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Old 01-16-16, 01:58 PM
OddballRoberts OddballRoberts is offline
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My Doctor won't increase my Vyvanse dosage.

This is actually my first post on here and I'm so excited to do this because we are all in this together. Ok, so here's my backstory. Was diagnosed with ADD at age 35. Started with Adderall for a year and then noticed the sharp dropoff. My doctor suggested Stattera but I didnt like it. He switched me to Vyvanse. Much better and after a few years, I'm up to 70mg daily dose. That worked for a while but in the last year, i've noticed it wearing off after about 5 hours. I work in a highly stressful, detail oriented job that makes the Vyvanse a dire necessity. When I take it at 8am, I'm plowing through all my work once it kicks in around 9am but wears off and by 2pm, I notice I dont have the drive as much. My workload has increased so I work until 530, 600 and sometimes as late as 8pm. Needless to say, my brain is mush by then. I recently asked my doctor if there was anything we could do to help my afternoons be more productive and all he would offer is to switch back to Adderall. I asked him about a small dose of Vyvanse to take later and he seemed like he just didnt want to go there and stated, "with controlled meds, I dont want to risk it." I wanted to get your thoughts on this. Is my doctor just being one of those doctors who is cautious or does he think i'm at risk for abuse or what? I'm torn and have thought about switching to my wife's insurance and get a new doctor. Thanks in advance.
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Old 01-16-16, 02:06 PM
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Re: My Doctor won't increase my Vyvanse dosage.

To me, it sounds like he's being cautious because he doesn't want the meds to react with each other to cause you harm (he could get sued if that happened if I understood it right)
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Old 01-16-16, 02:09 PM
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Re: My Doctor won't increase my Vyvanse dosage.

Yeah and I get that. Its completely understandable. I'm just making sure it's not me I guess. I was honest with him so I just want him to be honest with me.
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Old 01-16-16, 02:18 PM
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Re: My Doctor won't increase my Vyvanse dosage.

Well, your doctor isn't being completely unreasonable ... But what about a short-term dose of Adderall for later in the day? ....

Here's the other point:

1. It sounds like you are in a challenging job for someone with ADHD. Meds obviously can help but in my experience, you've got to get your lifestyle aligned with peak performance ... the meds can't do it all.

2. What's your sleep like? ... are you getting ample sleep? ... 8 hours of so?

3. Are you exercising?

4. Are you eating a good diet that is low in sugar and simple carbs that trigger cravings and disrupt our energy levels?

5. Also, you might consider a short term course of therapy and/or coaching (if you can afford it of course) where you get help in planning your day and working with your energy levels ... ADHD makes it hard for us to plan our work well ... as in, when I'm out of sorts, I don't prioritize ... and so I end up chasing emails as much as doing more important work ... So you might need help in prioritizing work ... so you don't spend a lot of your executive function on unimportant tasks ...

6. If there is any possibility, you might wanna think about what work you do more easily and that you enjoy more ... and see if you can take on more of that and let someone else do more of the tedious stuff that wears you down.

7. Meditation or short breaks during the day can be really good ... short walks can be good ... also listening to music can be good for me in sustaining some concentration ... getting my brain more relaxed ...

But basically, I would start with more sleep and rest ... and fiddling with diet and exercise ... I know that's hard. If you're not used to sleeping well and sleeping amply, getting enough sleep can be hard ... but it's worth working on ...

And yes, you might consider another doctor ... or just be more emphatic with this guy that you need more help ... In my experience, I get the doctors to make changes more when I tell them of my problems than when I suggest specific changes ... but that's just my experience ....

Good luck ... Let us know how things go ...

Tone
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Old 01-16-16, 02:21 PM
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Re: My Doctor won't increase my Vyvanse dosage.

Thanks man. That's some really good advice and outlook on things. I'll definitely keep everyone posted.
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Old 01-16-16, 03:22 PM
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Re: My Doctor won't increase my Vyvanse dosage.

