DD has been on Adderall XR 40 mg am with a 10 mg IR booster after school. She likes the Adderall but the XR doesn't typically last long enough for her to remember the 10 mg IR, and it's all downhill if she doesn't have that on board for homework.

In early March, her Pdoc prescribed 50 mg Vyvanse and we've been trying that out. While the effect is much smoother (no crash and burn in the afternoon), the 50 mg doesn't seem high enough. Also, DD seems to need the PNS stimulation to get off her chair and actually DO something. We tried upping the Vyvanse, but because of the way it's metabolized, she only had a longer duration of too little medication. (Stayed awake about 20 hours, was pleasant and focused, but didn't do much of anything - obviously not what we were looking for!)

I'd like to talk to the Pdoc about combining the 50 mg Vyvanse with a 20 mg XR in the morning. My theory is that the Vyvanse would provide a "floor" of long-acting, smooth medication until evening and the Adderall XR would provide the "kick start" DD needs. My understanding is that this combo would be roughly equivalent to the 40 MG XR + 10 IR and could eliminate the problem of DD forgetting the PM dose.

Does anyone combine Vyvanse with another stimulant? Any thoughts on your experience would be appreciated.

My son is on vyvanse (50 mg)- his kicks in better if taken w/a big breakfast (very impt. for vyvanse )-- he does get rebound from it though & now is taking seroquel in a small dose in the evening when the vyvanse wears off. Haven't heard of anything yet w/taking vyvanse w/another stimulant-- and yeah, the vyvanse keeps him up @ night all night-- was still playing guitar hero @ 2:30 a.m.!!

DD has been on Adderall XR 40 mg am with a 10 mg IR booster after school. She likes the Adderall but the XR doesn't typically last long enough for her to remember the 10 mg IR, and it's all downhill if she doesn't have that on board for homework.

In early March, her Pdoc prescribed 50 mg Vyvanse and we've been trying that out. While the effect is much smoother (no crash and burn in the afternoon), the 50 mg doesn't seem high enough. Also, DD seems to need the PNS stimulation to get off her chair and actually DO something. We tried upping the Vyvanse, but because of the way it's metabolized, she only had a longer duration of too little medication. (Stayed awake about 20 hours, was pleasant and focused, but didn't do much of anything - obviously not what we were looking for!)

I'd like to talk to the Pdoc about combining the 50 mg Vyvanse with a 20 mg XR in the morning. My theory is that the Vyvanse would provide a "floor" of long-acting, smooth medication until evening and the Adderall XR would provide the "kick start" DD needs. My understanding is that this combo would be roughly equivalent to the 40 MG XR + 10 IR and could eliminate the problem of DD forgetting the PM dose.

Does anyone combine Vyvanse with another stimulant? Any thoughts on your experience would be appreciated.

the "kick in the pants" you refer to is from the levo-amphetamine isomer in adderall xr. the peripheral stimulation / slight anxiety is from the action on norepinephrine.

I know of a few individuals who have a similar treatment with the slight difference that they will take a adderall IR 10mg like a "coffee" in the morning to get them going and then take their vyvanse a few hours later.

I see a potential issue with your plan in that you plan on taking the XR at the same time as the vyvanse. this may or may not be problematic because the XR half-life is usually less than that of vyvanse. IRs would be cheaper and if she can remember things on vyvanse, then if she's old enough/mature enough. she could determine when she needs the "kick in the pants" so to say.

the other concern i would have if i was following the same thing would be potential anxiety (I'm prone to anxiety. 20 - 30mg adderall IR over the course of a day drove me nail-biting nervous). You might want to watch if that becomes a problem with your daughter.

your strategy appears to be a viable one given the conditions you describe.
if your doctor likes it. you might want to try it out.

Thanks, variance. I agree that she needs the levo; even she notices that Vyvanse makes her pleasant, but does nothing for her initiative. I'm sorry to say, she needs the "kick in the pants" every day. During Spring Break, she was on Vyvanse only and about the only thing she got done most days was shower, cute clothes and make up, plus burning a CD or two.

