Some medications cause Adderall to have a weaker effect

[SweetNicole]

I have been on Adderall (both instant and extended release) for a total of four years now. In my experience I noticed that taking certain kinds of medications can decrease the effects of Adderall.
Spironolactone is a medication I take at a high dose (300mg) and causes increased rates of urination. The increased rate of urination causes Adderall to leave my system prematurely leaving me with little benefit from taking Adderall. On the other hand, Spironolactone also causes fatigue and taking Adderall allows me to stay awake rather than passing out and sleeping all day.
Allegra is another medication I take (180mg) for problems breathing thorugh my nasal cavity. This medication causes fatigue also and decreases the effectiveness of Adderall in keeping me awake.
Lexapro is a medication I take for major-depression (30mg) and causes fatigue as a side-effect. Once again the benefits of Adderall are reduced since I can’t be very active in life if I sleep all day from fatigue.
Estradiol is a female hormone that I take (6mg) which causes weight gain, fatigue, and increased depression. Adderall once again has to compete against the effects of the medication thereby reducing its effectiveness.
In summary, typical dosage regimen of Adderall (instant and/or extended release) and the combined side-effects of the other daily medications has resulted in a less-than-desired effectiveness of Adderall in the management of my ADHD (combined type with major depression – age 7). The response to this problem is a higher dosage of Adderall to restore me to an active role in life. This is a double-edged sword since higher dosages of Adderall correlates with increase in undesirable side-effects.
fficeffice" />>>
In my case I don’t just take Adderall for management of ADHD. It is part of a combined therapy to rehabilitate me into the community given the medication regimen that is in place.
>>
Unfortunately I can not reduce or stop my administration of Sprionolactone or Estradiol due to Gender Dysphoria and inability to afford alternative methods of management. Allegra is taken to help reduced the stress and strain of breathing through my nasal cavity, until that is looked into properly I remain on it. Lexapro is at an unusually high dosage and has been adjusted at different levels resulting only in increased depressive symptoms at the lower dosages.
>>
My most effective dosage of Adderall XR is 60mg/daily. This is a very high dose of amphetamines and is not recommended to anybody as a solution to counter medication side-effects. The lowest effective dose of Adderall daily is optimum for success in the general population of ADHD sufferers. Taking higher than necessary dosages of Adderall may and can lead to CNS damage and I do not recommend others to mirror my usage of the medication.

[nicolai]

aaaaa

[nicolai]

Apparently my last post messed up. Here ya go...

Hello-

I'm sorry to hear about your situation . Not sure if you were looking for advice, or just looking to give advice.

I'm kind of confused looking at the medications you take. Sorry if I've gotten to faulty conclusions and you don't have to reply.

That amount of spironolactone (300mg) is indicated only for primary hyperaldosteronism, aka primary aldosteronism, conn syndrome etc. If you are taking it for that, is this also the reason you take 1200mg of Calcium (which is an extremely high dose), due to the hypocalcemic effects of hyperaldosteronism?

Also, could I ask if there's a reason for taking 500mg of vitamin C? at that high of a dosage, Adderall's absorption is lessened, and it's clearance is hastened.

also, someone has told you to drink a TON of water, I hope? Right? If not, please do. Allegra + the corticosteroid + adderall + spironolactone could lead to severe levels of dehydration (which may be another cause of your fatigue).

Also, if you've been having breathing difficulties for more than 3 weeks, you should have been told to discontinue use of the corticosteroid (rhinocort aqua) assuming you are taking it for allergies.

last thing (the only thing that may be able to help you in any way...): spironolactone clears water and sodium from the distal convoluted tubule; the tubule resides on the kidneys and controls potassium, calcium and pH levels in the digestive tract. When spironolactone clears the excess water and sodium from the tubule, the functioning of the tubule increases, and the pH level of the stomach and urinary tract go up (because the tubule absorbs bicarbonate, which is an alkaline)

how thats important: pH measurement is the amount of acid in something. The lower the pH, the more acid. The more acid, the less effective Adderall is. To get to my point: spironolactone doesn't decrease the efficacy of adderall, but rather, it increases it, because it lowers the acidity in the stomach and urinary tract. Spironolactone flushes water out of the tubule I mentioned, on the kidney, which doesn't effect clearance of Adderall (because adderall is inside your blood plasma or bound to protein in the blood).

however..spironolactone decreases the efficiency of antidepressants used to treat major depression. I'd assume that's why you're on a really high dose of Lexapro.

