View Full Version : Tolerance and Max Dose IR vs. XR -- Anyone on 30 or 40 XR?


Squirmyboy
01-24-16, 01:08 AM
Hi
I have been alternatively on Concerta, Ritalin IR/SR, Focalin IR and Adderall...over the past 3 years the drugs have become less and less effective to the point that now they do little to nothing. I am shocked there is little recognition of this problem in the literature. I am sure most of you have experienced this.

I am prescribed 10mg IR twice a day - which my psych says is the highest normal dose.

There are really only two options at this point - increase the dose or take a big break. I want to ask my him to allow me to take more, though he has not been in favor of this and has no other good solutions.

The strange thing is that though IR doesn't come in a higher dose, XR comes in 30 and 40mg. Given that it is a bi-release mechanism these doses are equivalent to 15mg and 20mg IR. Is anyone here on these higher doses with good effect?

Any thoughts on the tolerance problem? I assume even if I go up I will become tolerant to the higher doses again and just be in the same place in a few months. Anyone else in this position? Cross-tolerance makes switching not that useful, unfortunately. Anyone with any solutions?

Thanks
Squirmy

Texasmexas
02-12-16, 10:03 AM
My pdoc started me on Adderall as an adjunct to depression. I was taking up to 70mg (30 IR + 40 XR) but it started making me fall asleep way too early and became a problem. I did research and asked to be switched to 60mg of Focalin IR (2 10mg tabs 3x's day) which worked great. Doesn't get me high but keeps me focused at work and doesn't make me fall asleep until normal bedtime hours.

Last visit I asked for 90mg/day and he prescribed it no problem. Even the pharmacy had to check with him. So there are docs that will prescribe high doses. I will admit I'm pretty shocked I got 90, in addition to a 90-day supply through my mail order pharmacy so 810 tablets in all. I can't help wonder what the street value of that must be but I only paid $50 through insurance.

So yeah, 10mg twice a day isn't going to be very therapeutic for most people. Next time you speak with your doc and just ask for a higher dose or to be switched to the XR. IR definitely wears off fast.

I haven't noticed a tolerance problem, but that could be why I need 90mg/day to get any benefit. They don't feel addicting to me either. Once in a while I will get jitters but I take Xanax or propranolol for that. I was mixing with morning coffee but had to switch to decaf.

You could also ask for Prozac if you're in the mood to try an SSRI. Apparently Prozac and Focalin/Ritalin potentiate each other. I haven't found any other potentiators except caffeine.

Keep researching and experimenting and don't be afraid to tell your doc what you think you need. You can always ask to go on a trial basis. Plenty of people are prescribed more than the max dose. It's up to you and your doc what works best, not the FDA.

Snake-Eater
02-13-16, 05:37 AM
With any stimulant you will always build a tolerance. Time off and taking something like jarrows adrenal optimizer during your time off will help make Stims effective again faster. I'm in to bodybuilding and the same thing happens when taking fat burners and high stimulant pre-workout supplements. Using n-acetyl-tyrosine, dmae, a good form of choline(Alpha-gpc,cdp-choline) and good forms of b- vitamins like jarrows b-right helps out when I'm on a stim break. Not sure if you prescribed anything else, so talk to your doctor before doing anything.

Snake-Eater
02-13-16, 06:25 AM
You could also ask for Prozac if you're in the mood to try an SSRI. Apparently Prozac and Focalin/Ritalin potentiate each other. I haven't found any other potentiators except caffeine.

Keep researching and experimenting and don't be afraid to tell your doc what you think you need. You can always ask to go on a trial basis. Plenty of people are prescribed more than the max dose. It's up to you and your doc what works best, not the FDA.

Not trying to bash your recommendations, but Prozac isn't prescribed for that, and dangerous to use it for that purpose. Adding more Stims will further increase tolerance. BTW, I take Prozac and focalin and still have tolerance issues. His CNS needs a break.

sarahsweets
02-15-16, 08:55 PM
The whole idea of tolerance is IMO overrated and a bit fear mongering.

Snake-Eater
02-15-16, 09:30 PM
The whole idea of tolerance is IMO overrated and a bit fear mongering.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036556/
http://www.medscape.org/viewarticle/529856

sarahsweets
02-16-16, 05:09 AM
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036556/
http://www.medscape.org/viewarticle/529856

I didnt mean to imply it didnt exist, just that the fear and chatter about tolerance is overrated. It has actually scared people away from trying meds because they read about how they could damage their bodies and end up turning into drug addicts.
I also clicked on the medscape link and it wouldnt let me read the article with out a log in.

sarahsweets
02-16-16, 05:18 AM
Stimulants' ability to cause tolerance is controversial, but the need for dose increases over time has been recognized in the literature by the American Academy of Child and Adolescent Psychiatry (AACAP). Their treatment guidelines state that “most” children will “require dose adjustment upward as treatment progresses.”.

These findings do not necessarily suggest the presence of tolerance. The participants may have also been nonadherent, dosed inadequately, or misdiagnosed to begin with. However, when a correctly diagnosed and dosed child's ADHD symptoms respond to a stimulant for several weeks or months and then relapse, what is the most likely cause? Why might stimulants lose efficacy, requiring higher doses over time?

I am not saying the article was a bad one just that it was a definitive when it addressed tolerance. It also mentioned addiction and withdrawal as well which I think are more appropriately addressed when talking about abuse of the medications.

Snake-Eater
02-16-16, 05:41 AM
Don't know whY the medscape link doesn't work now , had no problems when I found it. I've felt the effects of stimulants diminish over time, and need a higher mg to get the same effects. I take as directed too. Everyone is different, so could be that tolerance varies because our chemistry not being the same.

sarahsweets
02-16-16, 06:53 AM
Don't know whY the medscape link doesn't work now , had no problems when I found it. I've felt the effects of stimulants diminish over time, and need a higher mg to get the same effects. I take as directed too. Everyone is different, so could be that tolerance varies because our chemistry not being the same.
This is true. I just know that for some people they think if they cant feel meds working that they assume its tolerance. I guess what I mean is when you dont feel the meds it doesnt necessarily mean they arent workng at all and that you need a higher dose. ( not you specifically, I mean the general "you")

Snake-Eater
02-19-16, 06:14 PM
This is true. I just know that for some people they think if they cant feel meds working that they assume its tolerance. I guess what I mean is when you dont feel the meds it doesnt necessarily mean they arent workng at all and that you need a higher dose. ( not you specifically, I mean the general "you")

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