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Dexedrine/Dextrostat (dextroamphetamine)

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  #1  
Old 12-23-08, 10:48 PM
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People taking high doses - doesn't seem right..

I see people's posts describing how they take extended release (spansules) 2 or 3 times a day, or they take 80 mg of the regular release. Those doses are REALLY high!

The recommended dose is a maximum of 15 or 20 mg! The biggest spansule I've researched is 15 mg.

Are the IR (regular?) doses comparable to the spansules?
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Old 12-23-08, 11:08 PM
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Re: People taking high doses - doesn't seem right..

I believe the max recommended dose for the Spansules (extended release) is 30 mg a day, and the max recommended dose for Dex IR (instant release) is 60 mg a day. Some doctors may prescribe more or less, depending on the severity of ADD symptoms, and if there is any level of tolerance.
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Old 12-24-08, 04:21 AM
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Re: People taking high doses - doesn't seem right..

Quote:
Originally Posted by Ruby85 View Post
I believe the max recommended dose for the Spansules (extended release) is 30 mg a day, and the max recommended dose for Dex IR (instant release) is 60 mg a day. Some doctors may prescribe more or less, depending on the severity of ADD symptoms, and if there is any level of tolerance.
While it's pretty common to just give a straight mg dose, Keep in mind that most drugs should actually be based on the persons weight, so when you hear some people who are taking 80+mg, they may simply be REALLY BIG

My doctor says the Maximum dose for Dexedrine is 1mg/kg, so for me that is 80mg, though I have never taken more then 25mg a day.

Hope this helps.

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Old 12-24-08, 06:39 AM
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Re: People taking high doses - doesn't seem right..

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Originally Posted by RandomU View Post
While it's pretty common to just give a straight mg dose, Keep in mind that most drugs should actually be based on the persons weight, so when you hear some people who are taking 80+mg, they may simply be REALLY BIG

My doctor says the Maximum dose for Dexedrine is 1mg/kg, so for me that is 80mg, though I have never taken more then 25mg a day.

Hope this helps.

Random
A lot of medication is no longer dosed on body weight: it's all about metabolism etc.
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Old 12-26-08, 01:41 AM
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Re: People taking high doses - doesn't seem right..

Quote:
Originally Posted by Driver View Post
A lot of medication is no longer dosed on body weight: it's all about metabolism etc.
i'm interested in this method you say doctors now use of measuring metabolic rate to determine the dose of stimulant medication. i would greatly appreciate it if you could provide some references on this subject. many thanks.
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Old 12-28-08, 04:10 PM
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Re: People taking high doses - doesn't seem right..

Nothing personal against the OP but you really need to do your homework at least a little.
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Old 12-28-08, 04:24 PM
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Re: People taking high doses - doesn't seem right..

Everyone's body chemistry is different.

Plus,medicine is not an exact science.

So,there's really no way to tell what medications will work for which person,without trial & error.

Therefore, the dosage needed for efficacy of treatment will vary for each person.

Throw in age,gender, height & weight, and things get even more complicated.

The next factor would be the specific type of ADHD involved, as well as the severity.

As a result, you can't really look at someone's (individual) dosage and make comparison's,other than with themselves.

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Old 12-28-08, 06:48 PM
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Re: People taking high doses - doesn't seem right..

One should also keep in mind we are talking about rapidly metabolized drugs. The presence of these drugs in the body is measured in hours -- not days. Prescription of these drugs is not based on the steady building up of the drug in the bloodstream to a therapeutic level -- unlike say antidepressants.

Most of us take a series of doses over a day's time. Sustained release versions of these medications are simply a convenient way of doing so. For reasons of efficacy or cost many of us take a series of individual doses during a day.

Presently I am taking 15mg of generic Adderall at a time. I take these doses every 4 to 6 hours. I usually take an extra 5 mg in the morning. So we're talking an average of 50 mg a day. If I am working overtime etc. I can be expected to take another booster dose of 15 mg. So that adds up to 65 mg. I am actually attempting to keep my dosage low. From my past experience with dextroamphetamine (doctor santioned ) I know I can easily ramp up my dosage without ill affect. Thankfully I am a 6' 4'' man who has been blessed with a well functioning liver...
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Old 12-29-08, 12:08 AM
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Re: People taking high doses - doesn't seem right..