[SweetNicole]

Nicolai, this is a response to your botched posting:

I take a daily multivitamin (as directed) as well as Calcium, Vitamin B-12, and Vitamin C. The Calcium includes Vitamin D and comes in 600mg doses. I take one dose of Calcium when I wake up and one dose at lunch time; equaling 1200mg of Calcium daily. I receive 60mg of Vitamin C from the multivitamin. I take an additional 500mg dose of Vitamin C. The info sheet on Adderall from Shire says: Acidifying agents—Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCI, ascorbic acid, etc.) lower absorption of amphetamines. Just taking additional Vitamin C Supplementation I was unknowingly decreasing the effectiveness of Adderall. I will now cease the additional Vitamin C in attempts to improve the effectiveness of Adderall.fficeffice" />>>
Thank you for your response it was very helpful!>>
Nicole

[SweetNicole]

I apologize for any confusion I have caused you. Let me reassure you I had no intentions to create confusion. I am looking for other individuals input on the matter this includes advice.fficeffice" />>>
The amount of Spironolactone (300mg) is to suppress Testosterone levels as part of a cross-sex hormone regimen. I am a male-to-female transsexual (pre-op) that uses the Spironolactone to lower testosterone levels to that typical in a genetic female.>>
I was taking the additional Vitamin C (500mg) for no reason other than boosting the immune system. Now that you have pointed out an interaction that is confirmed in the data sheet of Adderall I have removed the additional Vitamin C supplementation from my routine.>>
Spironolactone is a diuretic meaning that is causes me to lose water quickly and urinate more often. I drink a lot of water as directed by my endocrinologist to reduce chances of dehydration.>>
I have had breathing difficulties since I was little and may be due to something structural. I will be seeing a specialist regarding my breathing difficulty in a few months. I have been prescribed the Rhinocort Aqua for several months. It could be a contributor to my fatigue and is something worth looking into. I don’t understand the relevance of your mention of Allegra.>>
Although Spironolactone creates a suitable ph condition in the stomach for Adderall it also creates side effects. Spironolactone treatment of 4 years at originally 400mg daily causes fatigue due to demands it places on the body.>>
Could you support your statement regarding reduced efficiency of antidepressants caused by Spironolactone?>>
>>
Thank you for all your input,>>
Nicole

[nicolai]

Nicole:

I don't know if I'll be able to explain it well.. but I can try

The main three glands of the neuroendocrine system are the Hypothalamus, the pituitary, and the adrenal gland..(the first two are on or near the brain itself, while the adrenal glands sit atop the kidneys).

The interactions between these three glands determine many of the emotional functions of our body, and the interactions these glands have are called the "hypothalamic-pituitary-adrenal axis" or HPA axis. The goal of antidepressant therapy is to increase the level of certain neurotransmitters in the brain.. these neurotransmitters are created or directly affected by the HPA axis. What antidepressants do, is bind themselves at corticosteroid receptors and directly increase the signaling (or 'communication') between each gland of the HPA axis.

What this means is antidepressants, even though they're not steroids, attach themselves to steroid receptors. By doing that, they are able to regulate the HPA axis easier (the exact reason behind that is unknown, like much of psychiatry..).

Now, this is only substantial because spironolactone, among many other things, is a "mineralcorticoid antagonist" .. anything with the world corti- or corticoid is a corticosteroid, and thus, has to do with steroid receptors. Spironolactone is an antagonist of steroid receptors, meaning it blocks steroid receptors in the body, and the antidepressants don't have enough places to attach, and instead, are just eliminated.

