Just to add some details about me, my name is Dean, I'm about 6' and weigh about 258-265 lbs.

Recently I started to visit a local adult ADD specialist at the behest of my family doctor. For the past 2-3 years I have, along with my family doctor, (the original doctor who had diagnosed me had retired around 2002) been trying to cut down on the amount of Ritalin I have been taking (at one point I was taking 9 10-mg tablets a day) out of worries that I was overdosing on Ritalin and some long term side effects my doctor had been worried about.

This new doctor had prescribed me 5 mg Dexedrine pills and set a schedule of how I was to take the medication over the course of the week before seeing him again (which was today).

When I took my first pill I noticed, outside of a few 1-2 seconds pain in my forehead area (sorry best way I can describe it), a dramatic difference, I was able to focus better than I had even when I had used Ritalin, however all subsequent times that I have taken the medication I have not noticed any improvement. When I took my second pill it felt like I had not taken anything at all. With increases in the dosage (up to 2 pills each time) I still did not notice anything. I felt like I had not taken anything, even when I was taking 1/2 - 1 pill of 10 mg Ritalin twice a day I noticed a difference in my ability to focus.

I had gone back to see the specialist today and he was surprised that the medication had not been affecting me. His recommendation had been to continue increasing my dosage, eventually with me taking 9 pills by Saturday. My cause for concern is that this was roughly where I was at with Ritalin and was worried that I was overdosing. Is what I am experiencing normal here? The doctor had even suggested putting me back on Ritalin when I see him next week. Is the tolerance I am encountering due to taking a small amount for my size?

Stimulant medication is not dosed on body weight - we have some petite females on this forum who take larger doses than some of the more buff males. Everyone is different.

Considering your large dose of Ritalin, I'm not surprised that a low dose of dex is barely noticeable. My guess is that you will need roughly 50mg of dex a day before you feel anything.

It's weird though, I was still getting a reaction from Ritalin when I was taking 10-20 mg a day (1-2 tablits) yet with Dexedrine I got a reaction from the first pill and nothing afterward.

It's weird though, I was still getting a reaction from Ritalin when I was taking 10-20 mg a day (1-2 tablits) yet with Dexedrine I got a reaction from the first pill and nothing afterward.

Not only is dosing and effect very different from person to person, dexedrine is often very, very subtle after you've taken it a few times. If you don't think you feel its effects, try not taking it for a while and you'll realize that it was actually working.

Stimulant medication is not dosed on body weight - we have some petite females on this forum who take larger doses than some of the more buff males. Everyone is different.

Considering your large dose of Ritalin, I'm not surprised that a low dose of dex is barely noticeable. My guess is that you will need roughly 50mg of dex a day before you feel anything.



That wouldn't be wise, since the maximum recommended dosage for dex is about 40 mg a day (equals aprox. 80 mg of ritalin).

your over-analyzing "preferred dosage ranges" . Individual response is all that matters. I've been on ritalin based meds for over 10 years ( diagnosed pre teenage years). I trialed dexedrine , actually vyvanse with dexedrine ir tabs and noticed the same thing. It's not that your looking for a rush actually your just used to the way ritalin works with your body , so it's a simple conditioned response that your brain is now trained to look for. Dexedrine works much differently , my guess is that you probably need a higher dosage. If your sleep is okay on a larger dosage regiment then you should titrate up until it helps control your adhd symptoms. I wouldn't worry or become too concerned until your doctor tells you to stop increasing in dosage. Since you came from a higher ritalin dose then it makes sense that you may just require a high dose or you may have more severe adhd. Don't reference your first results or dose level with ritalin to your dose now, in the beginning your more likely to run into side effects , if you didn't have that with ritalin in the first stages that could mean that you do in fact have severe adhd and need a larger dose. Quick question how manageable is your adhd without meds? Are you just off the board unfocused? If so , then just know your dose will be outside the standard deviation.

You definitely need a higher dosage. I'm a 115 pound woman who had been on Adderall 60 mg for a long time. I got switched to a Dexedrine (combined spansules and tablets) of 60 mg/day.

Like you, at first I basically felt nothing. Then at the end of the day it hit me like a ton of bricks and I almost had a panic attack. I found the Dex to be too strong in one sense, and too weak in another. Probably because I was used to the way Adderall effected me.

I went back to the Adderall. If I were you I'd just say that Dex is not working right for you. Don't say you want a larger dose, that'd raise a red flag. Your doctor might suggest that, and then try that. Or you could say you'd prefer to try something else. He'd probably say Adderall. Don't mention that though either, just let him do the deciding.

