (completely focused on myown inner thoughts but can pay no attention to class/tv/socialization.
I have truly full blown, maximum introspective ADD without physical hyperactivity; but much mental hyperactivity.
The vyvanse however, shocked me by it’s ability to let me maintain external focus on classes/everyday routines.
However I still don’t particularly enjoy taking it everyday, I take it maybe 3 days a week which leaves me kind of lazy/unmotivated when I don’t take it.
Anyways, I feel that dexedrin would be the perfect solution for my particular type of ADD. I’ve never tried dexedrine but I know that it’s just vyvanse with a chemically time released mechanism.
The perfect thing for me would be to take one low dexedrine dose in the morning before class and then not have to feel the AMP feeling for 18-24 hours as it often seems to be for vyvanse.
Sorry, about the length of this. My doctor refuses to give me dexedrine due to it’s ‘abuse potential.’ However I konw that me, as with most true ADD/ADHD people; is that AMPS simply arent recreational for an ADD mind (except when I use it to actually study neuroscience due to my intense interest of the brain.
So, since dexedrine is apparently not an option for me I was wondering something about titration:
It says to drink the titrated vyvanse IMMEDIATELY after liquifying it. My reasoning would lead me to believe that this is for the reason that once the vyvanse becomes aqueous, the lysine groups begin to break off by the friction in the liquid in the same way that it does in your blood.
Therefore it seems possible that I could pour maybe a 4th of a 50 mg capsule into a drink and let it sit for a day or so to allow the lysine to become detached; essentially providing me with non-time released dextroamphetamine (dexedrine). Therefore, I could drink a 4th of a capsule each morning and not have to be on Vyvanse for the next 18 hours.
Does this seem like a potential method to get just a short small dose of Dextro without dealing with the XR mechanism of it?
I’m wondering if my understanding of the lysince group detaches due to liquid friction, or is it some other blood/polar/non-polar reactoin that causes the lysine to detach and leaving me with just a few hour Vyvanse experience rather than a 18-24 hour experience of which is usually completely unnecessary and unsettling for me. All I need them for is class, and then i might take a full 50mg capsule when I really have to do some hardcore Neuropharmacology studying. I struggled like never before in that class due to my incompatibility with regular adderrall, or the XR’s, or vyvanse.
This is kind of an in depth question so I understand if your not sure of how the whole prodrug chemical time releasal works. My psychiatrist knew nothing when I asked her and I had to explain to her the difference between regular XR’s like adderall and the new mexhanism of Vyvanse.
Thanks I’d really appreciate any advice; and I noticed you reccomend people to store liquified vyvanse in the refrigerator so I wanted to bring up this topic just in case you were unaware of this seeming potential to turn vyvanse into dexedrine; which is what some of you patients may be unknowingly doing.
Anyways thanks and sorry about the length but I’ve been trying to fiVure this out all semester but I wanted to hear from a real neurologist like yourself first.
Thanks again for any help/advice you can give, I greatly appreciate your open kindness in giving free advice to all of us.
If you would rather repond to me with an email that would be completely fine too; as it’s probably best to keep certain information offline due to those who may seek abuse.
Again,Thanks ALOT.
I’m 21, soon to be graduating with a Major in Neuroscience. From my unerstanding the lysine group which is attached to the Dextroamphetamine will not allow the Vyvanse to pass the blood brain barrier until enough slow steady jostling of chemical blood reactions casues the lysine groups to break off thus giving a consistent administration of actual Dextroamphetamine to be
Hello, great blog you have here. Quick question: does temperature matter when using titration? I’m currently on 30mg Vyvanse, and feel the euphoric rush pretty strongly about 4 hours after taking the pill, and I often feel that odd, hard to describe feeling that indicates the medication is working up to 24 hours after the dose. My ADD symptoms are fairly strong without any medication, but I seem to do better with much lower doses of Vyvanse (incidentally I used to need 30mg of adderall XR, but even on 30mg I didn’t feel this amplified of an effect).
I plan on putting the mix in my water bottle, which has markings at the 4 oz and 8 oz mark so I know I’m getting a steady dose, and tossing it in the fridge. Is that advisable, or should I leave it out on the counter? My gut tells me it shouldn’t matter, but I just thought I’d ask to be safe.
Thanks.
C Dickinson,
Sorry I missed your post, it didn’t come up on my blog radar, so I just found it – Your neurologist is right in terms of the literature, but what you have found is what I have experienced in the office.
The symptoms at first don’t make any sense because the dose is as small as it comes, and the specific study is with kids 6-12, with 30mg as the smallest dose – but these symptoms clearly are a manifestation of too much.
Thus this post on water titration: #6 above would be one way to retry the med, but if he were my patient, I would recommend the #11 most conservative route. Further I would stay with 1/4 for awhile, 10-14 days to evaluate duration and any further side effects at this very low dose.
Your guy may have a problem with specific sensitivity to amphetamines discussed at #2 from the bottom in this post:
If so, an AMP may not be for him – see the hyperlink on pharmacogenomics at this last post, explaining the whole situation.
Hope this works for him!
cp
I had a colleague who tried out Vyvanse and he said it works well on his ADHD problem. Unfortunately, I won’t be able to verify what his takes are on Vyvanse now because he has since migrated to Australia.
My son has recently been diagnosed with ADD. The physician rescribed him Vyvanse 30mg. About four hours after the first dose, he started talking excessively, licking his lips and scratching his hands and arms. These seem to be very significant side effects and I have not repeated the dose. (His first dose was just yesterday)
In your opinion do you think this is a bad choice of medication for him or is the med perhaps OK and I just need to titrate it? He is 7 years old and weighs about 55lbs. The 30 mg seems like a large dose for him but the physician (a neurologist)assured me it was an appropriate dose.
ADHD Guy,
Obviously I don’t know you, but it sounds like your Vyvanse dose is simply too low. Check with your doc. I do not have an adult or adolescent that has to divide the dose of the 30mg, so am guessing that the dose is too low.
All the water titration material here is for those who are significantly sensitive to meds period. The way to tell if it is too much: side effects will often, tho not always give you the clue. Look for 12-14hr DOE, then it will be closer to correct dosage.
I am always [categorical term!] careful with categorical views such as “universally.” Nothing in medicine is universal. My only purpose with these notes here: to highlight my office observation that in most cases Vyvanse does seem more effective, if adjusted correctly.
Best thought: talk to you doc, and discuss duration of effectiveness with him/her.
Thanks
Chuck
I appreciate your thoughts on Vyvanse. I’ve been taking adderall xr for the past 11 months. My doctor gave me some vyvanse to try out as an alternative. I still haven’t decided which I like better. There are pros and cons of each.
Dr. Parker, are you saying that universally vyvance is better than adderall? Do you find that people get better results with it?
Vyvanse does seem to be “smoother” but does not do as much for my motivation as adderall does. I also seem to be in a better mood with adderall than with vyvanse.
I’ve been splitting the 30mg vyvanse in half, but getting the exact half dosage each day has not been that accurate I don’t think. That could be why there’s inconsistency with my results. I’ve just recently started to try the water method instead of just pouring half of it out. Maybe that will lead to better results.