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Vyvanse (lisdexamfetamine dimesylate)

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Old 03-04-10, 11:07 PM
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Question (Yet another medication question) Does anyone take Vyvanse together with an IR?

I'm considering switching to Vyvanse (from Adderall, which is the ONLY ADHD medication I've ever tried), but I'm a little nervous, partly because it's SO expensive.

So, in an effort to understand how people take it and how flexible my options are (with titration, etc.) I just thought I'd ask some questions. Any input would be GREATLY appreciated.

Does anyone combine Vyvanse with an IR medication? If so, which one (Adderall? Dexedrine?)

And if so, on what schedule? Is the IR used as a "booster" in the afternoons? Or is the IR taken first, then Vyvanse taken later in the morning?

I've also heard of people taking Vyvanse as sort of a "background" medication (at a low dose) to help "even out" some of the more negative effects of Adderall IR (anxiety, inconsistency of action, "rebound phenomena," etc.).

Maybe I've misunderstood, but frankly this last one sounds good to me. I mean the only reason I'm switching is because Adderall IR only lasts (for me) an hour and a half (ish) and the "rebound" is pretty nasty, especially having to experience it two or three times a day (Adderall XR doesn't work for me- something about how my body metabolizes it, I guess). Also, I guess Vyvanse doesn't help as much with alertness/activation and distractability because it doesn't impact norepinephrine the way Adderall does (??).

So the idea of having Vyvanse "in the background" to offer coverage and consistency sounds really good. And if it turns out that Vyvanse works great for me on its own, I could just ditch the IR. But at least I'd have more options.

In any case, I don't know what I'm talking about, so please let me know what your experience has been. Or if you have advice. Or if any of this sounds completely crazy to you.

I just want to get an idea of how it's used as part of an overall treatment regimine so I understand what my options are.

As I said, Adderall is the only medication I've tried for ADHD. My doctor thinks I should switch to either Ritalin SR (since it's generic and might offer better coverage throughout the day) or Vyvanse (even though it's pricey it's said to be longest lasting and most consistent).

So, I've been posting all over the place with questions about Adderall IR and asking all about people's experiences with Ritalin SR, Vyvanse, Focalin, etc. so I can be a little more educated when I go in to discuss it.

And trust me, there's nothing I want more than to stop asking because I've FINALLY found what works for me.

Thanks everyone!

Last edited by pembliss; 03-04-10 at 11:21 PM.. Reason: clarification
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Old 03-05-10, 12:18 AM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Pembliss:

I was diagnosed recently (January '10) at age 46. Psychiatrist started me at 30mg Vyvanse once a day, in the morning. After initial 3-5 day "adjustment" phase, I found it very smooth...I would take it between 6-7am...and by 8-8:30ish, I would simply "feel" better. I have no prior experience with stimulants, but did take opiates for rheumatoid arthritis...and I'd compare Vyvanse's medication "curve" to Oxycontin-another "extended release" medication...where Percocet would kick in with a BANG about 1/2 hour after taking, Oxy was smooth and steady for 8-10 hours.

However...the 30mg just wasn't doing much...and at my next visit, the doc told me that he started me on what he described as a child's starting dose; just so that I wouldn't get "hammered" with the early side effects. So, up to 60mg we go...which was great..but, it would wear off by 4-5pm, and I'd sometimes get a headache around that time, and be "worthless" during the evening. I tried splitting my dose-taking 30mg at 6am, then 2nd 30mg pill around 11am...this made me smooth all day and evening, with no "crash"...but was less effective than 60mg in one shot.

Told the doc this at my latest visit (yesterday)...and he prescribed Adderall IR 20mg to take at 4-5pm...and to do the 30/30 Vyvanse at 6am and 9am. So far so good...granted, it's only one day, but seems like a winner.

Vyvanse is good, because it's so damn smooth...I mean, you're waiting-waiting-waiting for a "kick"...but before you know, it's just "working"...hard to describe...it just is "there" in the background. Good stuff...but the 12-hour dose length is a fallacy...you will most likely need an IR booster, depending on your schedule.

