I know I recently gave a rant and a rave about the inventive ways that pharmaceutical companies make an old drug “new” by making it sustained release or orally dissolvable, but I wanted to call a new medicine to your attention. Vyvanse is a recently approved medicine for ADHD. It is good old dexedrine (dextroamphetamine), one of the active ingredients in Adderall, my overall favorite stimulant for ADHD. The neat thing about this medicine is that it is a prodrug–a medicine that is inactive on its own and becomes active after being metabolized by the body. In the case of Vyvanse (lisdexamfetamine dimesylate), once it is absorbed by the body, an amino acid (l-lysine) is cleaved off the molecule in the liver, leaving dextroamphetamine, the active ingredient. The maximum concentration in the blood (Tmax) is reached in about 3.5 hours. If it is taken with a high fat meal, the Tmax is reached in about 4.5 hours. Food does not effect the overall availability of the medicine (measured as ‘area under the curve’). Its duration of action is similar to Adderall XR showing clinically significant effects at 10 hours out. The standard starting dose is 30 mg and it comes in 30, 50, and 70 mg capsules. It is completely dissolvable in water and can be taken that way without it effecting how it is absorbed or metabolized. Since it is a less complicated compound than Adderall (which is a combination of a variety of dexedrine and amphetamine salts), it can be considered an option for someone who did not do well on, or tolerate Adderall.
The scuttlebutt on the street is that it has less abuse potential than Adderall or regular dexedrine because of it’s prodrug status. In looking over the literature that the company provided for me, I don’t see that that is necessarily true. I will have to see how my experience is with it in my patients over time. Since it is new, I have yet to find an opportunity to prescribe it.
Any comments from the audience???
–Dan Hartman, MD
I’m not a chemist, so I could be wrong. But if someone really wanted to abuse vyvanse, converting it into plain old dexedrine would be laughably easy. I won’t give full details here for obvious reason, but it doesn’t involve any particularly special equipment or chemicals.
I suspect that the lysine group is therefore more for patent purposes than to decrease abuse.
Is there any reason to prescibe it over Dexedrine SR?
Sorry Chimp, I gotta admit that it may be laughably easy for YOU to cleave the lysine off the dexedrine . . . I would be clueless! And honestly, it would probably be easier to go down the street and buy some Adderall off someone on the street (or a friend for that matter). Adderall is as ubiquitous as ibuprophen and not much more expensive. The comment made to me about it being less abusable has not been followed up by any company representative, so I don’t know what the party line is on that. I’ll let you know when I get ‘detailed’ by a rep. For your second point, is there any reason to prescribe it over sustained release Dexedrine (marketed in the USA as Dexedrine Spansules (GSK). No. Not that I can see, anyway. Your comment is interesting. Dex Spansules are not used very often–at least by me. And I don’t know why, quite frankly. Probably fell off the radar screen when the “new and improved” version (Adderall) came out. Given what I have just read about it in the PDR, however, why should I prescribe Vyvanse??? I’ll ask the rep when they stop by!
–DH MD
I have to drop something here… I am very (psychologically and mildly physically…) addicted to Vyvanse. Vyvanse was my first taste of amphetamine, and it hooked me. I’m eighteen so it probably holds a stronger effect over me than older adults, but I can defiently prove the whole non-abusive b.s. wrong.
You pretty much HAVE to swallow Vyvanse in order to feel it to it’s full potential, but that doesn’t make it… unabusable.
LDX–
So what are you going to do about it?
–DH MD
LDX: that’s ridiculous, if you don’t have adhd get off the vyvanse. I honestly don’t see why anyone who wanted to abuse an amphetamine would take vyvanse, because of it’s delivery you Don’t get any kind of rush or euphoria or energy, it just helps me concentrate. I Love being able to concentrate Without feeling wired. I can’t understand why anyone wants to feel that way.
Just started vyvanse on 50mg and can definately see myself abusing this little jewel
Bean-head . . .
Sorry if this sounds . . . unprofessional . . . but what do you expect from me with a comment like that. I could spout some sort of professionally PC comments about how it would be beneficial for you to consider some sort of rehab program, and that you need to consider your health, and all sorts of stuff like that.
But, I tend to be a different kind of shrink . . .
Your comment makes me angry because of the effect that you and people like you have on the perception of mental illness and appropriate treatment for mental illness. You are a jerk. I am not amused by your comment. If you are going to abuse your meds (or someone else’s meds), keep it to yourself. Go do some volunteer work with people who really suffer. Go work in a literacy program in an inner city school with kids that need to have this medicine for real reasons . . . not just self-amusement. Go make something of yourself.
–DH MD
Just a note about drug abuse: many individuals have a proponent towards an “addictive personality.” Some are more likely to become obsessed with something than others; just ask your buddy who is always on the computer or has a tendency to gamble. The same goes with drugs – a little curiousity and a tendency towards overdoing it is how many begin to abuse drugs. Calling someone a bad person because they are curious, and making rather bad choices, is cruel and stupid – and NOT what a doctor should say. I’d rather have someone toking up or ingesting a prescription pill than driving drunk, personally.
That aside, I must say that this drug is completely possible to abuse. In fact, I have a friend who sells it and finds more customers than for her adderall. It is the closest thing to meth that anyone can find in a pill (unless you actually NEED a stimulant, then it will just make you calm down; funny how this happens).
As I said . . . There is a side of treatment for substance dependence that is supportive, pro-health, reflective on the underlying reasons that are driving someone to abuse and misuse one thing or another.