Here's a link to a dr. who treats Adult ADD with larger doses than normal, based on body size. For someone at 250 lbs, he recommends up to 225 mg/day of Ritalin, or 185 mg/day of Dexedrine. He says he has never had any problems with anyone coming down hard on him for prescribing larger doses, since the dose recommendations are just that, recommendations, and the dr. is free to prescribe more or for off-label use in his or her discretion.

Check out the site, it is interesting:

http://www.drugs-forum.com/forum/showthread.php?t=57117

That wouldn't be wise, since the maximum recommended dosage for dex is about 40 mg a day (equals aprox. 80 mg of ritalin).

I take 40mg per dose for dex, without a "speedy rush." It's very smooth and clear, at some times I almost forget i'm on anything! It's even dropped my blood pressure since I test it every time I go to my doc, and once every 2 weeks while on dose (8 times each time, 30 minutes spaced apart for 4 hours).

Those "maximum recommended doses" are child doses, since the studies were only done on children at the time. Why would the drug companies spend money to re-submit newer (more expensive) dose approvals based on brand new (expensive) studies on adults? They already have approval now, there's no need in their opinion to go through dosage testing for adults.

Here's how it went in a nutshell: "start at smallest dosage possible, oh wait little jack got a tiny bit theraputic value that can be proven on paper, that's all we're going to submit." That just so happens to be the maximum recommended dosage.

My best day of Dex was my first as well. Zero side-effects- total calm. But there was also a mild euphoria (as is often the case on stimulants at first), and I think that had a lot to do with how "well it was working".

By day three, I was dealing with side-effects. More mild than any other stimulant so far but still somewhat problematic. I actually had insomnia from a stimulant for the first time ever last night. Ritalin never kept me up beyond the point where it was no longer working, and adderall put me to sleep. Dex apparently keeps me up!

But I will say that dexedrine has a much smoother onset than IRs. A lot of us associate the speedy bump that the IRs (particularly ritalin and adderall) with the primary effects (hey- we suffer from motivation problems, so it's not surprising that most of us see this as a very beneficial side-effect). The problem is that this speedy bump is often the first thing to go as our bodies adjust (which is why so many of us continually increase our doses even when there's clear cognitive benefit to the medication).

The real test for anyone being treated for ADHD, I maintain, is outside opinion. Particularly in terms of short-term memory and inattention- which we don't often notice ourselves. The same goes for impulse control. I've found that motivation and hyperactivity are the only two things I can reliably judge for myself on medication. I may have a vague sense as to how I'm doing on other fronts, but it's not nearly as reliable.

Maybe instead of giving up, you should seek out an objective opinion of someone who knows you?

But I will say that dexedrine has a much smoother onset than IRs.

I'm on Dex IR and it has a very smooth onset. It wears off smooth too. No jolt when it kicks in, no crash when it wears off. Dex is more gentle than Adderall and Ritalin, even in the IR form.

your over-analyzing "preferred dosage ranges" . Individual response is all that matters. I've been on ritalin based meds for over 10 years ( diagnosed pre teenage years). I trialed dexedrine , actually vyvanse with dexedrine ir tabs and noticed the same thing. It's not that your looking for a rush actually your just used to the way ritalin works with your body , so it's a simple conditioned response that your brain is now trained to look for. Dexedrine works much differently , my guess is that you probably need a higher dosage. If your sleep is okay on a larger dosage regiment then you should titrate up until it helps control your adhd symptoms. I wouldn't worry or become too concerned until your doctor tells you to stop increasing in dosage. Since you came from a higher ritalin dose then it makes sense that you may just require a high dose or you may have more severe adhd. Don't reference your first results or dose level with ritalin to your dose now, in the beginning your more likely to run into side effects , if you didn't have that with ritalin in the first stages that could mean that you do in fact have severe adhd and need a larger dose. Quick question how manageable is your adhd without meds? Are you just off the board unfocused? If so , then just know your dose will be outside the standard deviation.
I have to disagree, since the maximum recommended dose isn't established without a reason. If you need 50 mg merely to show any reaction, than it's unlikely that Dextroamphetamine is the right type of medication.

I take 40mg per dose for dex, without a "speedy rush." It's very smooth and clear, at some times I almost forget i'm on anything! It's even dropped my blood pressure since I test it every time I go to my doc, and once every 2 weeks while on dose (8 times each time, 30 minutes spaced apart for 4 hours).

Those "maximum recommended doses" are child doses, since the studies were only done on children at the time. Why would the drug companies spend money to re-submit newer (more expensive) dose approvals based on brand new (expensive) studies on adults? They already have approval now, there's no need in their opinion to go through dosage testing for adults.

