View Full Version : Adderall made my pulse high, but Dex is making me tired and no symptom relief...


cynthiab
01-20-17, 11:42 AM
I was diagnosed recently in my 30s. Started on Adderall (got a trial of both XR and IR, preferred the IR due to being better able to fine tune dosage). I worked my way up and ended at around 40mg, somewhat less on the weekends or days off, depending. Initially, my heart rate dropped when I started Adderall, but over time, it began to rise. I work at a desk job, and I'd be just sitting (or standing) at my desk and my pulse would be at 100 or 110. Without Adderall, my pulse would be at 60-70. I can keep pretty good track because I wear a fitbit. I'm otherwise in good health, work out, not overweight. I tried backing off on the dosage, but started having a lot of ADD symptoms (lots of spacey mistakes at work, forgetting things, etc.) I tried removing all caffeine but that didn't have any effect either.

So, then my doctor suggested adding guanfacine. I took .5mg per day for 6 weeks. It definitely lowered by blood pressure and pulse. But it also made me depressed and seemed to make my prior binge eating issues come back with a vengeance. (I get that the initial appetite suppression side effect of adderall will wane, but there's an element of binge eating being an impulse control issue, which seemed well under control for a while even after the initial appetite suppression had worn off.) I also had other impulse control issues. I found myself wanting to online shop a lot more, and seeking other activities to give some dopamine kick...

In the follow up after that, I asked if I could try dextroamphetamine instead, since I understand the L-amp is the one that is more likely to cause the peripheral stimulation. I guess that's not really the preferred option, but I explained I'd rather have IR than e.g. vyvanse, because a) I pay out of pocket for prescription drugs, b) I like to fine tune my dosage and find I need more dosage in the beginning of the day and less thereafter, and I'm able to overall take less by having IR option. The other options being suggested didn't really make sense to me: ritalin in its various forms, has similar heart rate effects. Dr. was like okay fine, but got a warning about abuse potential and possible hallucination side effects and come back in 2 weeks to check back and don't exceed 20mg per day.

So, I've been taking 20mg per day for a week now and have been feeling tired, spacey, forgetting things, losing things, forgetting and burning food in the oven / on the stove, getting comments to my work like "I think this is missing a verb or a noun or both?", crazy spelling errors, sending emails without attachments, and on and on. I feel worn out, unmotivated, overwhelmed by having a sequence of tasks ahead of me, anti-social. I basically want to just lie in bed by myself and play word puzzle games on my phone or something. I feel like it's not helping to address my ADD symptoms at all. It is however much better for my pulse. It's back to normal levels.

I'll obviously talk to my doctor next week when I have a follow-up, but wondering if anyone went through something similar?

I gather there's not really a good other option for counteracting high pulse from Adderall; not great to take beta blockers all the time.

I'm not sure if I should explore:
- Increasing dosage of Dex. I'm not sure if this is useful? Shouldn't I be feeling at least some symptom relief, even if the dose isn't quite an equivalent amount?
- Taking adderall and just seeing if I can live with the elevated pulse
- Seeing if I should try a different brand of dextroamphetamine (I got KVK when I filled this; I could try zenzedi and use the coupon - on Adderall, I typically took Barr/Teva, and once when I got Sandoz instead, it felt like night and day completely ineffective suddenly, which resolved when I went back to Barr/Teva.)
- I guess I could try Vyvanse / Spansules just in case.
- Trying Ritalin in some form in case that's better.
- Try some combination of Adderall and Dex. I understand having two scripts for two IRs is frowned upon. But I don't totally get why... I guess I don't totally understand the pull towards abusing these medications in the first place. It's not interesting to me to take more than I need to function well yet not be overly amped up or unable to sleep. In particular Dex seems to do nothing, so I'm unclear what's the big issue, but others must be affected differently. If it's a problem about it "looking bad" he could always write me a prescription for one for one month and the other another month and I could combine it in whatever way works, subject to whatever guidelines as to max combined dosage.