But read what jojo wrote. What was written was a reflection of abuse of a substance for self amusement. That by itself does not require a comment by me (as you mention we all partake of various things for self amusement). It was the taunting aspect of that that was of concern to me. It has no place on a forum for treatment and health. And if it is brought up in the manner in which it was brought up, it needs to be put in it’s place.
If someone came into my office and spoke that way, I would, of course, try to point out the relative virtues of not abusing prescription medication. If in the course of my conversation with him he started talking about how he couldn’t wait to “abuse this little jewel . . . ” I would know that this person is not serious enough about treatment to get treatment. I would also know that there is no place for that person in my office till he was ready to make some changes. This site is about treatment, not about figuring out how to get high. Calling his comments what they are . . . disrespectful taunting . . . IS part of treatment. Glossing over inappropriate and disrespectful actions or words allows the person to continue to think that what he is doing is not wrong.
Suppose, for example, that he held a vyvanse tablet in his hands and said the same thing to . . . his mother . . . his grandmother . . . a cop . . . how would they take that? Do what you want to do but do it in a way that is not disrespectful of others. On some level you and jojo know this because there are people that you do it and talk about it in front of and others that you keep shielded from your drug abuse.
As I said, I tend to be a different kind of shrink. Straight forward and direct. Not unsympathetic, not cold, not disrespectful, and, I guarantee you, quite savvy when it comes to knowing what to say and when to say it in my relationships with my patients. My patients know that they will get a straight forward and honest response from me, not a nebulous “hhhhhmmmmmm . . . how do you feel about that?” They (and jojo) may not always like what I have to say, but I am not in this business to coddle people who need a kick in the pants to make some changes in their life.
I stand by my comments to jojo.
–DH MD
DH MD:
I am a 36 years old, female, 181 lbs., 5’8″ tall, take other medications for asthma and allergies, am of average or slightly above intelligence, and of normal mental state and health.
I was recently switched from Adderall XR (60mg daily) which I had been taking for the past 4 years to Vyvanse (70mg daily).
Day 1: Within 30 minutes of taking Vyvanse I felt somewhat dizzy. A little later my arm seemed tingly and kind of numb in the hand and slight chest pain. Then toward the end of the day I had the worlds WORST headache. Decided stick with taking the Vyvanse as I read that it could take a week for it to be fully effective.
Day 2: I awoke feeling as if I had been continually beaten in my lower back area on both sides. I’m guessing this would be my kidneys reacting to something new? No more dizziness, tingling or numbness this day. Still feel the occasional slight chest pain and the all day, whole head headache.
Days 3-7: The only side effect I feel now is the whole head headache and occaisional tightness or slight chest pain.
Weeks 2-4: The whole head headache and occaisional tightness or slight chest pain.
Mental Effects: I love the way Vyvanse made me feel mentally. I felt happy, empowered, alert, focused and just “like real self”. I was able to complete my to do list each day. Did not have the tendency to get slightly depressed, overwhelmed, stressed or angry as with Adderall XR. In a nutshell, I had a better outlook on life and was ready to take it on. One positive (although is a negative for work) was the “don’t care/don’t matter” effect…. little things that would concern me, stress me or get me feeling down before had no bearing on me while taking Vyvanse. i.e. “Don’t Sweat The Small Stuff”. Did notice I was more easily distracted while working and did not tend to look at things from EVERY angle or as deeply on Vyvanse. Did feel, before researching dosages, as if it was just taking the edge off and if I could increase the dosage I would feel better physically and get better effects.
Physical Effects:
I hated the headaches and occasional chest tightness or pain. Was impressed with the lasting abilities of Vyvanse at around 12 hours compared to Adderall XR lasting around 8 hours. With Vyvanse I slept better and less and was ready to go and do from the start of the day until the end of the day. On Adderall XR I tend to sleep lighter and much more.
Results:
At the end of the 4 weeks, I was called to my Supervisor’s office at work. My Supervisor informed me that my quality and productivity was down and had received to many errors during the past month. I was handed a written copy of my “verbal warning” which is the first step in the disciplinary process. Obviously, the lack of attention to detail/distractability/don’t sweat the small stuff attitude on Vyvanse showed greatly in my work. I drove straight from work to my doctor and told her I had given it my best try but the headaches and low work performance was enough to cost me my job and asked to be switched back to adderall. I am now back on Adderrall XR taking 60mg in the morning with a 10mg “booster” dose in the afternoon. I am doing well on this regimen and the booster dose seems to help continue the effects long enough to finish out my day beyond work without feeling tired, depressed and not accomplishing anything at home.
Concerns:
I believe my dosage may needed to have been increased due to the fact I had the same type headaches with Adderall XR until the right dosage for me was found at a higher dose. My doctor would not prescribe more than the highest recommended dose of 70mg. I researched the internet and found that significant testing of Vyvanse has only been done in children, not adults. Dosing recommendations are for children, not adults. The approximate equivalent dosage for Adderall XR vs. Vyvanse are great. i.e. 70mg of Vyvanse is equivalent to 30mg of Adderall XR. This is a drastic change for those taking greater than 30mg of Adderall XR and being switched to 70mg of Vyvanse and it would be my guess that will be the main reason most will stop taking Vyvanse because of the difference in medications and shock of the lower dosing.
I am also very concerned that the only study in humans for Vyvanse was done on children for only six weeks! With that said…. What would be the best and appropriate dosing recommendations for adults? What effects, positive and negative, does the medication have on adults? What are the short term affects on adults? What are the long term affects for children and adults? What is the half life/metabolism of Vyvanse in adults? What are the effects on the organs, again short term and long term, with the metabolism and converting the the drug in the liver? What are the effects of the greatly increased amounts of the amino acid l-lysine in the body?
