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Vyvanse (lisdexamfetamine dimesylate)

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Old 01-18-18, 07:36 AM
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Trouble Dosing Vyvanse

I can’t seem to get the Vyvanse working how I’d like, disappointed so far. With Adderall XR, I could tell exactly how the different strengths of doses were working and when it came down. Besides having to tinker how long after taking it I’d have breakfast it was consistent (fine tuning between the 30 min to hour range, too long and it kicked in too hard and vice versa). 25mg was the sweet spot, (30mg further quieted my mind but at expense of increased dry mouth, OCD and anxiety, 35 and 40 sedated me).

The highest dose I’ve tried so far is 50mg. I didn’t know if I was under or over focused so I’ve gone down to 40mg before titrating upwards. Today, on the 40mg (had breakfast after 50 mins) I initially felt jittery, nervous, very dry mouth. Had a cigarette 3 hours after taking Vyvanse and felt better (less jittery and hard-wired, I wonder if it was the increased dopamine or metabolism that calmed me (hence dose got stronger or weaker?!).

Was feeling sleepy 6-8 hours after dosing! Looked like I was becoming more ADHD. And then bam, like 10-11 hours after the dosing it’s as if my mind was clearer, it’s kicking in again but to a level that is therapeutic. The same level I’ve been chasing (titrating up and down to reach it) that I reached on my Dexedrine boosters I used to take before after Adderall come down. In fact it seems like this has been happening often, whether on 40mg or 50mg Vyvanse, it works best in the evening (previously in the day I’d feel over focused and/or tired like it was wearing off).

Two important things to mention. I am taking and still dosing Synthroid for my under-active thyroid. More importantly, I have a fatty liver. It crossed my mind that as Vyvanse relies on metabolism, and the Vyvanse may stay in my system too long and build up in the liver, this could be why I’m having such a hard time finding the right dose.

The 50mg was definitely building up in my system and lasting way too long (never came off it seemed, would go off only to soon after switch back on!). A week ago my Synthroid dose increased and I titrated down to 40mg Vyvanse. Should I go off of it for a couple days to clear it out of my system and hit the reset button to better trial the 40mg? Thanks! Any other advise or input would be greatly appreciated. I’m thinking that maybe the Vyvanse just isn’t for me yet until my metabolism and liver is fixed but before going back to the Adderall XR I’d like to really give Vyvanse a try.
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Old 01-18-18, 09:08 AM
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Re: Trouble Dosing Vyvanse

Curious, why did you switch from adderall to vyvanse?
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Old 01-18-18, 11:00 AM
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Re: Trouble Dosing Vyvanse

40mg Vyvanse = 25mg Adderall in terms of the active dextroamphetamine base.

Vyvanse is primarily metabolized by the gut. It will not build up in your system, even in the case of hepatic insufficiency.


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Old 01-18-18, 05:42 PM
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Re: Trouble Dosing Vyvanse

Thanks for the quick response Sarah and Ian!

On Adderall, I felt that a therapeutic dose (25 or higher) gave me unwanted physical stimulation that may have been exacerbating my OCD/anxiety. What really convinced me to give Vyvanse a try was how I felt on Dexedrine which I took as a booster in the evenings. I’d take 5 to 7.5mg of Dexedrine depending on what I was doing.

Now I have noticed that my OCD and anxiety had continued while on Vyvanse. Maybe I need a smaller dose but I was on 25-30mg Adderall. I should mention, I’ve recently began an SSRI for the first time, and have been on 10mg of Lexapro for a month now (will try the same dose for another month).

I assumed that 25mg Adderall was equivalent to 60mg Vyvanse? I have thought about trying 30mg Vyvanse again (was my starter dose) but it seems too small. Good to know I shouldn’t worry about my liver affecting the dose though! I do wonder if my metabolism affects efficacy of Vyvanse more so than Adderall.
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Old 01-22-18, 06:07 PM
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Re: Trouble Dosing Vyvanse

My metabolism has improved (a way to go) with my thyroid medication and I have a better idea of the Vyvanse now.

I’ve noticed that the morning anxiety/jitteriness is most likely from ADHD. 40mg Vyvanse takes about 3.5 hours, give or take, to noticeably kick in. I take it with Lexapro, so 45-50 minutes before breakfast (usually I have Greek yogurt with blueberries, whole wheat toast with peanut butter, and sausages or bacon with a glass of milk).

The Vyvanse does better with a cigarette, and if I smoke 2.5 hours after taking it it’ll feel like it kicked in an hour earlier.

