View Full Version : Vyvanse didn't help, dex DOES, but... dosage & titrarion issues.


karenparker
11-03-16, 10:46 PM
I decided to ask here, as my pdoc is on holidays.

Long story short, after trying Vyvanse and going from 20mg to 70mg within a few weeks and noticing no improvement whatsoever, I ended up taking Dex IR only.
It has been helping a lot and I also have no crashes I had on Vyvanse, so all in all - brilliant.
Except for my problems with dosing.
Pdoc put me on 2x5mg three times a day and said I should titrate to find optimal result, but generally he seemed to be hesitating towards higher dose and said not to go over 40mg in total. Fair enough.

Now, my days are damn long. I need the meds at work (which is 9 hours + commute) and I just as much need the meds in the evening, which is problematic. I seeked help because of my constant frustration and feeling hopeless about myself (among others) and this is related to all parts of my life ADHD is affecting.

So, basically, I'm not sute how to titrate - and again, pdoc is away, so I can't ask.
10mg seems to relieve some of my symptoms and from one dose I get maybe 2 hours of therapeutic effect.
I also tried 15mg which works noteceably better and also a bit longer as well - about 3 hours.

My question is, what is the smart way to dose it? I read countless threads about Dex and am still not quite sure.

Is it better to take smaller doses more often even if they don't work as well as a higher dose? For example, would taking 15mg twice daily result in a higher tolerance than 10mg three times a day? Or anything else I'm not aware of?

Pilgrim
11-04-16, 02:04 AM
Maybe this may help a bit. That conundrum of dosing.
Sarah actually wrote a comment on dosing and titration not long ago that I thought was pretty spot on. In regards to 40 mg per day, this seems to be the new magical figure, I'm on this, and to be fair I don't think I could bear to much more.

2 at a time is the way to go, I think in your situation have your next dose just before your about to crash. Plan your day in the sense of knowing when you need to be on point, or when you can just vegout. I think a key to these medications is never pushing to hard, take stress away, always. Your problem really is getting the best results for as long as possible. It's the wrong approach. IMO. Look at where you need to apply yourself, and try to find timeouts throughout the day

karenparker
11-04-16, 04:28 AM
Hmm, taking it before I crash would essentially mean taking the dose every 2.5 hours, which means that 30mg, that pdoc seems to be inclined to, will cover me for 8 hours tops. But then I don't crash that much, so maybe I can have bigger gaps?

You say I should plan it knowing when I need it most - this is the issue. I've been struggling at work because of my lack of focus and I see I do much better with the help of meds.
But that's one thing. My other major issue with ADHD are that I'm just a terrible adult. For example I'm unable to keep my flat clean and always, no matter how hard I try, I end up living in a filthy, disgusting mess. This is *very* problematic for me. No matter how hard I try I end up living in a filthy, disgusting mess. On top of that I started my undergrad degree and I simply often have to study after work.

It'a incredibly frustrating knowing that meds can with both, and having to choose. My work live vs my after-work life literally have same priority.

I don't know. Should I just get over the fact that meds won't ever work long enough to help me with some crucial things in my life?

sarahsweets
11-04-16, 04:32 AM
For me, taking meds multiple times a day in smaller amounts is what works. I take both dex and adderall xr and due to my absorption issues I taken them every 4 hours, alternating.
I used to find an ir/xr combo worked really well. I would take dex spansules and then follow up with ir dex boosters.

karenparker
11-04-16, 04:46 AM
For me, taking meds multiple times a day in smaller amounts is what works. I take both dex and adderall xr and due to my absorption issues I taken them every 4 hours, alternating.
I used to find an ir/xr combo worked really well. I would take dex spansules and then follow up with ir dex boosters.
I'd LOVE to try spansules, I feel they might be the solution. Unfortunately they're not available in the UK (unless I'm willing to pay a few houndred pounds each month). :( Same about Adderal.

How many hours do you get out of your meds, Sarah?

For now I think I'll maybe try 10mg every 3 hours and will take the first dose in the late morning instead of after waking up, maybe this will help with the work & evening results.

Fuzzy12
11-04-16, 04:46 AM
What helped me was taking more doses with smaller intervals earlier in the day. Like that I t that they lasted longer rather an s pacing them out.

Pilgrim
11-04-16, 10:05 AM
Try to do everything fail, doing to little feel like you want to fail.

Everyday do the things you have to do. These medications work better the healthier and fitter you are.

Me time. I found and I probably did it a poor way was that as long as it built my confidence it was a step forward.