Basically, the antidepressants and spironolactone are competing for somewhere to land. Since spironolactone is an antagonist, it blocks the antidepressants from landing at the sites they need to land at for optimal functioning.

Research has also shown that spironolactone can interfere with the effectiveness of antidepressant treatment. The drug is actually (among its other receptor interactions) a mineralocorticoid (MR) antagonist, and has been found to reduce the effectiveness of antidepressant drugs in the treatment of major depression, presumably by interfering with normalization of the hypothalamic-pituitary-adrenal axis in patients receiving antidepressant therapy

As shown in rats and also in transgenic mice with impaired glucocorticoid receptor function, antidepressants enhance the signaling through corticosteroid receptors.

(both from The Rationale for Corticotropin-Releasing Hormone Receptor (CRH-R) Antagonists to Treat Depression and Anxiety, http://www.ncbi.nlm.nih.gov/pubmed/10367986)

And sorry for the "blotched" posts.. pretty much how I work :-p. I think of something in the middle of a sentence and add random things at random parts. Thanks for elaborating on your usage of spironolactone; I hadn't thought of it being used to suppress testosterone. I apologize for my ignorance.

I wish you luck seeing the specialist regarding your nasal problem and breathing. I couldn't even begin to guess what could be wrong there..if it's just your nose, then possibly nasal polyposis..which are masses in the nasal cavities (actually they're overgrown membranes, but they still block the airway). Anyway, I'm sure things will resolve as far as that goes after meeting with the specialist.

Best of luck

[The ADHD Fan]

I was just reading a blog on Adderall by Dr. Charles Parker. Since we're discussing the interactions of Adderall with other medications, I thought I'd throw this out. Dr. Parker warns against combining Adderall with Prozac and Paxil, which you can read about here.

[kiosk]

interesting about Lexapro...when I started it again, after 2 months or so the Adderall IR has almost become completely ineffective to a point where i now switched to Vyvanse and is working a lot better, hopefully for long time

i was told here somewhere Lexapro doesnt affect Adderall because of the protein type or something, cant recall...but apparently it does or is something else then

SSRI anti-depressants do not affect amphetamines in a negative way.
Anti-psychotics do block dopamine and some serotonin receptor sites which greatly reduces the effectiveness of amphetamine.

I know because I'm on Effexor XR(venlafaxine, anti-depressant) and was on Zyprexa(olanzapine, anti-psychotic). I had little to no effect from taking amphetamines no matter how high the dose prescribed until I stopped taking the Zyprexa anti-psychotic med.

[SweetNicole]

The article that The ADHD Fan provided a link to regarding the co-administration of Paxil and/or Prozac with Amphetamine medications is unsupported. Although the article attempts to convince the reader of an interaction no academic literature was used to support the claims. I understand from other responses to this post that there might be an interaction when combining an SSRI with an Amphetamine medication. I would like to know if anybody has happened to come across academic articles supporting the aforementioned interaction. Personal experiences with combing the types of medications are useful but the world of psychiatric medication can’t change things if it isn’t being published in academic journals.
I am very grateful that this posting has received so many responses and I would love to see more input posted. I am just beginning a neuroscience course at my university and I am hoping to discuss this topic with the professor during office hours. I’ll write a post sharing what he says to me so that everyone has access to the information.

[jeffpuffer]

I took lexapro 10mg for 7 months for anxiety. I began adderall treatment about 2 months ago and take 20mg a day. As of about 1 month ago, I started to taper off of my lexapro since I no longer need it. My taper schedule was 7.5mg for 2 weeks, then 5mg for 1 week, and then 2.5mg for 2 weeks. I'm on my last 4 days of lexapro now, and I've noticed that despite having been in my 2nd month of adderall, it has become more and more effective for me each time I tapered down to a lower dose of lexapro. Infact, it's gotten noticeably stronger in the past week that I went down to 2.5mg of lexapro.