Here's how it went in a nutshell: "start at smallest dosage possible, oh wait little jack got a tiny bit theraputic value that can be proven on paper, that's all we're going to submit." That just so happens to be the maximum recommended dosage.
Of course you are entitled to your opinion, but I very much doubt the researchers would agree. At any rate, your dose is still well below 50 mg. Now 50 mg could very well be acceptable, but if you need 50 mg just to show a reaction, it's unlikey that the doctor would increase the dosage any further.

I have to disagree, since the maximum recommended dose isn't established without a reason. If you need 50 mg merely to show any reaction, than it's unlikely that Dextroamphetamine is the right type of medication.

Then tell me Koz, what type of medication is "right" for me? Generic dextrostat in combination with generic adderall at my current dose is perfect to manage my ADHD inattention, with the fewest and least severe side effects (a tad bit of dry mouth at the worst). What do you suggest I take if you think my medication is inadequate? *Gasp* Desoxyn? Strattera? Clondidine? Bupropion?

I suppose we will have to agree to disagree :). There is a wide spectrum of possible reactions in response to CNS stimulants. Some are sensitive to them for a variety of reasons and others for some reason seem to already be tolerant to the same dose another person might have a heart attack from taking. We are not even near to hitting the tip of the iceburg so to speak on how the brain works, and what exactly goes on in it and why.

Of course you are entitled to your opinion, but I very much doubt the researchers would agree. At any rate, your dose is still well below 50 mg. Now 50 mg could very well be acceptable, but if you need 50 mg just to show a reaction, it's unlikey that the doctor would increase the dosage any further.

The "dose" i referred to is one instant release dosage, not total daily dose. And thankfully, my doctor is intelligent enough to access that his patients are ALL different, and are different about what drugs works best at what dosage. When I asked about the dose, he said it was a bit higher than his average (10-30mg average IR dose), but was nowhere near the highest. He is a highly intelligent doctor that lets his resume, experiences, studies and published articles with his knowledge of ADD/ADHD do the talking.

There are too many doctors that i've heard of that make people seem like street addicts because that 10-15mg/day dose the doctor so sparingly prescribed isn't doing jack crap.

If I needed a higher dose because what I had wasn't the correct dose, he would have no problem with me talking truthfully about it with him. If I asked him to raise the dose, saying I was thinking about it for a couple of weeks/months, yes he would question me, but about why I hesitated to ask him about raising the dose when it came to my attention. He poses the question "what's the point of taking medication if it doesn't work/help you over not taking it?"

The patient/doctor model is based on trust, and he seems to get that concept. So yes, I guess we can agree to disagree. :)

Then tell me Koz, what type of medication is "right" for me? Generic dextrostat in combination with generic adderall at my current dose is perfect to manage my ADHD inattention, with the fewest and least severe side effects (a tad bit of dry mouth at the worst). What do you suggest I take if you think my medication is inadequate? *Gasp* Desoxyn? Strattera? Clondidine? Bupropion?
That is up to your doctor to decide.

I suppose we will have to agree to disagree :). There is a wide spectrum of possible reactions in response to CNS stimulants. Some are sensitive to them for a variety of reasons and others for some reason seem to already be tolerant to the same dose another person might have a heart attack from taking. We are not even near to hitting the tip of the iceburg so to speak on how the brain works, and what exactly goes on in it and why.
Which is exactly the reason why there is a recommended daily maximum. The problem isn't the effect of a drug, but it's side-effect profile. You might not be able to feel the drug, or it's side effects, but this doesn't mean that the side-effects aren't there. Of course there are exceptions to every rule, but again, if you need 50 mg of d-amphetamine merely to show a reaction, it's unlikely that it will function as a drug of choice. In particular, since you'd have to increase the dosage even further for it to be effective.

The "dose" i referred to is one instant release dosage, not total daily dose. And thankfully, my doctor is intelligent enough to access that his patients are ALL different, and are different about what drugs works best at what dosage. When I asked about the dose, he said it was a bit higher than his average (10-30mg average IR dose), but was nowhere near the highest. He is a highly intelligent doctor that lets his resume, experiences, studies and published articles with his knowledge of ADD/ADHD do the talking.

There are too many doctors that i've heard of that make people seem like street addicts because that 10-15mg/day dose the doctor so sparingly prescribed isn't doing jack crap.

