Medication won't work until the evening

[Reagan]

Just started on Vyvanse -- up to 40 MG from 20 -- and it's been a bit of a rocky ride. The medication is incredibly inconsistent, sometimes it helps, but at other times it makes the ADD worse.

I was starting to think that my brain was responding to Vyvanse the exact opposite of the way it should. For the first 8 hours on the medication I would get no benefit, often feeling even more distracted. Then, after 12 hours, when I'm supposed to 'crash', I would get a little burst of help. I presumed that this burst was actually withdrawal from the medication.

Under my theory, if I woke up at the beginning of withdrawal I might actually see some benefit. So, one night I decided to take the Vyvanse about four hours before bedtime. Then something very strange happened: those four hours before I went to bed were the most productive, focused time I can ever remember. The medication works, it's just that my body only responds to it in the evening.

Has anyone experienced a similar problem or heard of this? I'm starting to think it might be an interaction with the Trazodone lingering in my system (I take it before bed). I can't yet discontinue the Trazodone because I'll get no sleep if I do. I am cutting down the dose. However, Vyvanse and dextroamphetamine are not considered among the 100+ drugs that interact with Trazodone. I've looked and looked and I can't find any evidence that these drugs interact with each other.

I would like to reiterate that the medication only works in the evening, regardless of what time I take it.

Meds:
100 mg Sertraline (Zoloft)
100 mg Strattera
40 mg Vyvanse
200 mg Trazodone before bedtime (I'm cutting this down)

[Reagan]

I forgot to mention:

Yes, I'm always sure to eat lots of protein in the morning.

There is no correlation to caffeine consumption.

I've tried varying the times I take the Strattera and Sertraline, in case they were interacting, but with no effect.

[Ruby85]

Maybe you're just not a morning person. I stopped Vyvanse for different reasons (general crappiness with no benefit), so I'm not saying that it's all in your head because it's true that Vyvanse can be inconsistent. But if you're the type of person who usually goes through the morning and afternoon in a fog and then hits your energy peak in the evening, then your medication will likely help you the most when your energy level is naturally at its highest. Of course, that's a huge pain, since most of us have to work during the day. But that could be the reason.

[Howard_C]

Trazodone is a member of a class of drugs (piperazine) that can interact with Vyvanse (amphetamine). The trazodone may partially desensitized certain receptors to amphetamine, at least for a period of time.

There are actually studies using compounds derived from piperazine to treat amphetamine and cocaine drug addiction and withdraw. Here is a reference to a possible mechanism of action ....

"These effects suggest that 5-HT1B/2C receptors are able to modulate the discriminative effects of AMPH, and that 5-HT3 receptors contribute to this modulation."

Trazodone elimination is a bit protracted, so the effects of the Vyvanse may be muted till your blood levels fall below a certain value.

Important side note - the mechanisms of action are more complex than the simple connection outlined above.

So, I think your theory could be generally correct - but I'm just passing on a bit of detective work.

From my general readings it would be very wise to cut back on your Trazodone intake gradually (if that is the route you take), as the medications, collectively, are changing the receptors on a functional and a structural level - to some degree.

[Howard_C]

Also - taking the Trazodone with food increases the rate of adsorption. That may mean that the amount you eat in the eventing may influence the amount that becomes present in your blood stream and/or it may increase how quickly it is absorbed (which may hasten the process of metabolism).

So the interaction with Vyvanse could vary a bit, depending on when and how much you eat in the evening. Just something to monitor, if your response to the Vyvanse seems to change a bit from day to day.