Overall:
If given the opportunity to try Vyvanse at a different dosage and shown controlled studies that support evidence to show no ill effects of long term usage with Vyvanse….I would be first in line at the doctors office asking for a prescription for Vyvanse and immediatly flushing my remaining Adderall XR down the toilet!!
(I am in a hurry and am just going to post this comment without proofing or spellchecking…my apologies for any mistakes in that deparment)
I am very interested to hear your thoughts on my good/bad trial with Vyvanse.
~Amy
Amy–
Hey . . . write any novels lately? I thought about editing this down, but decided otherwise. Just a couple of (quick) comments. It is rare for meds to get more than 6 week’s trial in the studies going up to FDA approval. Most medicine has a statement such as . . . “use for longer than 6 weeks has not been evaluated and might end up killing you . . . ” or some such statement. Look for yourself at the drug company info for most meds. Anyway, that 6 week thing never gets in the way of using most meds for longer. Of greater concern to me is your chest pain, let alone the headache. Given that pattern of symptoms, I would urge you to get a full cardiac work-up, including a stress test. There has been a low frequency of severe cardiac events in people taking stimulants and chest pain is one of the more concerning red flags.
I, too, would be reluctant to go higher on the Vyvanse with the pattern of side effects that you are experiencing. If I was your doc, I would urge you to stay on what works (the Adderall along with an afternoon booster–a fairly common strategy) and skip the Vyvanse for now.
You make me nervous!
–DH MD
ive started taking Vyvanse a couple months ago and have had great results. It does give me some what of a rush… a boost, and i noticed the only physical side effect it seems to have on me, is that i grind my teeth (molars) alot. its weird. but after i take it, i notice me tightening my teeth to the point that they get sore. im 24/male and take it for my ADD. it helps motivate me. although it does give you a ‘who cares’ attitutde about somethings, but thats kinda what i like about it.
Chas– That “edgy” sort of feeling is not uncommon with the stimulants. The best way of dealing with it is to lower the dose slightly. With Vyvanse, drop it down 10 mg every few weeks to see if you get to that happy spot where you get benefits and don’t have the teeth grinding thing going on. If you can’t find the happy spot, try another medicine.
–DH MD
I am a 30 year old male, and I’ve been taking stimulant ADD meds for about 15 years. The last 5 years I’ve been on Metadate CD 60mg every AM. Worked pretty good, and insurance covered most of it.My doctor switched me to Focalin XR,20mg AM. The Focalin seemed less potent, but I liked the idea of taking only 20 mg. Then, 3 days ago she switched me to Vyvanse, 50mg. Once daily. Wow. BIG difference. I actually, for the first time in my life feel like my ADD has been cured. The Metadate and Focalin made my armpits sweat uncontrollably. I was always nervous, jumpy and twitchy. Until 3pm, when it wore off. Then I felt like a zombie. I NEVER took it when I wasn’t at work, because I hated the way it made me feel. The Vyvanse is so different, comes on so subtle you hardly notice, then once you realize “hey, the meds are kicking in” it’s like 8 hours of pure concentration, no sweaty armpits, no jitters,just a brain that feels organized and efficient. Then the “comedown” is the same. You don’t even notice it until later, it’s sort of an incidental thing as opposed to a day-ruining crash. It is a lot more gentle than Methylphenidate. No huge speedy rush, no big irritable crash. One thing that makes me a little leery. I have noticed a slight chest discomfort at times. Just an ache near my breastbone that lasts maybe 5 min., then goes away completely. This has happened at least once every day I’ve taken Vyvanse. Usually twice. The reason I’m leery is I have a wife and 2 little kids. I have never been on anything other than Methylphenidate, now I’m on a form of Amphetimine which I KNOW is less safe. I hope that 15 years of ADD meds haven’t screwed up my heart. I would rather live with ADD than die young. It really bums me out, because finally I found something that works, and naturally it’s probably less safe.
I started having panic attacks and was very unsociable and kept to myself,all this started about 10 years ago. The doctors diagnosed me as bipolor,i’ve been on every med available for bipolar with no positive results. Last december my doc decided to try me on 20 mg 1 a day generic adderral. It turned my life around i was talking to people i had avoided for years and started back doing normal activities instead of cutting myself off from the rest of the world i also was not as angry as before. To start with one a day is all i could handle, it gave me more than enough energy. Now in august i am taking 4 a day and i feel almost like i did before i started taking them. I have severe headaches and mood swings,i also become very angry easily. My doc switched me to vyvanse, i am scared i will fall back in the rut i was in for all those years. Will vyvanse be as good as adderral, and how long should i take it before i notice a change? I wonder if i quit adderral for a couple of months and then start it again , will it give me the affect it originally did? My behavior is affecting my whole life. Is there any advice or anything encouraging you can give me?
I just got switched to Vyvanse (30mg) from Adderall (10mg) when I moved a few months ago and had to get a new Doc. He said I should try the new medication to see if I liked it. I’ve always had a kind of worker bee reaction to it and only take it during school. I haven’t noticed much difference between the 2 drugs other than the Vyvanse lasting a lot longer than the Adderall, which is terrible because I take it at 1pm and can’t get to sleep normally until 5am when i used to wind down by about 1 or 2. I notice chest and back tightness my eyes always feel dry, and I get anxiety when I’m normally too all over the place to really notice anyone else is in the room. I just thought I’d throw out my story.