If I needed a higher dose because what I had wasn't the correct dose, he would have no problem with me talking truthfully about it with him. If I asked him to raise the dose, saying I was thinking about it for a couple of weeks/months, yes he would question me, but about why I hesitated to ask him about raising the dose when it came to my attention. He poses the question "what's the point of taking medication if it doesn't work/help you over not taking it?"

The patient/doctor model is based on trust, and he seems to get that concept. So yes, I guess we can agree to disagree. :)
Apart from the fact that you might want to be more specific in your posts, I don't see how this changes anything? Although your dosage is above average, it's still within established limits. And if your doctor believes that in your case the higher then average dose is safe and effective, there should be nothing to worry about.

To be honest, I don't quite understand why you are so defensive?

Which is exactly the reason why there is a recommended daily maximum. The problem isn't the effect of a drug, but it's side-effect profile. You might not be able to feel the drug, or it's side effects, but this doesn't mean that the side-effects aren't there. Of course there are exceptions to every rule, but again, if you need 50 mg of d-amphetamine merely to show a reaction, it's unlikely that it will function as a drug of choice. In particular, since you'd have to increase the dosage even further for it to be effective.

To be honest, I don't quite understand why you are so defensive?

50mg is very close to 40mg, which is why I talked about that in regards. You stated if you need 50mg of d-AMPH, then it probably won't function as a drug of choice. I was curious as to what ELSE there is OTHER than desoxyn in regards to "effective drugs" for ADD. If 50mg is what you need to feel a reaction, what's the big deal? The problem is when you go up too quickly, I honestly was taking 40mg/day after the first 2 weeks, because I simply didn't feel any different, I could even sleep about an hour or 2 after dosing the lower doses. I haven't had to change it ever since (half a year), and have yet to have those "terrible withdrawls" i've heard about when I decided to not take it for a couple days after being on it for a month or so, or longer.

Why should a dosage amount of a limited drug "class" (stuck with 3 first class stimulants and really only 1 last resort) be a problem if there is no rapid tolerance, and minimal sides, if even that? That was my question :). And i'm being defensive for the people who have to go through that same situation every time an ignorant person (read: even most pharmacists) learns of their stimulant dose.

It's amazing that when someone finds out a person requires a larger amount of medication than normal under a doctors supervision, you could cut the "yeah right unlikely" doubts in the room with a knife ;)

50mg is very close to 40mg, which is why I talked about that in regards. You stated if you need 50mg of d-AMPH, then it probably won't function as a drug of choice. I was curious as to what ELSE there is OTHER than desoxyn in regards to "effective drugs" for ADD. If 50mg is what you need to feel a reaction, what's the big deal? The problem is when you go up too quickly, I honestly was taking 40mg/day after the first 2 weeks, because I simply didn't feel any different, I could even sleep about an hour or 2 after dosing the lower doses. I haven't had to change it ever since (half a year), and have yet to have those "terrible withdrawls" i've heard about when I decided to not take it for a couple days after being on it for a month or so, or longer.

Why should a dosage amount of a limited drug "class" (stuck with 3 first class stimulants and really only 1 last resort) be a problem if there is no rapid tolerance, and minimal sides, if even that? That was my question :). And i'm being defensive for the people who have to go through that same situation every time an ignorant person (read: even most pharmacists) learns of their stimulant dose.

It's amazing that when someone finds out a person requires a larger amount of medication than normal under a doctors supervision, you could cut the "yeah right unlikely" doubts in the room with a knife ;)
It's important to note that I stated something different: "I have to disagree, since the maximum recommended dose isn't established without a reason. If you need 50 mg merely to show any reaction, than it's unlikely that Dextroamphetamine is the right type of medication." I.e. 50 mg d-amphetamine could be acceptable, but it's unlikely that it would be the drug of choice considering the amount you need just to show a reaction.

There are many different classes of ADHD/ADD medication, and stimulants are just one class. Bupropion (Wellbutrin, an atypical antidepressant), or atomoxetine hcl (Strattera, works primarily on noradrenaline) are other possibilities in the treatment of ADHD/ADD. If one (class of) medication doesn't work (sufficiently), another can be tried.

Does anyone's brain work that different that they'd need 150mg of Dexedrine to function a day?

I posted the wrong link earlier- this is the one I wanted:

http://adultadd.info/HighDoseMedication.htm

This dr recommends up to 185 mg Dex a day for some people. He goes into a lot of detail as to why, and tells you how to deal with pharmacists, has said he has never been in "trouble" for his prescriptions....the recommended daily dose is just that, a recommendation. People are different. A doctor is supposed to be qualified to decide what dose you need and can take safely.

Could you quote him?