this may help clarify some questions in relation to dose
Quote:
Finding the Most Effective Dose
Some medications are prescribed best according to the patientís age, weight, or severity of symptoms. But stimulant medications do not reliably follow such guidelines. Nora Volkow and James Swanson (2003) described individual differences that affect oneís response to stimulant medications. Mark Rapport and Colin Denney (2000) demonstrated that body mass fails to predict optimal dose for ADHD patients. Some very young and small children need quite large and frequent doses of stimulant to get a positive effect; whereas other children, adolescents, and adults may benefit from very small doses of stimulant and may have adverse effects to larger doses. In short, more medication is not always better. And since it is not possible to predict the optimal dose from age, weight, or symptom severity, the usual approach is to begin with a very small dose of one or another of the stimulant medications and then increase the dose gradually, allowing about three to seven days on a dose before trying a larger one.
Browne, Thomas E. (2005). Attention Deficit Disorder: The Unfocused Mind in Children and Adults. London: Yale University Press.
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Old 01-05-09, 02:01 AM
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Re: People taking high doses - doesn't seem right..

Barring undiagnosed heart defects and the like, the minimum lethal dose of pure dextroamphetamine for a 40kg human is around 2,000mg. Therefore, keep upping the dose until it works, IMO.



http://adultadd.info/HighDoseMedication.htm

Quote:
For a medication to be approved by the US Food and Drug Administration (FDA) for sale to the public, the pharmaceutical company producing it must submit the results of extensive research on the medication demonstrating its effectiveness and safety. Such studies can take years to complete and can be quite expensive (millions of dollars). It is easier for a drug to pass the FDA testing requirement if it is tested at the lowest dose levels at which it may be effective. This way, side effects and other problems are less likely to occur, and the medication is more likely to be approved.


About forty years ago, drug manufacturers carried out tests on stimulants on children at doses up to 60 mg per day. The tests proved the medications worked and were safe for children. They fairly consistently showed that the higher the dose, up to the highest level tested, the better the effect. But they said nothing about the benefits or risks of higher doses. So the highest dose the FDA approved was 60 mg per day.
At the time the tests were done, it was generally believed that ADD did not exist in adults, that children outgrew it. We now know that hyperactive symptoms often disappear in adulthood but that inattentive symptoms persist throughout the lifetime of well over half of all children with ADD.



Fortunately for adults with ADD, doctors are permitted by law to prescribe medication at doses that are higher than those approved by the FDA. This is called "off-label" prescribing. However, if doctors can legally prescribe higher doses off-label, and pharmacies can legally fill those prescriptions, there is little motivation for pharmaceutical companies to carry out costly studies to determine whether higher doses are safe and more effective in adults. This task is left up to practicing doctors, who learn what doses work well and which do not, which are dangerous and which are not through experience, reading, and observing leaders in the field.

However, the FDA does not change its rules about dosing unless a pharmaceutical company submits a new application for it to do so, and that has not happened with the stimulants. So many doctors and pharmacists who are not familiar with current advances in the treatment of ADD still honor on the original FDA approved limits on dosing. For one thing, doing so protects them against malpractice claims, as they can always defend their treatment by noting that they prescribed according to government guidelines. However, once an off-label treatment becomes common enough, it is a sufficient legal defense to note that the clinician and patient were aware that the dosage was not within FDA limits but was in line with the standards of practice in their community. So while the FDA approval for most stimulants remains limited to use in children, their use in adults is now so widespread that most clinician feel secure prescribing them for adults as well.


Doctors who use off-label (higher) doses have found that, as a general rule (but not always), the more a person weighs, the higher the dose of stimulants they will need to get a beneficial effect. Thirty milligrams twice a day might work for a 12 year old facing an eight hour school day, but twice that dose might be needed by a 180 pound adult who finishes with work at 5 PM and then has to do work at home and/or interact calmly and productively with family members in the evening. As Dr. Biederman has often said, "pediatric dosing, pediatric effects." This became clear even with the treatment of children. In one of the largest studies of the effects of treatment for ADD ever carried out, the Multimodal Treatment Study, one of the most common causes of poor outcome was under-dosing.


In addition, there are differences in how stimulants are absorbed from the gut, how they are transported to the brain, and how they act in the brain. For these reasons, the same dose of a medication might be much too low for one person and much too high for another. Setting a fixed dosage does not make sense scientifically.


I am aware of no published research articles on the benefits or risks of supervised treatment using daily doses higher than 60 mg per day of amphetamines despite the fact that many patients have benefited from such doses with no ill effects. Patients who require more frequent dosing may especially benefit from higher total daily dosing. For example, patients who become irritable when their medication wears off at the end of the day often benefit from an additional dose in the mid to late afternoon even though the dose goes over the FDA limit.