On the abuse conversation above, I don’t understand why people would want to take this by choice…but I’ve always been told by others that it has the opposite reaction for them as it does for me. I get really calm and introverted when they all act crazy like I do when I’m off of it, haha. I do see how that comment coming from a Physician that truly cares about helping people could be a bit insulting though and would just like to throw props out to you doc man. It’s comforting to know that there are people out there caring for people rather than just running an assembly line. Keep it up and know that you all are not taken for granted.
-Matt-
I’ve just been prescribed Vyvanse for refractory Clinical Depression. I was hospitalized twice decades ago then was started on a regimen of dexedrine which I never abused. It got me through graduate sschool. After about seven years I was taken off it. since then I have had several severe depressions as I am now. I have been prescribed every possible antidepressant; the SSRIs make me somnolent, only Wellbutrin improves my mood somewhat, but the inability to focus is making me even more despairing.
After such successful experience with dexedrine, I am very angry at shrinks/psychopharmacologists who have denied me the one drug that has kept me from diving off the Brooklyn Bridge. I hope Vyvanse works.
Tried Adderall for 3 months…ANGRY crashes. Moved over to Concerta for the past year – wonderful…but started to become less and less noticable. Day 9 of Vyvanse…OMG – my husband thinks he’s married to a different person, my kids are shocked that I know how to cook, and I’m able to write/paint again (Which Adderall and Concerta, especially, made me not want to deal with…was difficult to find the creative spark). So, I love Vyvanse.
Now, here’s my I’M NOT A DOCTOR warning: I read the literature completely before switching to Vyvanse…and was concerned with the VERY BOLD PRINT warning about cardiac/stroke occurances to those with coronary disease and/or hardening of the arteries. Chest pain, arm tingles, AND headaches can be cardiac warning signals. The literature states that if any of those symptoms occur that you should contact a DR. right away and discontinue use.
So to anyone who is reading this…why not spend some time reading the advisory warnings before popping a new drug into your system. I mean, come on, how many Psych DR.s actually EVER ask about your heart condition before giving you a RX? Anxiety, suicidal thoughts, mood swings – yes…but NEVER EVER any heart health question. Anyhow. That’s my 2 cents. I don’t have heart issues, I respond really well to Vyvanse, and it lasts longer than Concerta.
The End.
OK, Now I am confused , I thought the point of meds for ADD was to help up concentrate, not jack us up, I have enough of that, I was diagnoised Bi-polar, but I think they are full of it. But I do not know where to go to get a doctor to help me. My primary sends me to mental, they want to know what the primary says.. Where do you get dx
Thanks
Amy
Amy . . .
Don’t be confused . . . Any of the meds for ADHD is for focus, concentration and impulse control. NOT to “jack” you up. It is not uncommon for patients who take the stimulants to feel more energized and awake. After all, they are stimulants. The ideal is for you to feel like you can focus and concentrate and not much more than that. If I get a patient who is too wired on the stimulants . . . it is time to change medicine.
As for getting a proper diagnosis, I would expect that a psychiatrist would be ale to do that. I would NOT expect your family doc to be sophisticated enough to do that. No cut to the doc . . . I don’t do hypertension. Sometimes, however, you need to make some noise. If you don’t like the doc that you were sent to . . . complain. Maybe there is someone else in the group or you can switch to someone else. IF you cant get satisfaction from your PCP, Ask for a new doctor.
–DH MD
I really never write in mess. boards but I have been on vayvance for almost 3 weeks.I have to say it is the best thing I have ever done.It has changed my life I can now be attntive to my kids and husband.I can be on time when I need to be some place at a set time I can be there I can play with my kids as before I never want to do anything I was plain and simply lazy and never wanted to be around anyone and not focus on anything..I am so greatful for this med.I used to have negative thoughts that would not stop all day long it was driving me crazy.I also used to have to take somehting like an over the counter med to help me fall asleep now I can sleep very good.The onlything not happy with is I wished it would last a little bit longer it worn off in about 4 to 5 hours and after it wears off I have so heart palpations but I was having them from the anxity before I ever strted the meds.I dont have them during the 4 or 5 hours it is working it is when it wears off.Any way God bless you all.
I am a 47 years old and I have been on Vyvance 70mg for about two months. I get very good results at work and at home. I am a lot more pleasant with my family and co-workers because I can comprehend what is going on around me. I am a lot more productive and have been able to take care of personal business that I have procrastinated about for years.
My son started with Vyvance about three weeks before I did. He has had very good results with his school work… normally would be getting C’s, D’s and F’s the first quarter and now he gets A’s, B’s and C’s!
At first there are a few mild side effects (headaches, tightness in the back, etc.). Within a few days these subsided for both my son and I.
I have had very good results on Vyvance, even on my job… I tend to be very attentive to detail without drugs so the people that have the “don’t care/don’t matter” attitude on Vyvance probably have never had that advantage. Vyvance makes me worry less about things that I can not change anyway. I have a nervous stomach and taking Vyvance has made life easier for me.
I have noticed that Vyvance does not last for 12hrs like it says it does. I am considering trying Adderall as a second does in the evening to get me through the day so I am able to get things done at home too.
What are your thoughts on that Doc?
I do plan on asking my Dr. but I wanted a second opinion.
Thanks
Sal–
The difference between Vyvanse and Adderall is the simplicity of Vyvanse. Being a single dextroamphetamine as opposed to the 2 dextro- and 2 amphetamine sals in Adderall, I think you are mucking up the waters by adding Adderall. If I was your doc, I would add a small dose or old fashioned short acting dexedrine to boost the effect of the Adderall
–DH MD
Doctordan – do you mean add dexedrine to boost the effect of Vyvance?
