View Full Version : Looking for plasma profile graphs on IR d-amphetamine


Omnipotent
08-13-17, 10:32 PM
When searching for this type of graphs google only find nummerous graphs for Adderall, Vyvanse and different methylphenidate formulations.

I found like one single graph showing one dose of 10 mg immediate release d-amphetamine sulphate.

But I want some line graph examples of real dosing schedules.
I assume not many people (or adults at least) are successfully medicated on a single IR dose.

I wanna see how the Vyvanse plasma concentration curve (with it's peak around hour 3-4) compare to the curves of some typical IR Dex schedules, for example 40, 50 or 60 mg's, divided into four (or more) doses.

Any information on this topic would be highly appreciated!

CharlesH
08-22-17, 02:52 AM
This isn't a graph, but according to the official FDA label for Dexedrine:

"Following administration of three 5-mg tablets,
average maximal dextroamphetamine plasma concentrations (Cmax) of 36.6 ng/mL were achieved at approximately 3 hours.
Following administration of one 15-mg sustained-release capsule, maximal dextroamphetamine plasma concentrations were obtained
approximately 8 hours after dosing. The average Cmax was 23.5 ng/mL."

A typical dosage schedule for an adult might be to take it every 4-5 hours (2-3 times per day). At least according to some studies, the properties of Vyvanse might make it so that even though the time to the peak concentration is around the same time as Dexedrine IR, how it gets to the peak is smoother, and this reduces acute tolerance, thus making its clinical effects last a ridiculously long time.

I agree with you that detailed graphs of such dosing schedules would be helpful, but I think you'll be hard pressed to find any. Pharma companies tend to not want to release any more information than the bare minimum mandated by law, and scientists aren't likely to do expensive clinical trials that would serve as uncompensated grunt work for the pharma companies.

sarahsweets
08-23-17, 03:07 AM
What about plasma graphs would help you?

Omnipotent
09-03-17, 05:53 PM
This isn't a graph, but according to the official FDA label for Dexedrine:

"Following administration of three 5-mg tablets,
average maximal dextroamphetamine plasma concentrations (Cmax) of 36.6 ng/mL were achieved at approximately 3 hours.
Following administration of one 15-mg sustained-release capsule, maximal dextroamphetamine plasma concentrations were obtained
approximately 8 hours after dosing. The average Cmax was 23.5 ng/mL."

A typical dosage schedule for an adult might be to take it every 4-5 hours (2-3 times per day). At least according to some studies, the properties of Vyvanse might make it so that even though the time to the peak concentration is around the same time as Dexedrine IR, how it gets to the peak is smoother, and this reduces acute tolerance, thus making its clinical effects last a ridiculously long time.

I agree with you that detailed graphs of such dosing schedules would be helpful, but I think you'll be hard pressed to find any. Pharma companies tend to not want to release any more information than the bare minimum mandated by law, and scientists aren't likely to do expensive clinical trials that would serve as uncompensated grunt work for the pharma companies.

That's great, I appreciate whatever information about the subject I get.


What about plasma graphs would help you?

Looking at this graph: http://www.secinfo.com/DB/SEC/2006-000/1140/361-0095/39-013.jpg
We can see that the d-amp levels from 40 mg IR d-amp almost perfectly matches the levels derived from 100 mg of lisdex - if you take the IR d-amp approximately 2 hours later.

Assuming then that the the same is true about 70 mg lisdex and the equivalent amount of IR d-amp (28 mg).

Then a single dose of 28 mg's of IR d-amp taken at 09:00 would be effective (lasting) to about the same hour as 70 lisdex taken at 07:00.

I'm guessing an well adjusted IR schedule would make the plasma concentration either flatline for most of the day or even slightly increase for the first half of the day with plasma levels increasing for about ~6-10 hours due to tachyphylaxis.

So I want my Dr to justify how he believes that I will benefit from a single dose lisdex for a whole day, one dose with a pronounced peak usually between hour 3 and hour 4 and the rest of the day just going downhill.

Having some graphs and fact about the subject would greatly increase the validity of my claims/questions.

And no. Splitting 70 mg into 40 and 30 mg, makes the individual doses way to ineffective. Now three doses 70+50+30 mg on the other hand worked pretty well, that regiment I found to be just as good if not even better than 20+15+15+10 mg IR d-amp. I prefer lisdex over IR d-amp simply because no consideration to food intake is needed, you can even flush down the lisdex with acidic stuff like orange juice. Pretty much whatever you do or don't do lisdex will be +95% bioavailable. The same is not true about d-amp.