Hope this helps...
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Old 03-05-10, 01:19 AM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Since I can't edit my post now...my Adderall IR dose is 10 (TEN) mg, not 20mg. My bad, stupid typo!
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Old 03-05-10, 05:16 PM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Thanks! Let me know how it goes, especially if anything changes...
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Old 03-05-10, 07:33 PM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

I take 50mg vyvanse at 5am and another 50mg at 11am. It lasts til 10pm. No need for a booster which is really great. Just smooth all day long.
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Old 03-05-10, 11:13 PM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

I have recently stopped taking Vyvanse, I do not think it was helping at all, and my doctor at the time was really "pushing" it on me. I took varying doses,but at times I was taking a 70 mg Vyvanse, plus up to about 120 mg of generic Ritalin, per day. (I know, huge doses, but I have a condition my doctor discovered - that I am a rapid metabolizer of certain drugs).

Since Ritalin IR has such a short half life (avg is 2 hours), it seemed like it would wear off much too fast. He thought the Vyvanse, being long acting, would provide a baseline and work synergistically with the Ritalin.

Usually I would take some Ritalin upon waking, and then the Vyvanse AFTER eating breakfast, since on an empty stomach it made me so nauseated.

But I had to take the Vyvanse in the morning, since it seems to be SO long lasting, it gave me insomnia. It did not seem to help anything and in fact probably was overstimulating me, so I stopped it.

But, if Vyvanse works for you mostly, and you just need some boosters, lots of people do well with about 30 mg of IR Ritalin, or about 15 mg of IR Adderall, or about 10 mg of IR Dexedrine (they are about equivalent at these doses).

Most people will take one dose of an IR first thing in the morning, since Vyvanse can take FOREVER to kick in, and then, if it wears off in the afternoon, take the other dose of the IR in the late afternoon.

It's worth trying.
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Old 03-05-10, 11:36 PM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Quote:
Originally Posted by Galileo View Post
I take 50mg vyvanse at 5am and another 50mg at 11am. It lasts til 10pm. No need for a booster which is really great. Just smooth all day long.
Sounds like a winner to me! How long have you been on stims and/or Vyvanse? (Reference point for me on 30/30/IR 10mg Adderall booster)

Thanks!
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Old 03-05-10, 11:49 PM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Thanks everyone for the input.

Quote:
Originally Posted by mike91163 View Post
Told the doc this at my latest visit (yesterday)...and he prescribed Adderall IR 20mg to take at 4-5pm...and to do the 30/30 Vyvanse at 6am and 9am. So far so good...granted, it's only one day, but seems like a winner.
Quote:
Originally Posted by Galileo View Post
I take 50mg vyvanse at 5am and another 50mg at 11am. It lasts til 10pm. No need for a booster which is really great. Just smooth all day long.
So for those who take it more than once a day, do you take two pills a day or do you divide the pills (either by dissolving it in water or using a gel cap)? I've heard of people doing it both ways. I'm just asking since my insurance company has limits on # of pills per month.

Quote:
Originally Posted by Scarletta View Post
I have a condition my doctor discovered - that I am a rapid metabolizer of certain drugs.
Scarletta, this is my concern too. My doctor has mentioned that the reason my Adderall IR only lasts an hour and half or so (and XR released into my system unpredictably) is because I'm metabolizing my medication it too fast. So, I'm hoping something like Vyvanse might help.

Right now I feel like I'm constantly riding the Adderall Roller Coaster, and I get motion sickness on roller coasters...
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Old 03-06-10, 02:06 AM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Quote:
Originally Posted by pembliss View Post
Thanks everyone for the input.

So for those who take it more than once a day, do you take two pills a day or do you divide the pills (either by dissolving it in water or using a gel cap)? I've heard of people doing it both ways. I'm just asking since my insurance company has limits on # of pills per month.
My Rx says 30mg Vyvanse-to take 2 daily, in the morning. Vyvanse comes in capsule form only, and doses of 20/30/40/50/60/70mg. I believe that federal law says that the physician/prescriber has ultimate authority over dosing regimen...but, Vyvanse is good, in that if the insurance co. really gives you a hard time about quantity, the doctor can simply re-write the script, and the Vyvanse capsules separate very easily, and be mixed in water...there's plenty of threads on here describing the method. If my insur. co. gave me a hard time about 60 vs. 30 capsules, the doc could simply prescribe a single 80mg capsule, and tell me to open it/mix it water, drink half at one time, half at another.