[quote=OddballRoberts;1781587]
Quote:
I recently asked my doctor if there was anything we could do to help my afternoons be more productive and all he would offer is to switch back to Adderall. I asked him about a small dose of Vyvanse to take later and he seemed like he just didnt want to go there and stated, "with controlled meds, I dont want to risk it."
What??? he doesnt want to give you more of the controlled medication that is supposed to be the least abusable and would rather switch you to adderall the most abused stimulant? This makes no sense. First of all I dont believe that any medication is abuse proof. And I dont think you shouldnt try adderall because its most abused. What I am trying to understand is what he knows about controlled substances. And what is he risking?
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Old 01-19-16, 12:39 PM
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Re: My Doctor won't increase my Vyvanse dosage.

That's exactly why I was asking the forum. It's confusing to me too. From a rational and logical viewpoint, I understand his obligations and being cautious but this is something I have mentioned to him several times over the last year and its not like i'm seeking more of it for other purposes. It is what it is at this point. I'll feel it out and revisit it the next time I have to get a refill. Thank you though
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Old 01-28-16, 07:24 PM
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Re: My Doctor won't increase my Vyvanse dosage.

I think he means that he doesn't want to risk writing for more of the drug, because all prescribers are closely monitored by the DEA. 70 mgs is the max daily dosage, although MDs can use their judgement and give you whatever dose they think will work. That can create a headache for some doctors, hence not wanting to risk it.

Do you see a psychiatrist? I found a world of difference when I switched from primary care to a psychiatrist. IMHO you should at least be seeing someone who truly understands ADHD. Although stimulants are abused, people with ADHD can't abuse them in the way others can, since they work differently for us.
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Old 01-28-16, 08:44 PM
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Re: My Doctor won't increase my Vyvanse dosage.

Vyvanse is also a single-pill per day med, as defined by the maker, the FDA, and in turn, just about every health insurance policy that covers Vyvanse (many don’t as it is still brand only.)

Prescribing more than one pill per day of Vyvanse means a lot of paperwork, a lot of effort, a lot of scrutiny, a lot of questions, a lot of back and forth, and a lot less cash in your pocket.

---

I take 60mg of Dexedrine per day. I get coverage from 7am to about 9pm...if I am also well-rested, and properly fed and hydrated. My job makes sure I get the necessary exercise.

To get the same results in terms of efficacy and time covered, I would have to take 150-180mg of Vyvanse, and that simply is not an option for all the reasons I mentioned.

With the supervision and approval of my doctor, I trialed Vyvanse dosages of 120mg and 180mg, so as to match the dextroamphetamine base equivalence of 60mg of Dexedrine. It worked beautifully for me, but it would just be problematic to pursue that on so many levels.

That’s why I stay with my tried, tested, and true...Dexedrine™.


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Old 01-29-16, 01:00 AM
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Re: My Doctor won't increase my Vyvanse dosage.

You might want to switch to something like Adderall IR tablets. The best results I've ever had with medication is when I was taking "2 10mg tablets twice daily", but I broke them up.

I took 1/4 of a tablet when I woke up, 1/2 an hour or so later, 1/2 after another 2 hours, and then 1/2 roughly 4 hours after that, and then 1/4 around three hours later to taper off for the day. It wasn't always exactly like that, but that's pretty close. Maybe something like that will work better for you.

For me it was really smooth, and with minimal side effects. I never had too much at once, and it never wore off too soon. I could tell how much I needed and when I needed it. Best of all I didn't have any problems with insomnia, or lack of appetite. I loved being able to control how much I got and when it entered my system. Then I changed doctors and the new one insisted I take XR because they said that the XR is "designed to enter your system gradually", but I don't believe it. I've always hated XR because it always hits me with too much too fast, and I end up worn out and undermedicated about halfway through the day. I never feel like I can be assertive about my medication with doctors because some treatment is better than none, and asking/protesting can get you labeled as a druggie, especially since IR is more abusable. Maybe after I get reevaluated and can get back on my meds I'll have Dr. who will take me seriously and listen to my preference without kicking me out.

Anyway, hopefully you can get it worked out. I hope I was helpful. Best of luck!
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