My problem is that few Dr's (in the public psychiatric care) are willing to exceed the daily dose recommendations (70 mg for lisdex and 40 mg for d-amp). It makes them look "unprofessional" somehow.

CharlesH
09-03-17, 07:59 PM
So I want my Dr to justify how he believes that I will benefit from a single dose lisdex for a whole day, one dose with a pronounced peak usually between hour 3 and hour 4 and the rest of the day just going downhill.

Having some graphs and fact about the subject would greatly increase the validity of my claims/questions.

Has this actually been a problem for you yet? Has he turned down your previous requests for you to have multiple dosages throughout the day?


And no. Splitting 70 mg into 40 and 30 mg, makes the individual doses way to ineffective. Now three doses 70+50+30 mg on the other hand worked pretty well, that regiment I found to be just as good if not even better than 20+15+15+10 mg IR d-amp. I prefer lisdex over IR d-amp simply because no consideration to food intake is needed, you can even flush down the lisdex with acidic stuff like orange juice. Pretty much whatever you do or don't do lisdex will be +95% bioavailable. The same is not true about d-amp.

Were you given permission by your psychiatrist to try the 70+50+30mg dose schedule? If so, then just tell your psychiatrist that this schedule worked well for you.


My problem is that few Dr's (in the public psychiatric care) are willing to exceed the daily dose recommendations (70 mg for lisdex and 40 mg for d-amp). It makes them look "unprofessional" somehow.

Are you in Sweden? I don't know much (or anything!) about the system over there. I'd imagine that, unless there are any strict laws or regulations, some doctors are more flexible, and some doctors stick to arbitrary practices. In the USA, the 40 mg limit is only a recommendation, not a strict rule. Dexedrine is only FDA approved for children/teens, so the use of it in adults is off label, regardless of dose.

Omnipotent
09-04-17, 07:10 AM
Has this actually been a problem for you yet? Has he turned down your previous requests for you to have multiple dosages throughout the day?

No he let me splitt the dose into 40 and 30 mg (it was fine just as long as I didn't exceed the daily recommendation 70 mg) which wasn't very helpful.

So I went back to a full 70 mg.

Later I suggested to add an additional dose of IR d-amp and that was apparently fine. When picking up the medicine I found that he hadn't really added anything, he had just swapt 30 mg's of the total 70 into 10 mg IR d-amp, giving me 40 mg of lisdex (Elvanse) and 10 mg IR d-amp (Attentin).
Needless to say not very helpful.


Were you given permission by your psychiatrist to try the 70+50+30mg dose schedule? If so, then just tell your psychiatrist that this schedule worked well for you.

No not really, he (and I'm starting to think public psychiatrists in general) strictly adheres to daily dose guidelines and recommendations.

I know for a fact that many people are prescribed way higher doses than I am without any problems.

Sometimes it feels like my problems* aren't fully acknowledged because I don't have any documented substance abuse history and the fact that I have managed to hold down a job for a staggering period of ~10 years.
But that's another story.

*=I have a lot of them, I've just been really good at hiding them behind dysfunctional coping strategies.

Are you in Sweden? I don't know much (or anything!) about the system over there. I'd imagine that, unless there are any strict laws or regulations, some doctors are more flexible, and some doctors stick to arbitrary practices. In the USA, the 40 mg limit is only a recommendation, not a strict rule. Dexedrine is only FDA approved for children/teens, so the use of it in adults is off label, regardless of dose.

Sweden, yes sir!

I starting to think that a private psychiatrist is the way to go. Actually I'm going to contact one in the nearest future, it will probably be costly but it's a price I'm willing to pay if I can get a good functional treatment that is more tuned in to my individual needs rather than any guidelines.

Attentin, approved 2016 is the first approved amphetamine medication in Sweden since the 60's I think,
it too is only approved for ages 6-18.
So my Dr did in fact prescribe me the IR d-amp "off-label".

The pattern is clear to me in that the one major objective surrounding amphetamine prescription is to keep doses low.

CharlesH
09-04-17, 03:42 PM
No he let me splitt the dose into 40 and 30 mg (it was fine just as long as I didn't exceed the daily recommendation 70 mg) which wasn't very helpful.

So I went back to a full 70 mg.

Later I suggested to add an additional dose of IR d-amp and that was apparently fine. When picking up the medicine I found that he hadn't really added anything, he had just swapt 30 mg's of the total 70 into 10 mg IR d-amp, giving me 40 mg of lisdex (Elvanse) and 10 mg IR d-amp (Attentin).
Needless to say not very helpful.