The problem with the IR is that she's in high school and first period is at 7:30 (don't even get me started on how foolish it is to make teens start that early when it clearly goes against their natural tendencies). One IR only lasts her about 4 hours, which would mean she'd have to go to the nurse every day for a second dose. Obviously, the stigma of daily trips to the nurse is pretty great for teens. Also, she's still very "in the moment" and if someone said, "Hey, go to lunch with us," she'd completely forget to go to the nurse.

My goal is to have the Vyvanse last from morning through homework and the Adderall to last through the school day. Addy XR am plus IR pm works well, but she can't remember to take the IR when she comes home, even though it's a programmed daily event on her phone and I call her and tell her. If I stay on the phone with her until she's taken it, she feels like I'm treating her like a little kid. Sooooo trying to work around that issue. No point in irritating her over meds every single day. I'd rather irritate her over homework, showering, too much texting, etc. :D

Thanks, variance. I agree that she needs the levo; even she notices that Vyvanse makes her pleasant, but does nothing for her initiative. I'm sorry to say, she needs the "kick in the pants" every day. During Spring Break, she was on Vyvanse only and about the only thing she got done most days was shower, cute clothes and make up, plus burning a CD or two.

The problem with the IR is that she's in high school and first period is at 7:30 (don't even get me started on how foolish it is to make teens start that early when it clearly goes against their natural tendencies). One IR only lasts her about 4 hours, which would mean she'd have to go to the nurse every day for a second dose. Obviously, the stigma of daily trips to the nurse is pretty great for teens. Also, she's still very "in the moment" and if someone said, "Hey, go to lunch with us," she'd completely forget to go to the nurse.

My goal is to have the Vyvanse last from morning through homework and the Adderall to last through the school day. Addy XR am plus IR pm works well, but she can't remember to take the IR when she comes home, even though it's a programmed daily event on her phone and I call her and tell her. If I stay on the phone with her until she's taken it, she feels like I'm treating her like a little kid. Sooooo trying to work around that issue. No point in irritating her over meds every single day. I'd rather irritate her over homework, showering, too much texting, etc. :D

ah public high school. I'm guessing they have a very strict policy that the nurse is only allowed to administer the dose... I was gonna suggest but probably wouldn't work there
http://www.forgettingthepill.com/ForgettingThePill/images/325.jpg

helps alot for me since I'm on the go all the time. i keep a few reserve tablets/capsules in them and it's nothing out of the ordinary. people tend to think they are RFID keys you swipe at the gas station.

as for her unwillingness to remember.. is it that she "forgets" or that she's disinclined to take it? I myself feel a inclination against redosing when I feel like im coming down.. have you talked with her about how she feels on the medication aside from her outside performance? the side-effects some feel.. emotional blunting, verbal restraint. etc.

and high school being roughly 10 years ago.. i still remember what it was
to make up excuses to my parents to avoid explaining things I didn't want to confront.

I think she really does forget (or more accurately, gets distracted). Her Dad and I have talked to her about the importance of the PM dose because her rebound is pretty severe and she's absolutely NO FUN to be around without that boost. These conversations, unfortunately, have usually occurred when we've come home from work and found her grumbly and edgy, making it obvious that she DIDN'T take the IR when she got home from school.

A few weeks ago I talked to her about it after she actually took the PM dose. When I came home from work, she was doing her homework (without being told, since no adult was home to tell her!!) and told me that I was right, her mood was better and it was easier to do homework if she took the IR when she got home. She said she'd try to remember to take it.

Heck, she still forgets to put on anti-perspirant and brush her teeth (which clearly benefits her more than me), so I know she really does forget things. As a result, it's hard for me to tell what's truly forgotten and what's avoided.

We went ahead and tried the combo of 50 mg Vyvanse + 20 mg Adderall XR yesterday morning. She reported that she actually did a good portion of her assignments during class (instead of writing notes, doodling, reading a novel, etc.).. They have four classes per day on alternating schedules, so each class is about 90 minutes long and typically includes some time to start on homework. She also seemed pretty pleasant and emotionally stable right through 9:00 p.m., when she did the normal teen thing and retreated to her room. We'll try it again today and see if this holds up.