I know none of the literature says that interactions exist between lexapro and adderall, but it find it hard to believe since I'm experiencing this myself, and I haven't changed any other rx's nor have I added any. My diet has remained constant as well.

I have my own theory that lexapro has a higher binding affinity for serotonin transporters than does amphetamine, and that SSRI's (especially very potent ones like escitalopram) interfere with amphetamines binding at serotonin transporters.

[hannielaggie]

Little formal study of coadministration of antidepressant and stimulant treatments has been conducted. However, there are no prominent drug-drug interactions between stimulants and SSRIs and no known contraindication to simultaneous treatments when both are beneficial and well tolerated. SSRIs do not improve ADHD symptoms, which may make agents that do have proven ADHD efficacy, such as bupropion and desipramine, appropriate alternatives in some cases of comorbid ADHD and depression.

It is worth noting that atomoxetine, a nonstimulant used to treat ADHD, is metabolized through the 2D6 cytochrome P450 pathway, so SSRIs like paroxetine and fluoxetine may affect atomoxetine levels.

It is fortunate that SSRIs are compatible with ADHD treatment, given high rates of mood and anxiety disorder comorbidity among individuals with ADHD. The recent replication of the National Comorbidity Survey reported rates of mental health comorbidity in the last year for participants. It suggested that among subjects with ADHD, 18.6% had experienced major depression and 47.1% had experienced an anxiety disorder in the previous year, compared with 7.8% (major depression) and 19.5% (anxiety disorder) of subjects without ADHD.

In clinical practice, anecdotal evidence suggests that outcomes may be optimized in patients with comorbid presentations by treating prominent mood and anxiety distress before addressing ADHD treatment. However, people with mild depression or anxiety symptoms often experience improvements in ADHD symptoms with standard ADHD pharmacotherapy, and with relief of ADHD burden many patients report less mood and anxiety distress.

[greylochdruid]

I have combined type ADHD. I have been on Adderall XR for right at 4 mos now. Currently I am taking 30mg xr a day. I take 1 when I get up and a 10mg abt 3 or 4 hrs later. I take my last dose at around 6pm. I liked to drink something carbonated but know that citric acid messes with my adderall so I have been drinking club soda. I dont have any bad reactions doing this. I know that sodium bicarbonate increases adderall in the blood from what I have read but so far so good. No High BP or anything. I have a blood pressure cuff and take it periodically. I am HIV + as well and I am taking viramune 2 times a day and 1 truvada at night. I also take cayenne pepper occasionally and multivitamin at night. I am taking lovastatin for genetic high cholesteral. I take the statin drug at night with my HIV meds. I am pretty newly diagnosed. I took bupropion xr for a few months but it pretty much stopped working. I didnt have insurance for a couple of months so when I got it back I went and talked to a therapist and she got me hooked up with a psch doc. I am currently about to go up to 40mg a day. 1 20mg xr when i get up and a 10mg xr a few hrs later and if i need it I will take another 10mg xr. I have a headache occasionally but that has pretty much gone a way for the most part. I have family members that are add/bipolar 1 and 2. My birth mother and my aunt. So far I havent had any manic episodes or anything like I have seen described on the this site and what I have read on others I am soooo glad about that. I know I am rambling sorry guys. My ?? is really does anyone know of any reason why I should stop drink the club soda??? Does anyone know of any interactions with any of my other meds?? I noticed that my attentiveness during conversations wasnt what I thought it should be so I asked my psch doc to up my dosage another 10mg. I would appreciate any feedback I could get from anyone on my ??s. OH I almost forgot. Does anyone have any joint issues with the XR??I have achy wrists sometime. I am taking the generic by the way. I took the brand name last month and it work just the same. I am also a recovering crack addict. I have been clean from coke almost 8 yrs now. Appreciate anyones feedback. Thanks everyone.