I went to get my monthly supply of Adderall XR today and decided to ask the pharmacist (small pharmacy, 40 year old male) a few questions. I take 30 mg Adderall XR twice a day!

Me: "I know my urine pH is low (5.0-5.5, acidic urine), do you think if I take an urine alkalinizer I could possibly require less Adderall XR?"

Pharmacist:"Well, the alkalinizer will make the urine less acid...hmm...to be honest, I don´t know...hmm..."

Me: "So Adderall won't be eliminated as fast?"

Pharmacist: "Which way is it...more acid more absorption?..."

Me: "No, the other way around."

Pharmacist: "Regardless, I don't think urine pH would have any effect on Adderall levels." At his point I had his opinion about urinary acid and proceded to ask about stomach acid.

Me: "I take Prilosec (for an acid stomach), do you think I'm absorbing more Adderall than I would if I did not take Prilosec?"

Pharmacist: (He already knew by now that acidic environments are not good for Adderall absorption) "Yes, if you were not taking Prilosec you would be absorbing less Adderall."

Me: "It seems that stomac acidity has an effect while urinary acidity does not."

Pharmacist: "That's right."

Me: "I wonder if my doc could do a blood test to find out if I'm a fast metabolizer."

Pharmacist: "You first need to be taking Adderall for a few months so that your blood levels are stable, then your doctor can meausre adderall in blood."

:eek: Obviously, by now I realized I could not even trust his answers to even the prior questions. I decided not to ask him about whether talking to my doc about dropping the small amount of thiazide (a diuretic) I take could be eliminated now that I'm taking Adderall (it acts as a diuretic). I thanked him and left.

I don't know if most pharmcists would be as confused without looking the info up first. More scary, I'm not sure if many doctors would be better off. :confused:

The trouble is , a pharmacist is not an MD, he does not know a lot of biochemistry

Pharms are a very mixed bag - some are morons and some are geniuses. The best are usually (unfortunately) in research and the morons are stuck in WalMart pharm centers.

i don't understand about urinary pH having an effect on adderall levels in the blood.

i can understand that stomach acidity would have an effect on the absorption time for some drugs, but once the medication is in the bloodstream, what effect and why does acidifying or alkalinizing urine have on how quickly the metabolites of adderall are excreted?

I have also read and it's widely believed that urine pH does affect amphetamine half-life. I'm not sure that the effect is very substantial but it appears to be fact that acidic urine will reduce the half-life. FYI, nobody reading this post likely has to worry about having too acidic or basic urine. It's relatively uncommon.

I did a little digging and found that
Amphetamine Excretion is accelerated in a person with an acidic urine

Quote from Healtyplace.com (http://www.healthyplace.com/medications/adderall.asp)
"With normal urine pHs approximately half of an administered dose of amphetamine is recoverable in urine as derivatives of alpha-hydroxy-amphetamine and approximately another 30%-40% of the dose is recoverable in urine as amphetamine itself. Since amphetamine has a pKa of 9.9, urinary recovery of amphetamine is highly dependent on pH and urine flow rates. Alkaline urine pHs result in less ionization and reduced renal elimination, and acidic pHs and high flow rates result in increased renal elimination with clearances greater than glomerular filtration rates, indicating the involvement of active secretion. Urinary recovery of amphetamine has been reported to range from 1% to 75%, depending on urinary pH, with the remaining fraction of the dose hepatically metabolized. Consequently, both hepatic and renal dysfunction have the potential to inhibit the elimination of amphetamine and result in prolonged exposures. In addition, drugs that effect urinary pH are known to alter the elimination of amphetamine, and any decrease in amphetamine’s metabolism that might occur due to drug interactions or genetic polymorphisms is more likely to be clinically significant when renal elimination is decreased"

So i believe your assumptions could be correct about needing less adderall with a less acidic urine. I don't think prilosec would alter absorption rates of adderall as it is only altering acid output, not the acidity of it, and I would assume that the difference in amount of acid would only alter the absorption, due to dilution of stomach acid, would be negligable. If you would like to raise you urine PH, a diet rich in citrus fruits, legumes, and vegetables raises the pH and produces urine that is more alkaline or lower sodium intake. If the doctor isn't t worried about the urine PH, i wouldn't worry to much a person's urine ph can normally range from 4.5-8, but you could find out why you kidneys are producing a more acidic urine. I would ask the doctor before elimination of thiazide depending upon what it is being used to treat. I agree with Maxprime about pharmacists, if you want one that is more knowledgeable ask around or maybe you doctor knows a couple. I hope this helps but keep in mind i am no doctor.:D

Thanks all.