Throughout the day I can feel a little sleepy in the late afternoon or early evening, and need to drink a cup of tea or small latte to help with feeling tired/lazy. That’s around 50-75mg of caffeine. I’ve noticed that a medium latte (150mg caffeine) will be too much and I feel over focused with increased OCD. Now, I can’t rely on caffeine for the boost and am planning to quit cigarettes soon. I don’t want to give up on Vyvanse yet so will try 50mg for a couple weeks, unfortunately I have a bit less than 2 weeks left of the 40mg to finish first.
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Old 01-22-18, 06:15 PM
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Re: Trouble Dosing Vyvanse

I should mention, depression has taken over me in the past few years and I used to be far more productive without any ADHD medication than I’ve been on them since last August. That may be interfering with my success on these meds as well. In a month I will have been on Lexapro 10mg for 8 weeks and revisit increasing dose or switching medication.
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Old 01-23-18, 04:39 AM
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Re: Trouble Dosing Vyvanse

Quote:
Originally Posted by aeon View Post
Vyvanse is primarily metabolized by the gut. It will not build up in your system, even in the case of hepatic insufficiency.
According to David W. Goodman, "Lisdexamfetamine Dimesylate (Vyvanse), A Prodrug Stimulant for Attention-Deficit/ Hyperactivity Disorder," Pharmacy & Therapeutics 35 (5) (May 2010):

Quote:
LDX [i.e. lisdexamphetamine] is rapidly absorbed in the intestine. Conversion of LDX to the active metabolite d-amphetamine occurs primarily in the blood through enzymatic cleavage after active absorption of LDX from the GI lumen.
I've also read another article by Michael Pennick, "Absorption of lisdexamfetamine dimesylate and its enzymatic conversion to d-amphetamine," Neuropsychiatric Disease and Treatment (3 June 2010) which also says that lisdexamphetamine is absorbed intact into the bloodstream and then metabolized there in red blood cells with the amino acid lysine being cleaved off of the dextroamphetamine.
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Old 01-24-18, 01:49 AM
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Re: Trouble Dosing Vyvanse

Interesting find today. Smoked a cigarette 2 hours after taking Vyvanse today and it kicked in sooner and stronger, didn’t have the brain fog/buzzing and brain was rather quite silent. Also felt in the beginning period an anxious feeling in the stomach. I doubt the time I have a cigarette after taking the Vyvanse should affect it’s metabolism throughout the day, so rather, since I felt very hungry, it rather increased absorption of my thyroid medication which then (faster metabolism) affected Vyvanse.

Vyvanse seems to be influenced by the metabolic rate much more so than Adderall it seems.
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Old 01-26-18, 04:47 PM
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Re: Trouble Dosing Vyvanse

But then there is this:

Quote:
The oral bioavailability of amphetamine varies with gastrointestinal pH;[122] it is well absorbed from the gut, and bioavailability is typically over 75% for dextroamphetamine.[133] Amphetamine is a weak base with a pKa of 9.9;[134] consequently, when the pH is basic, more of the drug is in its lipid soluble free base form, and more is absorbed through the lipid-rich cell membranes of the gut epithelium.[134][122] Conversely, an acidic pH means the drug is predominantly in a water-soluble cationic (salt) form, and less is absorbed.[134] Approximately 15–40% of amphetamine circulating in the bloodstream is bound to plasma proteins.[135] Following absorption, amphetamine readily distributes into most tissues in the body, with high concentrations occurring in cerebrospinal fluid and brain tissue.
And this:
Quote:
The prodrug lisdexamfetamine is not as sensitive to pH as amphetamine when being absorbed in the gastrointestinal tract;[6] following absorption into the blood stream, it is converted by red blood cell-associated enzymes to dextroamphetamine via hydrolysis.[6] The elimination half-life of lisdexamfetamine is generally less than 1 hour.[
So which is it I wonder. I used to have better links around which talked more extensively about how much the gut is involved with vyvanse, which is why my doc always advised me to have my daughter have a tiny nibble of something with protein-something that would get the gut moving to encourage its mechanism of action.



Quote:
Originally Posted by PoppnNSailinMan View Post
According to David W. Goodman, "Lisdexamfetamine Dimesylate (Vyvanse), A Prodrug Stimulant for Attention-Deficit/ Hyperactivity Disorder," Pharmacy & Therapeutics 35 (5) (May 2010):



I've also read another article by Michael Pennick, "Absorption of lisdexamfetamine dimesylate and its enzymatic conversion to d-amphetamine," Neuropsychiatric Disease and Treatment (3 June 2010) which also says that lisdexamphetamine is absorbed intact into the bloodstream and then metabolized there in red blood cells with the amino acid lysine being cleaved off of the dextroamphetamine.
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Old 01-26-18, 07:45 PM
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Re: Trouble Dosing Vyvanse

I might be wrong, but I think that scientists think that the activation of d-amp occurs in the red blood cells. Amp would then be cleared from the bloodstream through the liver.
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Old Today, 10:02 PM
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Re: Trouble Dosing Vyvanse

Just a quick update. The improved metabolism from Synthroid has been helping especially with digestion. While 10mg lexapro gave me emotional blunting which helped OCD, anxiety and depressive thoughts, it made be tired, sleepy, and less motivated. I asked the doc to increase Vyvanse to 50 but instead he told me to take 5mg of Lexapro instead. Will see how it goes.

I had some options in my head, such as increasing to 60mg Vyvanse which doc didn’t support, or a couple others I didn’t get around to discussing, trying Adderall with the Lexapro 10mg or trying a different SSRI such as Zoloft. Will be patient and see how this goes, I did need less serotonin and more dopamine I think. I’m only concerned as 5mg Lexapro is quite low.
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Old Today, 10:39 PM
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Re: Trouble Dosing Vyvanse

Correction: I asked the doc to increase Vyvanse from 50mg to 60mg. Will instead take 5mg Lexapro instead of 10mg.
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