Pill-splitting, like with generic Adderall IR, is another story alltogether...again, a nice benefit of Vyvanse--no mess, no fuss.

Hope this helps!
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Old 03-06-10, 11:50 AM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Thanks again everyone.

I'll be seeing my doctor Monday and I've made my nerdy little pros and cons list about trying either Vyvanse or Ritalin SR. I'll show it to my doctor and she can talk me through any worries I have about either one.

Then, hopefully, she'll just give me a prescription for a 10 day or 2 week supply (of SR or Vyvanse) so that if it isn't going to work I won't be stuck with it too long. And I'll ask her about boosters (though I would still have enough IR left over from this past month to try that for a couple of weeks)

If we go with Vyvanse, I may ask her to err on the high side as far as dose- like starting out with 70mg, and I'm fine with starting by opening the capsule and using only 35mg, then titrating up.

So, we'll see. Thanks for all the input!!
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Old 03-06-10, 05:12 PM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Just throwing out a couple more questions...

1. I keep hearing the word "smooth"- when I was (briefly) on Adderall XR, I found the "crash" to be the same as with IR. In other words, the morning dose would release, but would wear off and I'd have the "crash" and then the afternoon dose would release. But as far as "smooth" it wasn't any better than two IRs. It sounds like it's different with Vyvanse. There aren't multiple "bursts" it just gets into your blood and stays there consistently until it wears off at the end of the day?

2. I've heard 70mg being compared to 30mg of Adderall XR, so if Adderall XR is like taking 30mg over the course of 6-8 hours, then does that mean 70mg of Vyvanse would be like taking 30mg of Adderall over 12 hours? (I know most people don't get 12 hours out of Vyvanse, I'm just using it as an example). Because then it sounds like less- since I take 30mg a day over the course of a few hours. If I expanded that into a bunch of smaller doses over 12 hours, each dose would be way smaller and not very effective.

Ok, sorry for all the questions.... But I really have appreciated the input. It can get so complicated if you have no experience with a particular medication AND you don't have an advanced degree in pharmacology (which is what I feel like I need these days)
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Old 03-06-10, 07:22 PM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Hi,

A 70 mg Vyvanse capsule is approximately equivalent in strength to about 30 mg of IR Adderall, not Adderall XR. And the 70 mg capsule is also equivalent to about 60 mg of IR Ritalin, or about 25 mg of IR Dexedrine.

But, there is a huge difference, because Vyvanse works completely different than the others. It starts to kick in at different times for different people, really dependent on food (supposed to eat a substantial amount of protein before, which helps the breakdown of the pill and subsequent absorption to be better). Also, for me if I took it on an empty stomach, I got nauseated.

vyvanse is a prodrug, which means its basically inactive Dexedrine (dextroamphetamine) combined with an amino acid, L-Lysine. It does not become activated in your system until your digestive system "tears" the two apart. The lysine pretty much is the thing that keeps the release of the d-amphetamine from occurring at once, and depending on many factors, it can last for a very long time, or a short time.

I also found that Vyvanse merely gave me insomnia. I didn't want to NOT sleep! It was like a bunch of Vivarin- just to keep me awake- no therapeutic benefits, no concentration or focus help, etc. Just basically keeping me up all nite, so I was useless the next day. So never getting anything done.

The IR Dexedrine, Adderall and Ritalin are all different drugs that will affect people differently, but the rough equivalent factor is that Adderall is about twice as strong as Ritalin, and Dexedrine is about 1.5 times as strong as Adderall. (Kind of like the comparison between a shot of whiskey, 6 oz glass of wine, and a 12 oz beer- which are supposed to all be about the same strength, although they are obviously different and some people cannot drink wine or whiskey and only beer, and vice versa, etc.)

I did not find a "crash" with Vyvanse at all. Both the onset, and the tapering off, occur subtly, and are barely noticeable to me. Except when I cannot sleep- then I know it lasts too long for me.

You could either space out your doses of Adderall to several small ones a day, to keep you on a more even keel, or maybe consider taking Adderall XR or Concerta as a baseline (supposedly a lot longer lasting than the IRs,) but I do think you will also need boosters of IRs because for a rapid metabolizer, the extended release forms tend to hardly work, because once again, your system is fast, and the pill is likely to be excreted from your system fast, thus never getting your blood levels up to what is necessary for it to be effective. Also, I find the extended or sustained release drugs to be very inconsistent- sometimes for hours I would not have any feeling at all, then suddenly, it seems like the entire dose (meant to be released over several hours), gets released at once, making me sick. It's just not that predictable.