I'm trying to avoid having another two weeks stuck on some not useful regimen and feeling back to low self esteem and hopelessness and also damaging my prospects at work whereas I've been making good progress career wise until recently. (I started treatment somewhat soon after starting this new job...)

dvdnvwls
01-20-17, 07:35 PM
Do you have any caffeine at all? (Energy drinks, coffee, tea, anything) If yes, stop now. See if that helps.

If you already have no caffeine, then either your dose is much too large or this is the wrong drug.

cynthiab
01-20-17, 07:51 PM
On dex my heart rate is fine / regular low. In the 60s or 70s if I'm sitting around working at the computer, so I don't think cutting out caffeine would help my situation with dex.

On Adderall, I did for a good month completely cut out all caffeine (I anyways only have about 100mg of caffeine per day, and no other tea, soft drinks or even really chocolate in any significant amount, and it made zero difference.

Little Nut
01-21-17, 03:33 PM
Hey Cynthia, maybe I misread, but you essentially moved from 40mg/d Adderall IR and your symptoms were fully addressed, but had a high heartrate. You went to 20mg/d dexedrine and the treatment is much less effective?

If I understood correctly, that would make sense. (I think I did the math properly here, but it wouldn't hurt if Aeon double checked me.) 40mg Adderall contains the equivalent of 22mg dextroamphetamine sulfate and 7 mg of levoamphetamine sulfate. Both treat your ADHD symptoms, just not equally well. So when you switched you got less dextroamphetamine AND less levoamphetamine.

When I went back to your Doc I would ask to bump me up to 30mg/d dexedrine and point out that as far as your understanding is that it should still be less stressful on your heart than the 40 mg/d Adderall. Then you can go from there based on your symptom treatment and heart rate. I would stick with it a while longer because you know the adderall treated your symptoms and it is 3/4 dextroamphetamine so you would expect the dexedrine to be able to treat your symptoms. I kinda look at is as the amphetamine is a bird in the hand and the Ritalin is 2 in the bush. HTH, -LN

Jenn1202
01-21-17, 04:54 PM
If you found 40 mg Adderall effective, 20 mg Dex probably won't do much for you. You may want to try to work your way up to 40 mg or until you get positive effects or cannot tolerate the medication. My guess is that you probably won't feel much until you get to 30-35 mg. But you probably want to keep monitoring your heart rate and up your dose very slowly (2.5-5mg per week), because Dexedrine can also cause heart related side effects, especially in higher doses.

cynthiab
01-22-17, 04:34 AM
Thanks all. I will try to get an increase to the dosage.
I actually figured out what was at least part of the problem. I had a handful of tablets that got a little but wet (just water). I figured it was no big deal, since I'd seen before that people said you could just let them dry out and it'd be fine. But I could barely get out of bed, so I'm thinking it caused those tablets to be ineffective.
Once I finished those tablets and moved to the pristine ones I got a better response to where it felt like there was improvement or some effect. It doesn't give that adderall l-amp boost but that's fine.
I also, had tried taking 15 in the morning to see if it would be helpful to go that direction, and it definitely was. But of course it's not enough to have just one 5 booster left for the day, so that's not an option on the current dosage. I'll see if he's okay to prescribe an additional 10 for a total daily dosage of 30, to work with as needed and figure out best timing and distribution of the dosage during g the day etc. That would get me closer to the 40 mg in adderall I was taking, that I get it's not entirely a math calculation to translate from one dose to another.
I definitely got the sense that prescribing red was not really something he was keen on doing. I actually was meeting with the physician assistant when I made the request and then got the email response that he's willing to let me try on a trial basis but start at 5 mg per day and then titrate up and don't exceed 20 and greater abuse potential and possible hallucinations. I don't entirely understand the increased abuse potential of dex vs adderall. I don't really notice anything in taking Rex except incomplete symptom relief. And a bit of edginess when it wears off, but I have some herbal things I take that help with that a lot. It'd help too to have better coverage for the day with an additional booster.
I monitor my pulse pretty closely because I wear a Fitbit that tracks it throughout the day. Now it's low and normal, but it can go up a bit when the medication wears off in the evening.