On the off-chance that he simply misunderstood your request, maybe you could try to clarify with him that you wanted the 70mg Vyvanse + 10 mg d-amp



No not really, he (and I'm starting to think public psychiatrists in general) strictly adheres to daily dose guidelines and recommendations.

I know for a fact that many people are prescribed way higher doses than I am without any problems.


At first glance, the two sentences seem contradictory. Regarding the people who are prescribed way higher doses, are they people outside of Sweden, or people with private psychiatrists?




Sometimes it feels like my problems* aren't fully acknowledged because I don't have any documented substance abuse history and the fact that I have managed to hold down a job for a staggering period of ~10 years.
But that's another story.

Are you saying that people in Sweden with documented substance abuse history and unemployment status would have an easier time getting prescribed higher dosages? Maybe things are upside down in Sweden compared to USA, but in USA many doctors would refuse to prescribe any abusable medications to these patients. Same thing for unemployed people, whom are often viewed by society as inherently immoral and untrustworthy.

sarahsweets
09-05-17, 04:51 AM
Is dexedrine not an option? Vyvanse is the weakest of amphetamines.

Omnipotent
09-05-17, 10:04 PM
On the off-chance that he simply misunderstood your request, maybe you could try to clarify with him that you wanted the 70mg Vyvanse + 10 mg d-amp

No, not a chance. I've been crystal on this. 70 mg's taken at once will provide me ~4 hours of good therapeutic effect. Splitt into 40 & 30 mg's I will barley have any effect at all.


At first glance, the two sentences seem contradictory. Regarding the people who are prescribed way higher doses, are they people outside of Sweden, or people with private psychiatrists?

Are you saying that people in Sweden with documented substance abuse history and unemployment status would have an easier time getting prescribed higher dosages? Maybe things are upside down in Sweden compared to USA, but in USA many doctors would refuse to prescribe any abusable medications to these patients. Same thing for unemployed people, whom are often viewed by society as inherently immoral and untrustworthy.


Talking about Sweden in general here. To my understanding (more or less confirmed) people with a history of substance abuse are more often prescribed higher/off-label doses than non-abusing people (under the condition that they leave regular, clean drug tests).
Major reason for this is to prevent these people from self medicating/abusing and to stop any harmful/uncontrolled/possibly deadly consumption like polydrug and IV-abuse.

Second reason, if they only would get 40 mg dex or a measly 70 mg cap Vyvanse a day, few of them would find it worth the trouble of staying clean (from other drugs like cannabis, bensodiazepines, opiates, RC's et.).

Doctors tend justify these "dose variations" by proclaiming that brains/dopamine receptors damaged from prolonged abuse require higher doses to respond. Which sounds somewhat reasonable. But...

To me that signals that I have too go haywire, shoot up street speed for a couple of years, lose my job and/or apartment before I can get sufficient treatment, which makes me quite freaking furious...


Is dexedrine not an option? Vyvanse is the weakest of amphetamines.

Nope. Our equivalent to Dexedrine/Dextrostat is Attentin which comes as IR tabletts containing 5, 10 & 20 mg's of d-amphetamine sulphate. No XR variants approved unless you count Elvanse (a.k.a. Vyvanse).

You can get basically every imaginable medication under some sort of individual license system, that is if your doctor can justify it.
That wouldn't help me since national dose recommendations for d-amphetamine are the same regardless of brand.

aeon
09-05-17, 10:48 PM
Regardless, dextroamphetamine sulfate yields ~2.5 the dextroamphetamine base of lisdexamphetamine given the same dose.

40mg of Dexedrine has more CNS activity potential than 70mg of Vyvanse.


Cheers,
Ian

CharlesH
09-06-17, 02:43 AM
Doctors tend justify these "dose variations" by proclaiming that brains/dopamine receptors damaged from prolonged abuse require higher doses to respond. Which sounds somewhat reasonable. But...

To me that signals that I have too go haywire, shoot up street speed for a couple of years, lose my job and/or apartment before I can get sufficient treatment, which makes me quite freaking furious...

Wow. I don't think that drug abusers should be denied treatment, but I also don't think they should effectively get extra rights. Why can't doctors just give everyone individualized treatment? Common sense tends to get lost in ideological societies (both liberal and conservative). If what you're saying is correct, then I guess you'll just have to spend the money to find a private psychiatrist who is willing to provide you with individualized treatment.

Omnipotent
10-14-17, 10:31 AM
Update: Private psychiatrist = problem solved. :yes: