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Vyvanse (lisdexamfetamine dimesylate)

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Old 02-07-14, 12:06 AM
alog880150 alog880150 is offline
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May have solution for ineffective Vyvanse.

Hi, everyone.  I am currently taking 70mg Vyvanse daily and it is no longer working and my ADHD is back in full force.  I am so frustrated and cannot afford to not have my ADHD under control, my life is literally falling apart when I was doing so well. But, I think I found a possible solution and I'd like to get some opinions... this also may help a lot of people in similar situations.
 
I want to clarify what I mean by "no longer working/having the equivalency of a sugar pill," this doesn't mean that I'm suddenly used to the initial effects and what I'm missing is the speedy boost before our bodies grow accustomed to the medicine. That's definitely not the case, I had taken 70mg for half a year before I noticed the decrease and now it's been two full years. I can promise you those first effects have been long gone, but they were nice while it lasted lol. So, please don't post anything about how I shouldn't be "chasing a euphoria" or the medicine only being half of the solution and the other half is up to me. I can assure you that I did put in the time to educate myself and successfully took steps to control my ADHD with the focus, clarity, and control medicine gave me.

When I say sugar pill... I mean there is absolutely zero effect from the medication, good or bad. Well, nothing except one thing -- when I take stimulants my appetite is completely gone. I never got it back over time… But now, on medication days, I have a completely normal appetite like how I ate before I had ever taken a stimulant, and on days that I don't take the Vyvanse I tend to consume anything/everything in sight. This is the only difference between days that I take it and days that I don't take it… minus the very select few days that it starts working again.

Background info:
Started Vyvanse two years ago at 20mgs and titrated up to 70mgs where I have stayed for about 1.5 years.  I was never able to get a full 12-14hr coverage, not even close actually.  But, my metabolism is pretty fast and I tend to burn through medication quicker than average.  At 70mgs I was able to obtain 6-8hr coverage and since my doc does not go above the FDA guidelines the only option was to switch to another medicine again.  (I started at Metadate CD, then Ritalin IR, and finally Vyvanse.)  I wanted, and still want, to stay on Vyvanse because it controls my ADHD yet still lets me feel like me; there's no drugged or medicated feeling and I don't have a crash.  So that's where I stayed.
 
I don't take any other medications except for a Melatonin supplement 1.5mgs/night and occasionally if it's needed, half of a Benadryl or half of a Unisom to fall asleep... Currenly, I don't take anything to sleep because I could sleep all day since Vyvanse quit working; sadly, sometimes I do.
 
Last year around summer time I noticed that there would be the occasional day or two where the medicine didn't work, I even wondered if I had taken it on those days or if I forgot.  I wasn't too concerned.  But over time these days where it wasn't working got more and more frequent, and by September I was starting to really struggle with my ADHD because the medicine was only effective half of the time... as in, there were as many days that it didn't work as there were that it did.  It continued to increase to the point where I am now...
 
I skip weekends just because I like to have days where I don't take medicine, and starting that Monday the medicine is working again, Tues through Friday it's back to sugar pill status. If for some reason I don't skip the next Saturday and Sunday it will continue to be useless through the entire next week, as well.  Sometimes I will take a one to two week break from it and when I start taking it again it is back to working effectively.  Starting on Monday things go great and meds work; Tuesday, I am still pretty good; Wednesday, I notice a drop but still have some control; Thursday, it continues to drop; by Friday it's back to nothing. 
 
I've know quite a bit about Vyvanse because I am not huge on medication and when I do take it I tend to find out as much info as possible just so I know what I am putting into my body.  With that, observing my habits, and the pattern of ineffective/effective days I have come up with a theory that may/may not be the answer.  But I'm hoping someone on here may be able to tell me if I am onto something or not.
 
On days that I skip I tend to resemble a ravenous dog and I eat EVERYTHING I can get my hands on... It's definitely not a pretty sight.  Lol. It's not because I'm not eating and starving myself so I can't really explain this and it's definitely not because I'm hungry all day...but I've always been this way even when the medicine worked great, I would skip and eat until I was in pain...and I still do.  On other days, I just eat normal and get hungry like any normal person whereas before I had to force myself to eat normally because there was nothing telling me that I was hungry and I would forget if I didn't set myself alarms to remind me.  This worked well and I was able to eat normal using that system.  The difference between those days that I skip and the other days is how much I eat... the amount of food I inhale throughout the day would not be healthy over the long run lol.  But it's an abnormally large amount.  
 
When food hits the stomach this tells the pancreas to release two enzymes that aid in digestion and one of them is trypsin.  Without trypsin Vyvanse would not metabolize correctly, or at all.  Trypsin and Vyvanse hit the liver, trypsin attracts lysine, and that cleaves away the lysine bond which activates the d-amp. 
 
Little to no trypsin = little to no active amphetamine = sugar pill
 
The effects of Vyvanse over time have not yet been able to really be studied as thoroughly as the older stimulant meds, so I am wondering if it is possible that Vyvanse causes a reduction of the amount of trypsin that the pancreas produces over a period of time in some people. It would explain why there are quite a lot of people claiming that Vyvanse just does not work anymore. 
 
Such a HUGE amount of food that I consume on those certain days would obviously need to be digested, so the increase in needed digestion may increase my trypsin level putting it back up to normal/maybe a little higher. My trypsin level increases and I have stored up enough over the weekend to activate the Vyvanse for one day.  And when I take long breaks over the two weeks I store up enough Trypsin to last a solid 3-4 days as opposed to the one day after a skipped weekend. 
 
If this is possible and I am onto something here, there may actually be an easy fix.  Pancreatin is a supplement that contains Trypsin... I'm not a doctor so I have no idea how much or when, but it seems logical to supplement with Pancreatin for the Trypsin reduction. 
 
So, what do you guys think?  Could I be right about this?  I know this is long so thanks if you had the time to read and I would appreciate any input… I don't really want to run this by my doc bc he constantly wants to add meds like antidepressants to increase effects but I am not fond of this idea. I don't like to have to take a medication every single day. I want the choice. But he pushes it constantly, and I know that would be the only answer I would receive.

Besides, I'd rather talk with people who have actual experience with ADHD and medications that treat it...
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Old 02-07-14, 02:22 AM
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Re: May have solution for ineffective Vyvanse.

Whatever works for you man. Sounds pretty far fetched to me. Adding an SNRI really helped my vyvanse.

I agree with your doc. I hate taking meds too but that's life!
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Old 02-07-14, 05:48 AM
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Re: May have solution for ineffective Vyvanse.

ADHD meds are best taken everyday for consistency. My adhd is always there, its chronic and lifelong. I need my meds everyday.
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Old 02-07-14, 01:17 PM
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Re: May have solution for ineffective Vyvanse.

Subscribed. I'm very curious to see where this is going.

I have to say I had the opposite effects when I didn't take it. Took it on a Friday for the first time, it was perfect. Didn't take it Saturday and Sunday, and when I took it on Monday, nothing....same for Tues and Wed. Then Thursday, it came back. I'm currently experimenting with different foods to take it with. So far, spoonful of peanut butter, a few sunflower seed cookies and a nectarine worked best. Obviously I'd like to work in a healthier breakfast but still working toward it, as I've never eaten breakfast before.

Anyway, all I gotta say is be extremely careful with any supplements you take. They obviously took the time to work through all the ways the pill will work, and take everything into account. Messing with the chemicals the pill works with can possibly be dangerous.
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Old 02-07-14, 04:29 PM
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Re: May have solution for ineffective Vyvanse.

Quote:
Originally Posted by HelloMyNameIs.. View Post
Subscribed. I'm very curious to see where this is going.

I have to say I had the opposite effects when I didn't take it. Took it on a Friday for the first time, it was perfect. Didn't take it Saturday and Sunday, and when I took it on Monday, nothing....same for Tues and Wed. Then Thursday, it came back. I'm currently experimenting with different foods to take it with. So far, spoonful of peanut butter, a few sunflower seed cookies and a nectarine worked best. Obviously I'd like to work in a healthier breakfast but still working toward it, as I've never eaten breakfast before.

Anyway, all I gotta say is be extremely careful with any supplements you take. They obviously took the time to work through all the ways the pill will work, and take everything into account. Messing with the chemicals the pill works with can possibly be dangerous.
Thanks for the advice, Hello. And that is actually why I haven't bought a bottle of OTC Pancreatin to test it out...

The concern that I have is that Vyvanse doesn't actually have any extended release properties -- take away the Lysine and you've got Dextrostat. The time release mechanism comes from Trypsin, each time the pancreas releases Trypsin throughout the day it continues to the liver where little by little lysine is cleaved and the d-amp activates.

Too much Trypsin could actually activate too much of the medicine, that's never any fun lol.

Interestingly enough, there are people with digestive problems and trypsin deficiencies aren't uncommon; which is why poeple take the Pancreatin supplement. If I happen to fall into that category that would explain why the medicine only lasted 6-8hrs at 40mgs, 50mgs, 60mgs, and 70mgs...not much of an increase in intensity either.

I just need to know how to test it out...

As far as your Vyvanse issues there are a few things it could be... but, i'm curious... On the days that it didn't work did you eat/drink anything prior to the dose, and on days when it worked did you wait until after to eat/drink? I could not have anything at all on my stomach when I took it or it wouldn't work... it's exactly like this sugar pill effect I'm having now.
(now that I think about it that could possibly be bc I didn't have enough trypsin to digest breakfast and the medicine... maybe???)

Wait half an hour to 45 minutes after your dose and eat something with a MASSIVE amount of protein... I shoot for at least 15mgs and that is a pretty good amount. Your neurotransmitters will thank you and stick around a lot longer with protein than without protein.
Be sure you take it with 8oz of water...

Are you still in the trial-and-error process with correct dosing? If so, that's another possible answer... dose too low is very unpredictable.

Anyway, I'm going to keep digging and post any updates here if I find out any further info on the trypsin... Thanks again for the reply.

Quote:
Whatever works for you man. Sounds pretty far fetched to me. Adding an SNRI really helped my vyvanse.

I agree with your doc. I hate taking meds too but that's life!
I'm curious why you termed it as "far-fetched," do you mind elaborating?

Quote:
ADHD meds are best taken everyday for consistency. My adhd is always there, its chronic and lifelong. I need my meds everyday.
I think that skipping days or taking med breaks is just a personal preference. There's even a few people that don't even take medicine for their ADHD and treat it in other ways which I couldn't even begin to imagine. So I wasn't saying my ADHD was suddenly gone during the weekends... But it would be nice if it was lol. It's just something I've always done in order to "reset" myself, so to speak.

If you don't mind me asking, what do you take for ADHD? Honestly if the Vyvanse wasn't always so unpredictable and I knew what to expect with every dose I probably wouldn't skip...
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Old 02-14-14, 04:54 AM
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Re: May have solution for ineffective Vyvanse.

Forget what you think you know about Vyvanse, these are from published research papers:

Lisdexamfetamine (vyvanse) is a prodrug of dexamfetamine bound to lysine (an amino acid residue -- one of the twenty building blocks that make up proteins). Following oral administration and absorption into the circulation (occurs in the duodenum -- the first part of your small intestines, the part right after the stomach), the covalent amide linkage between dexamfetamine and L-lysine (there's L and R amino acids, all life uses only L, though i'm sure there are exceptions) is enzymatically hydrolysed in the blood (as i understand it, some enzyme in or on red blood cells is responsible for this reaction), releasing the active agent (dextroamfetamine). (Pennick M, 2010)


Administration of lisdexamfetamine with food has no significant effect on the extent of absorption of dexamphetamine, although the rate of absorption is slightly delayed.
(Krishnan et al. 2008)



The maximum recommended dosage is 70mg, but that doesn't mean higher dosages aren't unheard of. Talk with your doctor about a trial on 80mg (2x40mg) for a month; increase by 10mg/month until whatever they decide is too much; take it slow.
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Old 04-19-18, 07:18 PM
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Re: May have solution for ineffective Vyvanse.

Hi, I really enjoyed reading your thoughtful post. I'm about 4 years late to the party here, but thought I'd chime in.

Sometimes when a stimulant stops working, its because it has made brain chemistry unbalanced over time. Its now established that there's a "see-saw" relationship between stimulants, (which increase dopamine and norepinephrine transmission), and seratonin levels in the brain. Its very common for ADHD people to find the effect of the stimulants wore off over a period of time, ranging from three weeks to many months, and then find that it works almost as well as it originally did, when the start anti-depressant therapy with an agent that works for them. When you increase dopamine with stimulants, that very often causes seratonin levels to fall to levels where you get lethargic and depressed, and so the stimulant no longer helps you concentrate.

1st, I would get the following book, (no, I'm not Dr. Parker, I'm a patient of his who's been helped immensely by him), New ADHD Medication Rules. In there he talks about "THe Rules" of medication treatment for ADHD. I would encourage you to book an appointment with Dr. Parker, (he does them over skype), but in my unprofessional opinion, I think you should give a solid antidepressant, like Cymbalta, (excellent SNRI), a shot, and see if by the third or fourth week, you don't feel like your old self again, when you first started vyvanse. It doesn't work overnight like stimulants do, but for ADHD, once you find the right med, it should work indefiniately, and if it stops working, its because something else has changed in your body, or what your taking, (ie another med interacting).

I know it would be nice to take just one drug, or none at all, but for many people with ADHD, the simply must take an antidepressant to counteract the seratonin-lowering side effects of the stimulants they need. NEVER take prozac or paxil with stimulants, as both of these are almost complete blockers of one of the main enzymes that metabolize dexedrine products and adderall. There are better alternatives anyways, Cymbalta, Trintellex, even effexor for some people. Here's what I would do: Ask your doctor if you can try Cymbalta with vyvanse, see how you're doing after three weeks, or a month if you're not sure.

If your'e doing much better, but the vyvanse doesn't last as long as it should throughout the day, it means your could be a fast metabolizer, and *possibly need a higher dose. It doesn't seem like your doctor feels comfortable going above the FDA recommendations, so at this point I'd book a consultation on skype with DR. Parker, and have him work with your family doctor, as your GP would have to prescribe the meds Dr. Parker recommended. He'll take it from there. Dr. Parker does a lot of allergy testing, which although it can seem like a pain to go through all that, made a significant difference to how well my meds worked, (reducing the foods I had a problem with).

Last edited by peripatetic; 04-19-18 at 07:22 PM.. Reason: removed commercial link per guidelines; added paragraphs to ease reading
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Old 04-20-18, 12:02 PM
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Re: May have solution for ineffective Vyvanse.

There is some truth to that.



My suggestions are to first eat a balanced diet everyday. Be sure and get your veggies, amino acids, and healthier carbs. Avoid simple sugars. This is not only important due to the mechanism of action for vyvanse (it's not the same as Dex or adderall) but it's also important for stable blood sugar levels and restoring the nutrients, vitamins, and minerals that are needed when taking these drugs.


Also you may have luck with the M-W-F approach to taking meds. I did that approach for 2-3 years and it helped keep my tolerance at bay and only needed 20mgs, never more. And no meds on weekends. Some people and especially doctors will advise against this but the drugs do lose their effectiveness to a degree over time regardless.



I 100% agree with you on not running it by your doctor, in my experience the majority know little to nothing about ADHD meds unless they specialize in it or are an exception. ADHD is one of those things you have to do a lot of research for yourself(as with anything) to find that balance. Throwing more drugs at the symptoms is not going to fix the problem, that can more than likely be fixed by nutrition and supplementation to restore balance of the neurotransmitters.




EDIT: Damn this threads old.
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