Sal . . .
ooooopppppssss . . .
Yes, I mean to boost the Vyvanse. But, on that same topic, plain old dexedrine can logically be added to Adderall, too, since it is at it’s root a dexedrine compound.
Thanks for the correction!
DH MD
It seems like the problem with people abusing Adderall XR, Vyvanse, and other long acting stimulant medications is not caused by the medications themselves, but how they are prescribed. Whenever an amphetamine reaches a certain concentration in the blood stream, euphoria is commonly a side-effect. This is the “buzz” that people talk about, and what people that are addicted to amphetamines strive for. An easy way to get this feeling is to put amphetamines into the system at a rate that is much faster than the rate that your body can eliminate it. That is why abusers might inject or inhale amphetamines instead of taking them orally. When people abuse Adderall XR and Vyvanse they still must take it orally (these two medicines are designed to not be effective when they are inhaled), but many still say they experience euphoria for the first 4-6 weeks of taking them. It looks like they are reaching a blood plasma concentration of the amphetamines at a high enough rate to induce euphoria even though they are taking it orally. Also, because it only lasts 4-6 weeks, it seems that as the brain gets used to the medications they no longer produce the euphoria. In order to get the medicine to a therapeutic level without causing the addictive euphoria (that makes jojo excited to abuse amphetamines), maybe we should think of prescribing these medications in a gradually increasing amount. I noticed in the Shire’s (the company that manufactures both of these medications) research that they gradually increase the amounts by 10 mgs a week. It seems that this is the key to allow ADDers to gradually get used to the medications in a way that does not cause the euphoria effect of stimulant medications. I recommend starting the prescription out at 10 mgs a day and then increasing it by 10 mgs/day every week until the desired effects are reached. Another advantage that I have found in this method is that it avoids the patient making the association between the medicine “working” and “the buzz” they feel. Sometimes when this method is not used, I have patients constantly wanting me to increase their dosage. They think that because they no longer have the buzz that there medicine stopped working. If every physician prescribed the long acting stimulants in this way, it may help the way society views these stimulants.
I just wanted to put my two cents into this one…..I’m a 38 yearold male who has been searching in vein for several years now to find something to help my overall approach at life. I’ve taken meds for anxiety, depression, and bipolar. I have gotten very little results from all. Today, however, may have changed my perception of not only my diagnosis but my meds that I have been taking. Lethargy was and has been the main culprit and for years I declared anxiety and or depression as to the reason. Today I was prescribed Vyvanse and some three hours after taking I feel FANTASTIC! Just worries me that anything that works this well and this quick could come with a hefty price…Any comments on this would be helpfull…thanks to all…Roland
I was prescribed 70mg Vyvanse for debilitating chronic fatigue. The 70mg was totally ineffective. At 6’2″, 220 pounds, I think the dosage was too small. My psychiatrist will not increase the dosage. I self-titrated and found that 210mg will get me through the working day but I’m exhausted by 6:00PM. Can Vyvnse be prescribed above 70mg?
K–
good issues brought up. Look at the Jan 24th entry for a complete answer.
–DH MD
everybody argues back and forth about whether vyvanse can be abused. from my own experience, yes it can. i have self medicated myself and am now under doctors care and now on the proper dosage. anyone who says that it can not be abused is absolutely 100% wrong. at a therapeutic dose it works wonders for people who really need it. it has been a god sent to me. at the proper dosage, but it can be abused i know from experience. for person 27 years old, 70mg is the maximum dose to date
I am currently an eighteen year old college student at a prestigious university in Washington D.C. Vyvanse is the first ADHD medication that i’ve ever been prescribed. If you were to meet me on a good day, you wouldn’t think that I have ADHD or any type of learning disability because I’ve discovered that balancing my blood sugar and maintaining a well balanced diet is paramount in conquering my symptoms of ADD and ADHD. This practice, however, as most college students can attest to, is much easier said than done. For this reason, I endorse Vyvanse as a perfect contender against my ADHD. Although the bottle says take one pill daily, I tend to take two or three pills of the 30 mg every two or so weeks, usually a few days before a long string of tests or due dates for papers. I was formerly perscribed to the 60mg dosage, but found it hard to sleep at night, even if taken early that morning. Because of this I requested that my dosage be lowered. This drug has truly saved my academic career.
My first experience with the drug was in high school; I took it before the SAT’s on my second attempt. In cmparison to my first attempt, in which I took the test with no study drugs, I was actually able to raise my score by 280 points! This, in no way, is an endorsement towards abusing perscription medicine, which I, unfortunately, did since I was not perscribed to any ADD medication at the time, but I definitely do not regret my actions.
I’ve found that taking the drug when one “really needs it”, will reduce the changes of dependency and reduce the chances of experiencing the negative side effects, to a much greater extent.
I’m 48 years old and I’ve been taking Vyvanse for over a year now. Prior to that I was on Adderall XR, which worked great, but wore off about 1pm every day. My doctor switched me to Vyvanse because it was long lasting. It also was wonderful, I got things done, enjoyed being around people again, but it wore off after the same amount of time, even when I worked up to taking the 70mg dosage. So when I asked my doctor what we could do, she wrote a prescription for two 70mg Vyvanse a day. I wasn’t sure about it, but the first week it really worked.
I’ve been taking that dosage about half-time (only on days I feel really exhausted early in the day) for over two months now and have started experiencing chest tightness during the day and shortness of breath anytime I lie down. I have strange sensations in my feet and legs, feels like bugs are crawling on me, but nothing is there.