The abusive use of high, or even standard, doses of stimulants or the use of stimulants for recreational purposes has cast a shadow on the therapeutic use of off-label doses by responsible clinicians. However, the excessive use of stimulants by some people and/or the unsupervised prescription of excessively high doses by a small percentage of irresponsible clinicians or the lethal effect of amphetamines mixed with street drugs does not justify withholding helpful doses of medication from responsible patients being treated by responsible doctors.



A repeated note of caution: After reading this page, you may think that you should try a higher dose of your medication.



Do not increase your dose of stimulants without the approval of your doctor as there may be medical or other reasons that a higher dose may not be healthy, or might even be dangerous, for you.
Body Weight
methylphenidate maximum dose amphetamine maximum dose Vyvanse maximum dose*
100 pounds 90 mg per day 75 mg per day 160 mg per day
120 pounds 110 mg per day 80 mg per day 200 mg per day
140 pounds 125 mg per day 100 mg per day 250 mg per day
160 pounds 145 mg per day 120 mg per day 300 mg per day
180 pounds 165 mg per day 135 mg per day 350 mg per day
200 pounds 185 mg per day 150 mg per day 450 mg per day
250 pounds 225 mg per day 185 mg per day 625 mg per day
* Vyvanse (which contains dextroamphetamine) dosing is usually about two and a half times that the other amphetamines. This is because each molecule of dextroamphetamine in Vyvanse is bound to an inactive but heavy molecule that keeps the dextroamphetamine from working. After Vyvanse is taken orally, the inactive molecule is split from the dextroamphetamine by digestive enzymes in the intestines, allowing the dextroamphetamine to be slowly absorbed into the blood stream.
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Old 01-05-09, 01:02 PM
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Re: People taking high doses - doesn't seem right..

I have been reading this forum for months and joined as a member only yesterday. One thing I have noticed is how crazy people are about dosage. I have seen several 'maximum dosages' thrown around which is not surprising.

I can see that as an adult male who will truthfully and freely share my dosage with everyone I am in for some 'Wow that is too high' responses. I am sick of people saying a certain dose is too high but not saying why. Why is it too high? Heart Attack? Or general word of mouth paranoia and the dominance of a focus on children with ADD not adults?

Quote:
A lot of medication is no longer dosed on body weight: it's all about metabolism etc.
Yes this is very interesting to me as well because I have a very fast metabolism that not only means a 'high' dose compared to what I see at the 'norm' but also that timed release drugs (I have tried Adderall XR and Dexedrine Spansules) don't work very well for me and there is no way they last for 8-12 hours. More Like 5 hours and not as effective with instant release stuff in general. I am about 6' 175 lbs and my doc and I are still experimenting with my dose but we know it will be at least 1mg/1kg of body weight maybe more. Anyone who knows more about metabolism for dosing level and not body weight please mention something.

I do believe that body weight and gender are relevant for dosage but I think metabolism from personal experience is just as, if not more, important overall. Concerning gender: if a male and a female who weigh the same both consume the same amount of alcohol there blood alcohol level (BAC) will be quite different. It is because they metabolize things differently. Also if 2 people of the same gender and same body weight but with different metabolisms consume the same amount of alcohol they're BAC will be noticeably similar but in as little as a couple of minutes and over time the one with the faster metabolism's BAC will drop faster. So metabolism cannot only change dosage level but also possibly frequency. So why wouldn't this be true for any other drug? Or anything that is metabolized at all. There are no sweeping generalizations that are appropriate for dosage and overdose is WAY higher than people think it is.

I am starting to really feel bad for males weighing 200 lbs+ with a fast metabolism and people attacking them for their dosage level and frequency. These guys are probably deterred from posting there dosage level or posting anything at all because the first 5 answers have nothing to do to with what he was saying or asking and are more like 'OMG that is waaaaaaay too high. Are you sure you are not dead?' It's not fair. That goes true for anyone with a 'low' dose or females that might require a high dose as well.

Right now I am resisting the urge to quote studies on things that are easily found and known as general knowledge like my alcohol example and I think the other ones above are sufficient for what we are specifically talking about. I hope this never turns into a forum where people have to backup everything they say with a scientific reference leaving everyone handcuffed to say anything at all. I have seen that happen in non-ADD related forums and it sucks. But on the other side of things saying something is this or that without saying why is pointless and just spreads more fear and drug related paranoia that already greatly looms around ADD culture.

The truth is finding the appropriate dose is individualistic and more a sometimes grueling process of trial and error and a constant battle against tolerance than what the FDA says.
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