Also with meds another reason they titrate you slowly is that as time goes on , this can take months and months, all the good things you have learned prove the meds work better as time goes on.

sarahsweets
11-04-16, 10:07 AM
I'd LOVE to try spansules, I feel they might be the solution. Unfortunately they're not available in the UK (unless I'm willing to pay a few houndred pounds each month). :( Same about Adderal.

How many hours do you get out of your meds, Sarah?

For now I think I'll maybe try 10mg every 3 hours and will take the first dose in the late morning instead of after waking up, maybe this will help with the work & evening results.
I get between 4-6 hours out of both adderall xr and dex. Its important to note that I have absorption issues so even long acting meds do not last the purported amount of time.

karenparker
11-04-16, 10:34 AM
I get between 4-6 hours out of both adderall xr and dex. Its important to note that I have absorption issues so even long acting meds do not last the purported amount of time.
Is the Dex also XR?
My pdoc says I have a fast metabolism and it will be hard to get the meds to work for a long time. :(

Anyway, I skipped meds this morning (so I'd take the last dose later in the evening) and all I can say is, wow, I realised how much they're helping! Around noon I took 5mg and it worked for about 1.5 hour? There is no crash whatsoever though, so I think maybe I'll try to experiment with low doses taken frequently and after a few days I'll see what 10mg does to have a comparision.

sarahsweets
11-04-16, 02:08 PM
Yes the adderall is xr and the dex spansules are also considered like an xr. I have a friend in the UK who is on dex ir and has to take multiple doses throughout the day- like something like 5 or 10mg 6 or so times a day. This is also because she cant get spansules there.

karenparker
11-04-16, 05:51 PM
Yes the adderall is xr and the dex spansules are also considered like an xr. I have a friend in the UK who is on dex ir and has to take multiple doses throughout the day- like something like 5 or 10mg 6 or so times a day. This is also because she cant get spansules there.
Thanks, Sarah, you're always so helpful! <3

Anyway, I think my main worry is that I will need a higher dose in the end and either current pdoc won't be happy with it or if I change pdocs at some point, another one won't continue. I'm terrible, I shouldn't overthink it.

I am really happy with the results, I seem to finally function like everyone else, and have literally no bad side effects, the only issue is the fact that it just doesn't last long enough. :(

I just feel/worry I will look like a junkie if I ask for a higher dose. I told my pdocs about my cocaine use before and none of them focused on that much, they didn't seem surprised at all either, and I have, obviously, nothing to hide. But I just wish Vyvanse worked for me, it just seems there's less stigma around it because of the relatively low abuse potential. I worry being on a high dose of Dex will prove problematic in the future.

karenparker
11-09-16, 12:41 PM
Well... 10mg was working well and now doesn't seem to anymore. I'm taking 15mg twice a day now, 4 hours apart, and it seems to help, but barely covers my work day. But then so did 10mg initially... should I accept it wont work out? :( when Dex is working its such a life changer, I have no side effects and everything is like always, except at the end of the day just realise I have done all I planned. I don't want to lose it....

Also, I wanted to ask my pdoc about Modafinil, I was hoping maybe it would help and possibly I could take smaller dose of Dex with it and have a benefit? Or maybe it would help and I could take breaks from Dex to avoid tolerance (pdoc said it can be an issue and that it's best if I can use Dex as needed rather than all the time).
Does anyone have experience with that?

aeon
11-09-16, 01:48 PM
It’s unfortunate that there is no XR dextro-a in the UK, a la Dexedrine.

I get a solid 10 hours of coverage from my Dex.


Cheers,
Ian

karenparker
11-09-16, 01:55 PM
Itís unfortunate that there is no XR dextro-a in the UK, a la Dexedrine.

I get a solid 10 hours of coverage from my Dex.


Cheers,
Ian
I know. :(
I'm really saddened, I felt so good! As in, not-a-useless-piece-of-crap-good.

I have appt in 2 weeks, I'll see what pdoc will say, but he was suggesting intuniv and I don't want to take it.

an0nadd
12-18-16, 09:37 AM
I was first taking 70mg Vyvanse as well, but it was only effective for ~5 hours. I have found that in my experience for me extended release medications just never work long enough, and taking a second dose of an XR medication throws me into insomnia. I then started taking 70mg Vyvanse and a 20mg Zenzedi in the afternoon as a booster. But now I have switched to just the IR Zenzedi 60mg a day spaced out in 3 doses each 4 hours apart, and this lasts for a solid 12 hours. The Zenzedi is the best medication I have tried thus far, and I've tried them all.