And I don’t feel like the medication is working any more. Occasionally I will take it and have a couple hours of productivity, but most of the time I just sit and look around me at the things that I should be doing and wish I would do them and the next thing I know the day is over and not much got done.
I’m tired all the time and frustrated with myself that I don’t get more accomplished. Short-term memory problems and ADD symptoms led to my losing my job three years ago, I don’t want to lose the rest of my life too.
Doc,
Is this thread still active? I am a 22 year old male with a history of drug abuse, opiates specifically. I have taken amphetamine based medicines in the past but only to help me concentrate on school work. I never considdered it to be recreational or reach the level of abuse. I was diagnosed with ADD about two years ago but do to my drug abuse and sack of sufficent clean time my phychiatrist/out-patient recovery center doctor would not prescribe me any amphetamine based drugs. We tried Stratera but i found that to be utterly useless. Now, I have almost 18 months of clean time and at my urging my doctor has agreed to prescribe me a closely monitored Vyvanse regimen. I started about a week ago at 40 mg. The first day I felt a little too much, second day was perfect, the third nothing. I tried upping my dose by 20mg and I had slightly improved concentration but the next day when i took the 60mg again I felt nothing, no improved concentration at all. I am not med seeking I just want to be able to focus on my massive work load. But i’m afraid if I voice my concerns my recovery doc will just think i’m trying to get high, and frankly if 60mg doesn’t work i doubt 70 will. Can you recomend any other meds that you think might be suitable or any way to effectively approach this situation with my doc? By the way, I have had no urges or cravings since starting Vyvanse. If this thread is still live I’d appreciate your advice.
-Thanks, Pete.
well i dont know if anyone come to this page anymore but i was recently prescribed vyvance and personally i love it it made me seem like normal like all the little things that i jsut constantly stressed over i no longer worried about and im 16 years old and a senior in high school and i jjsut took it today and i was prescribed 1 3omg pill a day and i took 4 in the morning before school and it jsut made me feel really good and happy and focused and my anxiety no longer bothered me but i took it at around 7 am and its aporximatly 2 am and i have not eaten anything all day i know i need the food but im just not in the mood for anything and my mind is wide awake but my body is deffinitly exhausted i love the way this pill works but it ha its flaws that really get to me like the erectile disfunction im deffinitly not down for that and i just took it today and i noticed that problem as well as randomly i go to class and i get very agitated over nothing for like two minutes then it goes away and im fine but i still dont like that and i also have had back aches and head aches and numbness through out certain parts of my body and my chest has also had sharp pains out of no where that lasted around 10 to 15 minutes which wasnt to fun but i like the way this makes me think and focus but i absolutly hate the side effects occasionally i would get lost and confused and just didnt know what to do i personnaly dont like that feeling also my vision became kinda blurry but it makes me happy and relaxed and it gave me a good tingly feeling through out my body at random times its kinda like a very low dose of ecstasy i occasionally do stuff like that but i also smoke everyday and this drug made me feel like i didnt need it i have been prescribed concerta and within a few days of taking it it made me very bipolar id flip about anything so that was for me but im just not cool with the idea that i have to take pills for the rest of my life to be normal. and is there any similar adhd pill with out the ed?
Hi
Have read all the comments with interest…can you lot help me…my wife has been taking dexidrine for about 5 years 3x a day 15mg …it keeps her awake and able to concentrate, but there are a few side affects such as voice changes when she is tired and an odd mouth movement (tic) She has tried Ritalin but that makes her depressed. Also when she drinks alcohol she becomes very moody. At weekends she wants to stay in bed until midday. Iwas wondering wether Adderrall SR or Vyvanse would be better. There is a history in the family of ADHD, and our 2 sons have ADD the youngest takes Equasym XL but not sure if that is helping him at school. His grades are low and not very motivated with writing. At the end of the day can be very silly and rude…and aggressive but no harm. No Crank replies please. English GPs are more than useless with this condition
Neal–
What you talk about is switching a short acting agent for a long acting agent. For many people, long acting agents give a smoothness that is absent with the short acting agents. It might feel better to her but I am not sure it will make a difference with her side effects. For those of us on the west side of the big pond, “Equasym XL” is a long acting ritalin based product.
–DH MD
Ripping apart a person for using vyvanse recreationally is a bit hypocritical in my opinion. Apparently there are people that ‘need’ vyvanse but those people are typically looking for a shortcut to solving their adhd problems, no matter how unhealthy it is to give amphetamines to 10 year old kids despite the overlooked neurotoxicity of it, why don’t you toss in some oxycontin for social anxiety. I was prescribed amphetamines and taking over 130mg of adderall a day until I realized i could overcome my adhd with much healthier means, but that is the heart of america, gratification now for the expense of tommorow. It is a lot safer to use it recreationally as opposed to getting continually dosing children with amphetamines, destroying dopamine receptor sites and leaving them dependent on a medicine to keep them feeling normal. I’m a recreational user, though i much prefer psychedelics to amphetamines. Just because someone uses drugs does not make them a degenerate slob who is uncapable of helping society.
DUPOS–Perhaps you need to re-read my comments. I do not make judgements about what people choose to do with their lives. I am actually fairly liberal about those sorts of things. I am a stickler for respect. The entry you are referring to (I think) talked about doing what you want to do but being respectful to those around you. My job is to help people with their real-life psychiatric issues and medicine is just one of the tools that can be used. It should never be the only tool used. My work with patients is predicated on a certain degree of trust and accountability. I will do my best as I make decisions that impact on people’s lives . . . they follow through on my recommendations or, at least, be straight forward and honest if they do not. I don’t lie to them or deceive them . . . they don’t lie to me or deceive me. It is a relationship like every other relationship.