Sickle
01-22-17, 06:01 PM
I had the opposite experience. Adderall didn't calm me down as good as dex does. I am really hyper though. Dex for me is stronger than adderall. I take 60-90 mg/day though but I had been on them most of my life.

dvdnvwls
01-22-17, 08:02 PM
I'm really confused that you even think it might be good to try a higher dose. Too low a dose does not make you tired and does not make you antisocial or over-focused on useless things. All the evidence is pointing to your dose being too high, or else to interference from caffeine. Don't increase, it will make you worse.

Unless your reports of symptoms are wildly inaccurate, your dose needs reducing, not increasing.

Too low of a dose does just nothing - there are no symptoms at all to a too-low dose, neither good nor bad. (Unless the drug causes a bad reaction for you even at low doses.)

cynthiab
01-22-17, 11:29 PM
I'm really confused that you even think it might be good to try a higher dose. Too low a dose does not make you tired and does not make you antisocial or over-focused on useless things. All the evidence is pointing to your dose being too high, or else to interference from caffeine. Don't increase, it will make you worse.

Hm, interesting thought. I did start on dex at 5mg and worked up to 20mg. I didn't find it was better at lower dose, I would have stayed there. The lowest dose that addresses my symptoms would be my preference always, just to avoid side effects, etc.

I was figuring having a sudden reduction in dopamine (since I previously took Adderall every day), would have me feeling unmotivated and tired.

I wouldn't say I was over-focused on useless things.

I should probably update the original post but what I think was causing the dex to be ineffective initially is that I got a couple of tablets slightly wet (with water) and let them dry and took those until I was done with them, figuring if it was just water it wouldn't affect the effectiveness, but apparently it did.

Seeing the doc tomorrow and will see what happens. If I could have a 5-10 mg more to work with, I think it'd be a lot better, seeing as the one day I frontloaded more of the dosage in morning (and had a short day, so just one booster dose thereafter) felt a lot better, in terms of addressing symptoms. It's such a hit to my self esteem when I am forgetting everything, unable to think through things, making "careless" mistakes, losing items, etc.

dvdnvwls
01-22-17, 11:38 PM
I get it - that makes more sense.

chaotic_cortex
01-24-17, 05:50 AM
Do you have any caffeine at all? (Energy drinks, coffee, tea, anything) If yes, stop now. See if that helps.

If you already have no caffeine, then either your dose is much too large or this is the wrong drug.

Just out of curiosity, what happens when dexedrine and caffeine are combined? I ask because I am finding dexedrine to not be helping my symptoms either and I'm a really heavy caffeine drinker. I drink between 10-15 teas per day which works out to between 700 and 1000 mg of caffeine, or, 10 cups of coffee per day. Mind you I am recently diagnosed and am trying different meds. My doc is keeping me really low at a 10mg spansule at the moment. I think I have been self medicating for a long time with caffeine. People talk about jitters and anxiety from coffee. Lol, please; I need coffee just to stop fidgeting in my seat.


Sorry to hijack your thread, op, just curious why caffeine is a no no with dexedrine.

dvdnvwls
01-24-17, 05:10 PM
Just out of curiosity, what happens when dexedrine and caffeine are combined? I ask because I am finding dexedrine to not be helping my symptoms either and I'm a really heavy caffeine drinker. I drink between 10-15 teas per day which works out to between 700 and 1000 mg of caffeine, or, 10 cups of coffee per day. Mind you I am recently diagnosed and am trying different meds. My doc is keeping me really low at a 10mg spansule at the moment. I think I have been self medicating for a long time with caffeine. People talk about jitters and anxiety from coffee. Lol, please; I need coffee just to stop fidgeting in my seat.


Sorry to hijack your thread, op, just curious why caffeine is a no no with dexedrine.
For many many people but not all, ADHD medications including Dexedrine cause the well known unwanted effects of caffeine to be greatly magnified.

If you quit all caffeine, you may end up with a higher more effective dose of medication. Caffeine feels like it's working, but it's really not very helpful. Throwing coffee into an ADHD brain is like putting rocket fuel into a broken leaking car engine... You get bigger explosions, but it still doesn't run right.