But some people find it good for them. I do think the IRs, though, would be a good addition, giving you additional, short term intense focus, concentration, etc when needed or when the XR doesn't seem to be enough. But the XR should with the IRs should boost your blood levels to where they need to be.

Does that make sense?
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Old 03-06-10, 07:27 PM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Quote:
Originally Posted by pembliss View Post
Just throwing out a couple more questions...

1. I keep hearing the word "smooth"- when I was (briefly) on Adderall XR, I found the "crash" to be the same as with IR. In other words, the morning dose would release, but would wear off and I'd have the "crash" and then the afternoon dose would release. But as far as "smooth" it wasn't any better than two IRs. It sounds like it's different with Vyvanse. There aren't multiple "bursts" it just gets into your blood and stays there consistently until it wears off at the end of the day?
As I had mentioned before, I used the "smoothness" analogy of Vyvanse/Oxycontin vs. Adderall IR/Percocet. Granted, two TOTALLY different (and frankly, opposite!) types of medications...but Vyvanse is VERY different, in that its chemical formulation is dextroamphetamine with a lysine molecule attached...and that chemical bond is ONLY broken by a yet-unknown metabolic process in the liver. Due to this extra "time-consuming" step (which, BTW, varies from person to person), the dextroamphetamine in Vyvanse is released much slower than other stimulant formulations. Adderall XR, which is a blend of 4 different amphetamine salts, is made "extended release" by "enclosing" the "pure" medication in different pH-sensitive beads. In an Adderall XR capsule, some of the beads will break down in the highly acidic (low pH) environment of the stomach for rapid release/absorption into the bloodstream; the other beads break down in the less acidic (higher pH) lower GI tract.

The problem with this method is that far too many foods and GI disorders can dramatically affect how fast Adderall XR is absorbed. For example, someone who takes a lot of antacids will raise their stomach pH levels...thereby releasing the "long-term" beads too early. The result? Too much medication too early...and nothing left for hours later.

One other important feature of Vyvanse is that unlike other stimulants that can be abused via injection or sniffing (immediate release into the bloodstream), Vyvanse cannot be abused via these methods, period. Several medical studies have proven that direct injection of Vyvanse into the bloodstream does nothing-the parent drug, lisdexamfetamine, MUST be metabolized by the liver.

Quote:
Originally Posted by pembliss View Post
2. I've heard 70mg being compared to 30mg of Adderall XR, so if Adderall XR is like taking 30mg over the course of 6-8 hours, then does that mean 70mg of Vyvanse would be like taking 30mg of Adderall over 12 hours? (I know most people don't get 12 hours out of Vyvanse, I'm just using it as an example). Because then it sounds like less- since I take 30mg a day over the course of a few hours. If I expanded that into a bunch of smaller doses over 12 hours, each dose would be way smaller and not very effective.
Well, yes...and no. The delivery and absorption methods are completely different...and metabolism affects both as well. There hasn't been enough experience yet with Vyvanse to establish safe and accurate "conversion ratios". Generally though, it seems to be somewhere around 1:2 or 1:2.5 for Adderall:Vyvanse. Your experience, though, will vary...

Quote:
Originally Posted by pembliss View Post
Ok, sorry for all the questions.... But I really have appreciated the input. It can get so complicated if you have no experience with a particular medication AND you don't have an advanced degree in pharmacology (which is what I feel like I need these days)
Don't be sorry! Ask away...trust me, we would rather you ask questions than to wonder "am I doing the right thing?"

Oh, don't worry about the whole pharmacology thing...believe me, knowledge is power...it IS important that you research your medications...you would be surprised how many things you'll learn that your doctor may not tell you...and not necessarily out of neglect or malice. It is, though, pretty cool learning about the REAL "nuts and bolts" of how your body and brain work...
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Old 03-06-10, 07:28 PM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

Scarletta-SORRY, I didn't mean to "step on" your post...you posted yours while I was typing mine.
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Old 03-06-10, 08:15 PM
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Re: (Yet another medication question) Does anyone take Vyvanse together with an IR?

No prob!!
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