And, by the way, your knowledge of psychopharmacology, developmental neurochemistry and the practice of clinical psychiatry is cursory at best. I suggest you stick to expressing your experiences with medicine and doctors and don’t make generalizations based on limited knowledge and experience.
–DH MD
I’m going to throw in some points to everyone on vyvanse and some of professionals.
I too have been on vyvanse for about one to two years now. It is a phenomenal concentration, diet, energy. I’m in grade shape with a 3.5 gpa and it even doubles as an anti-depressant so I’m in a good mood right now. But does anyone want to share some side effects? As a child I was admitted into a special program for having a higher than normal learning ability. IQ average from 3rd to 8th grade was an astonishing 154 (I’m not trying to brag). Long story short something happened in my life and I dropped out of school, eventually got back to the real world and was prescribed vyvanse.
It’s been about 2 years now and I’ve noticed a lot of difference in myself. I seem to have developed an abnormal Heart rate. I seem to get a fast pulse for climbing a flight of stairs. I’m not anywhere near out of shape.I am constantly forgetting small things, the worst part is like many said before you become mentally addicted to this drug. You seem to not operate without it, its horrible. My friend john has been on adderall since high school now and he is even worse. He was sent home from work because he couldn’t do his job.
The point I’m making is the long term effects of these drugs seem to point to some sort of psychological deterioration, is this possible? If this drug facilitates chemicals in your brain, could this eventually lead to your body shutting down its own natural “focus juice.” I know that any hormone supplementation in regard to physical performance many times can cause ones body to stop producing it’s own essential hormones, so why wouldn’t this be similar?
I’ll be making an attempt to stop taking vyvanse after finals this week. Lowering my dosage till hopefully I don’t need it ever again.
I hope John from Dec. 15th gets an answer from Dr. Dan. I was on a low dose of Ativan for many years for anxiety and when I stopped in my late 40’s, I realized that “brain fog” was a terrible problem. The drug was very easy to get from doctors and I didn’t abuse it, but it was terrible for my concentration and awful to quit completely. I have never regained sharpness of concentration and yes, John, psychological deterioration is indeed possible from mind-altering drugs. Now for Vyvanse – my son (35) started on it a yr. ago. I feel it somehow led to him relapsing on drugs(pain pills, and finally heroin)after being clean for almost 10 yrs. He has been clean for a couple months, but I am paying for his expensive prescription Vyvanse plus some Adderall;He has thought from the beginning that this was his miracle drug which helped his concentration at work. All I can see happening is that it started his downward spiral into job loss, drug abuse and all the misery that goes with that. Comments on whether I should keep providing his “miracle” prescription drug?
Nanci–Your son is 35 years old and well past the age where you should feel that you should feel obliged to coddle him. If you have concerns about the medication, go in and talk to his doctor about it. If your son doesn’t want to “allow” you to have that much contact with his doctor, stop paying for it. It is, quite frankly, none of your business what medicine he takes and how it works. If, however, he has made the decision to allow you to be part of the treatment process, then you need to do what you need to do to feel comfortable with your participation in that process. That, I expect, means having some ability to communicate with the doc that is prescribing it. If he refuses, let him pay for it. If he expects you to put your money out for it, you should have reasonable access to know what it is you are buying. Your ability to communicate freely with the doc will also decrease his risk of substance abuse which may or may not be related to his use of stimulant medication.
–DH MD
Hi Dr. Dan. First of all, I think this is a great site and thank you for all the advice you have shared on here. Anyways, I wanted to share my story with Vyvanse as well as ask a couple of questions. Sorry it is so lengthy but I would really appreciate your input. I am currently in the final year of pharmacy school and will be graduating in May with my PharmD (very happy about that!). Just some background on myself: When I was in my third year of pharmacy school, I was diagnosed with panic attacks secondary to severe anxiety. My doctor prescribed Zoloft and the drug seemed to work well at first. However, Zoloft eventually changed me into a horrible person that I didn’t even know. Even my closest friends started to abandon me because they thought I was becoming a horrible person (angry, drinking excessive alcohol, no drug abuse, thank God). Anyways, I came off the Zoloft about 2 years ago because I told my doctor that I just could not focus well on anything and I didn’t like the person I was becoming on the drug. My grades in pharmacy school (years 1-3) were mediocre and I just felt so much anger towards the school, the professors, and just life in general. I knew that I wanted to become a pharmacist but just could not picture myself actually making it through college. I had very low self-esteem and I did not understand why. My doctor suggested that I try Vyvanse 30mg PO Qmorning. It worked EXTREMELY well for me during my entire fourth year of college. However, after my fourth year, I decided to come off the Vyvanse because I wanted to try and live a normal life without medication and try and deal with my ADD myself. The thing is, up until this point, I still hadn’t really accepted the fact that I had a form of ADD. I just thought this drug would work well for now and just get me through college. So, although my doctor advised against it, I stopped taking the Vyvanse. This was a BIG mistake! I have to admit that I did absolutely fine in school during my fifth year (without the Vyvanse). I even almost made dean’s list! However, studying was still kind of a struggle for me and it would take me a LOT longer to accomplish things than other students in my class. I still had bouts of anxiety from time to time but I just dealt with it. Now, here is the problem: While I was in my 5th year, I started to develop bad habits again (angry, drinking a lot of alcohol, depressed, low self-esteem, seemed like the future was out of my reach, the bad things go on and on). In December of 2009, I was written up at work (I work in a pharmacy) for making careless mistakes. I was devastated. I wasn’t even aware that I was making them! I felt terrible about myself, even had thoughts of possible suicide…..which I can assure you is absolutely unheard of for me! I have a loving family, great friends, and a great career on the horizon. So, I could not understand why I had these terrible feelings and it forced me back to the doctor. I restarted on the Vyvanse early January 2010 (50mg per day) and it was the best decision I have ever made! It has literally snapped me back out of it and I feel like I am the person I should be at this point in my life. I have accepted the fact that I have ADD. The ADD was the root cause of the anxiety, panic attacks, self-medicating with alcohol, troubled relationships, weird thoughts, etc.) From day one of taking the Vyvanse, I have felt great in every single aspect of my life. The person I was before seems like something I can leave behind forever. I can picture myself succeeding and I am proud of who I am (which is amazing!). I drink alcohol only socially and I have at most 3 or 4 beers and I can actually be social with people instead of being the one puking/passed out that everyone laughs at. Schoolwork is a breeze for me now and I have absolutely no feelings of anger. Side effects are also very minimal for me. So, now that you have the whole story (haha), here are my concerns that I hope you can help me with:
1) I feel that this medication works very well and honestly, I am scared to death of ever coming off of it because I fear that I will become that terrible person again. Is it common and safe for someone my age (24) to be on this type of medication for the long term? Is it possible that in the future I can come off this medication and be alright without it? The last thing I need is to harm a patient because of uncontrolled ADD.