Day 3 of 50 mg Vyvanse and 20 mg Adderall XR. I wake her up at 5:30, she takes both with as much water as I can get in her, then goes back to sleep for 45 minutes. Eats a protein breakfast (Morningstar Farms soy breakfast burrito + 8 oz soy milk = 23 mg protein). She says this is working better for her than Adderall 40 mg XR with 10 mg IR booster or 50 mg Vyvanse alone. Still seems to be relatively functional and pleasant until 9:00 pm or so. Is awake until around 11:00 (typical for a teen, unfortunately; her brother is NT/no meds and keeps the same hours).

When she texted me after school and said that this seemed to be the best med combo so far, I actually teared up. Gosh, I hope this is it. We've been floundering 2 and a half years (all of high school) since Concerta faded from effectiveness after junior high.

Day 3 of 50 mg Vyvanse and 20 mg Adderall XR. I wake her up at 5:30, she takes both with as much water as I can get in her, then goes back to sleep for 45 minutes. Eats a protein breakfast (Morningstar Farms soy breakfast burrito + 8 oz soy milk = 23 mg protein). She says this is working better for her than Adderall 40 mg XR with 10 mg IR booster or 50 mg Vyvanse alone. Still seems to be relatively functional and pleasant until 9:00 pm or so. Is awake until around 11:00 (typical for a teen, unfortunately; her brother is NT/no meds and keeps the same hours).

When she texted me after school and said that this seemed to be the best med combo so far, I actually teared up. Gosh, I hope this is it. We've been floundering 2 and a half years (all of high school) since Concerta faded from effectiveness after junior high.
Thanks for the updates.
That's terrific she finally found the right amount with minimal side effects.
I'm still in the midst of finding my "perfect" combination as I just switched to Vyvanse + IR myself. I might have to give the XR thing a go myself.

I currently take 40mg of adderall IR and a 70mg vyvanse.

Dosing is as follows: 9AM 70mg vyvanse and 10mg of Adderall IR, 12PM 10mg adderall IR, 2:30PM 10mg adderall IR, 4:30 10mg adderall IR

Not sure how I feel about it. The adderall work wells for me but I have a good bit of side effects I could live without. The vyvanse is alright and if anything (taken by itself) isn't that effective. Maybe it has to deal with how low the dose really is: I'd say just take a adderall XR 30mg and spread it equally over 12 hours and dump the l-amphetamine and thats vyvanse.

I honestly can say I dont really like this combo or really care for adderall. The pns stimulation is a double edged blade.. I'm going to talk to my doc when I can. So far I've been on the vyvanse for a week.

Neoamd, I assume your Adderall side effects are related to feeling too "stimulated" physically? Do you think you need a higher dose of Vyvanse? For my daughter, increasing the dose just extended the duration of effect. It wasn't a higher level of medication, just lasted about 20 hours!! I don't know how your doctor feels about adjusting your dose on your own, but there's a water titration method explained here.

http://www.corepsychblog.com/2007/11/vyvanse-for-add.html

I guess dex boosters might be an option??

Neoamd, I assume your Adderall side effects are related to feeling too "stimulated" physically? Do you think you need a higher dose of Vyvanse? For my daughter, increasing the dose just extended the duration of effect. It wasn't a higher level of medication, just lasted about 20 hours!! I don't know how your doctor feels about adjusting your dose on your own, but there's a water titration method explained here.

http://www.corepsychblog.com/2007/11/vyvanse-for-add.html

I guess dex boosters might be an option??

I'm taking the highest dose of vyvanse availble now. No, I lack a stimulated feeling, just have cold hands and feet and have headaches. Now the 20mg dose works well but it doesnt last long enough. I got the vyvanse because the doc gave me a free trial script (30 70mg capsules) and also because I told him I'd like to do a bit mor research before I bumped up in dose.

I'm going to ask about dexedrine but who knows.. I'll may just give the adderall a couple more months and try it out with a higher dose. I just hate the fact the side effects will prob become worse with the higher dose.

Thanks for the link!

Update:
Had an email discussion with the pdoc about the Adderall XR + Vyvanse combo. He said to leave her on it until our appointment next week, but he wants to try upping the Vyvanse to 70 mg w/o any adjuncts. We tried giving her 2 50 mg at once and she was up for about 20 hours (but it was the weekend, so maybe that didn't mean anything??). My understanding is that since the body can only process so much Vyvanse at any time, a larger dose only causes a longer duration of effect, not an increase in the amount "on board" at any given time.

Well, we'll trudge along.