JHarman16, great research.

I have not noticed any difference in absorption of Adderall the days I don't take Prilosec (omeprazole), but it is listed (proton pump inhibitors) on the patient info sheet as affecting absorption.

I did an experiment recently: I took sodium bicarbonate 2-3 times a day for a couple of days and took a reduced dosage of Adderall. The less acidic urine had a more pronounced, specially a longer lasting effect through late at night!

I tend to have slightly higher than normal levels of uric acid in my urine. (This seems to be caused by acid urine.) My doc said he would rather not prescribe allopurinol for it (uric acid) unless I get kidney stones or symptoms of gout. I'm going to talk to him about treating the acidity (rather than the uric acid) with an Rx alkalinizing agent, i.e. urocit-k or citrolith. Sodium bicarbonate is not a first line treatment and can raise blood pressure. (I am taking a low dosage of thiazide for blood pressure). Perhaps it will make sense if it allows me to reduce Adderall dosages.

Then again, I could say that I am not really on 60 mg of Adderall, since I know I'm getting rid of much of it without getting its effects. It is like if I ere taking virtually less Adderall. Does this make sense to you all?

Yea it does, kindof a good way to spin it.:) I just started looking for the proton pump inhibator interactions and it only references to tell your doctor, but the PDR sheets don't mention anything. Kindof strange, my guess is that it could cause a problem but only in theory and no study has shown these effects. (just an asumption, couldn't find anything either way)

I did however find this

" Alkalinizing agents --Gastrointestinal alkalinizing agents (sodium bicarbonate, etc.) increase absorption of amphetamines. Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion. Both groups of agents increase blood levels and therefore potentiate the actions of amphetamines.

So, this is kindof out in left field, the thiazide may increase blood levels of the amphetamine, lowering the amount of recoverable amphetaine in the urine i.e. more potent of a dose, while the acidic urine may expell the amphetamine more readily, shortening the half life of the molecule. So, even farther out there but kindof fun to think about, you may be getting a higher dose than thought but for a shorter amount of time. So if you change any of you meds, you might have to increase the dose of adderall, to compinsate for the decrease in absoption, but take it less often:D.

That was kindof fun to write out. I wonder if this kindof of logic would even come close to holding true in the real world. But anyway if it is important to you, than i would suggest discussing your feelings with your doctor again, who knows you might get a medical article written about it:). Good luck and let me know what you think of the amphetamine paradox i just gave you.:cool:

... you may be getting a higher dose than thought but for a shorter amount of time.
Interesting...I wonder if I could do better by taking smaller, but more frequent dosages (even possibly IR rather than XR). I do notice my XR's "second release" at 2.5 hours after taking it - rather than four. I could take 3 dosages a day, i.e. 30, 20, 10 or so.

My doc recommended against IR and, since I'm taking 60 mg XR, I decided not to insist on it (he would have given it to me) in order to reassure him that I have no plans to crush it and snort it. You see, I make him feel like I'm not going to get him in trouble (I am not!) and that is why he works with me.

Hey guys i think I can help out a bit...I am a second year medical student and in the middle of my pharmacology block..what you are talking about is called acid trapping. They dont really do it any more and if they do its to perform the opposite and acidify the urine to get increased clearance of abused drugs. So to keep it simple this is not a therapeautic practice and you should not try it unless you want to risk your health.

First of all proton pump inhibitors like prilosec works specifically in your gastrointestinal tract if anything it will increase absorption. Ampetaimes are weak organic bases and their absorption is enhanced in basic environments.

Your kidney and liver have everything to do with the bioavailability of the drug in your system. they are in charge of removing it. The therapeautic goal is to keep a drug concentration in your system that is somewhere above the threshold for effect and below toxicity. So what that means simply is there is a constant supply of drug going in (especially with time released XR) and a constant supply going out (thru the kidney and liver). Second, messing with thiazide diuretcs or anything that alters your electrolyte profile is very dangerous. A) it will enhance toxicity and risk of drug interactions of anything you are currently taking B) These drugs are designed and tested thru thousands of hours of clinical research and their pharmacokinetic profiles are specifically designed with your safety in mind.

In short, I would not mess with anything in your kidney, it is the by far the most complex organ save the brain and utterly essential for life.you are better off just continuing as your MD directs. The 100 dollars month you would save is not worth the agony of kidney failure/transplantation.