2) Although I have accepted the fact that I have ADD, I have feelings of denial or guilt over the fact that I have to take an amphetamine-based medication to treat it. I really do not want anyone to know that I have this condition. I know from experience that there are still healthcare professionals out there who feel that ADD is a “croc” and people on amphetamines are just addicted to them. Are these feelings normal?
Thanks so much for your time and I would appreciate your input or feelings on my situation!
Drew–I am of a mixed mind about question #1. I started typing the conventional answer which is . . . at your age, it is not likely to change and you will need medicine for the rest of your life. I am not so sure at this point. One of my recent interests has been in how to heal your body and heal your mind in a way that reduces or eliminates the need for medicine to help with focus and concentration. I don’t have specific answers right now, so I will say to use it while you need it and stay tuned. Looking to the future, however, I think there will be greater insights into how to get away from the use of medicine. As far as # 2, your feelings are normal and you are just going to have to get over it. The “silent majority” out there does know and does live it so will not cast any shame upon you. Brain Health issues effect every family. If you find you are being treated less than respectfully by a health care provider, bluntly tell that person so and find yourself a new doctor.
–DH MD
Vyvanse is a prodrug. It is said to be less abusive because it has to be taken orally and metab. by the body to get the effects. So, all the drug abusers out there who snort or inject won’t get high from vyvanse. This is the only reason dr’s say it is less abusive.
I know this is an old thread and I am joining the conversation very late, but I started taking this medication about a month and a half ago after complaining to my physician that Adderall “over wired” me; by which I mean I felt so wired up that I thought my heart was going to beat out of my chest, even at the smallest doses. I actually preferred to NOT take it and just suffer the consequences of being all over the map with regard to work and tasks and concentration problems.
We had success with a different medicine called Nuvigil, but my insurance company refused to pay for it and I could not afford the thousand dollar plus a month cost for it (or for it’s older relative medicine, Provigil). So my doctor suggested Vyvanse and after six weeks, yeah, it is a LOT better than Adderall.
Vyvanse seems to be working for me in what I think is a relatively small dose – 30 mg – for a man my age (45) and size (5’10”, 190 lbs). I don’t get the scary rapid heart beat symptoms, I am completely able to stay focused and concentrate throughout my work day, and I cannot for the life of me see why anyone would abuse it: to me there is no “rush,” no “high,” no “buzz”…it just seems to slow my thoughts and brain down enough that I can stay on task and concentrate but not so much that I feel like I am taking a harsh medication like I did with Adderall.
One other small bonus: for the first time in I don’t know how many years, I don’t have difficulty sleeping at night, so I have been able to cut a completely different medicine out of my life: Restoril.
So for me it seems to work and has the happy side effect of taking me off a completely unrelated medicine that I was taking *only* to combat the unwanted side effects of the medicine I actually need.
The less pills every day the better, as far as I am concerned.
I am a 30 y/o female. I was diagnosed with ADHD, primary inattentive type during my first year of grad school in clinical social work. Teachers had repeatedly told my mother that I needed to be assessed for ADHD, but she refused. After being diagnosed, my psychiatrist, an ADHD specialist, prescribed Adderall IR due to lack of insurance and then placed on Vyvanse a few months later after enrolling in their patient assistance program. Though the Vyvanse was ‘smoother; than the Adderall IR, I still suffered from severe anxiety, insomnia, irritability and extreme weight loss. (I went from 130 lbs. down to 108 lbs. Finally, after trying various dose of Vyvanse (ending at 40 mg per day), my doc prescribed Dexedrine IR (10 mg x 2 daily). The Vyvanse made me jittery and anxious and I crashed very hard after 7-8 hours. The Dexedrine calms me down and helps me focus. The dexedrine curbs my appetite but I don’t experience food revulsion as I did with Adderall and Vyvanse. The Vyvanse and Adderall were too powerful. Good old dexedrine works the best for me.
Also, I was prescribed Prozac after my father died on Vyvanse, and the combination of the two drugs caused a very strange anxiety riddled and loopy experience. I did some research, and discovered Vyvanse and Prozac sometimes creates this bizarre reaction.
It took a while, but I finally found what works for me!