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Old 04-06-10, 10:46 PM
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Barr generic Dex not working- how to continue treatment

Sorry this is long . I just feel like I should share all info. You can probably skip to my list if 3 questions if you can't read through all this.
OK, so I am unsure how to continue from here. I have inattentive type, was diagnosed as an adult a few months ago (age 25) because as a grad student I can no longer get away with it. My primary symptoms are extreme procrastination with school work, taking forever to read for school due to lack of focus (it takes me all day to read a 5-page article and I have to read at least 100 pages a week), messiness, no motivation and fatigue. Overall I feel like I have lost intelligence (my symptoms have worsened for the past 4 yrs).
Sleeping well, drinking coffee and getting exercise seem to help a little.

Over the past three months I have tried brand name and generic Ritalin (couldn't tell the difference between the two), generic (Barr) Adderall and generic (Barr) Dexedrine (all instant release). All were started at a very low dose and slowly titrated up. Ritalin made me feel a little energized but weird and jittery. Adderall made me feel nicely energized at 10mg, but did nothing for my other symptoms. At 15mg, I started feeling like I had too much coffee (i.e. jittery).

Now I am on Dex which I had high hopes for at first. It made me less fatigued without being jittery. I felt awake, but calm. It hasn't helped with my focus and so far I am surprised at how little effect it seems to have in general. I am increasing the dosage quicker this time and 15mg seems to make me feel less tired, but not focused. Sort of "in my own world", i.e. I am not distracted by outside noises etc., but still by my own thoughts. At first I felt similar as on Adderall, minus the increasing jitteriness with dosage increase. My heart rate seems to increase a lot less than on Adderall (after 15mg, it goes up to about 76, while on Adderall it went to 85-90). Although Dex didn't focus me, one night I stayed up super late (I usually work better at night) writing a paper for school with it. It barely had any effect on me, so I kept taking more of it (about 30mg in 12h). I was still distracted, but the pressure of the upcoming deadline helped me finish. This is the best paper I have written for this class so far and my writing tutor said it was pretty good. Anyway, that's not the point. All the Dex did for me that night was keep me awake (I know all-nighters aren't good for me and I try to avoid this kind of stuff).

Now after a couple weeks on Dex (up to 20mg) I am starting to feel a little weird, almost dizzy, but still energized. I never felt that on Adderall. Also, recently I have sometimes felt sudden extreme frustration, as in I hate myself for being such a loser and not getting things done. This often comes in the evening and lasts a few hours. I don't know if this is the meds causing depression or a sense of frustration I feel that nothing, including meds seems to be working. I am not sure how to continue from here. I see my pdoc again in 10 days. I am taking several factors into consideration and have some questions:

1) I have read heaps on this forum about the Barr brand being bad and requiring higher doses. Do you think it makes sense to get another Rx and this time fill it with another generic brand like Malinckrodt?

2) My appetite is quite supressed while on Dex but comes back when it wears off. I have definitely been eating a lot less though which hasn't bothered me because I am normally a chronic overeater and very fixated on food. I still enjoy food and cook, just eat less. I am not too concerned with weight loss at the moment as I am on the very high end of a normal BMI (so far I have only lost 2 lbs since starting meds in January). But could my lack of food intake be making my symptoms worse?

3) I have read about Strattera helping some people with my symptom profile very well. My doc mentioned potentially combining it with stimulants. I just like the reduced fatigue from the stims and am worried the Strattera might not do that as some complain about sleepiness. Anyone tried a combo?

At 40mg per day, should I bother increasing my Dex dose? My plan is next time I see the doc to get another Dex prescription and fill it with a different brand and maybe take Strattera at the same time because it takes weeks to build up. The reason I want to keep trying Dex instead of Adderall is because it doesn't make me jittery and it affects my heart less. I already take a whole foods multivitamin, kelp and fish oil.

Any other suggestions? I am starting to freak out that I might not graduate this year as planned. Please don't be mad at me for writing so much
All advice is greatly appreciated!
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Old 04-07-10, 02:56 AM
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Re: Barr generic Dex not working- how to continue treatment

Quote:
1) I have read heaps on this forum about the Barr brand being bad and requiring higher doses. Do you think it makes sense to get another Rx and this time fill it with another generic brand like Malinckrodt?
Yes, it does make sense to get a new Rx and have it filled with a different generic brand. Different brands can have positive or negative results. By doing this you can determine which works best for you. I take 10mg of generic dexedrine IR (BARR brand) once in the afternoon when the 50mg dose of vyvanse starts to wear off.

IMO I prefer the BARR dexedrine. It works well for me. There are only 3 pharmacies that make generic dexedrine IR right now according to the FDA.

BARR, Mallinckrodt, and KV Pharm. There is also an oral solution (Liquadd) made by ProCentra. Although there is currently no generic. It is bubblegum flavored and comes in a 5mg dose.

Quote:
2) My appetite is quite supressed while on Dex but comes back when it wears off. I have definitely been eating a lot less though which hasn't bothered me because I am normally a chronic overeater and very fixated on food. I still enjoy food and cook, just eat less. I am not too concerned with weight loss at the moment as I am on the very high end of a normal BMI (so far I have only lost 2 lbs since starting meds in January). But could my lack of food intake be making my symptoms worse?
It is key to maintain a good regimen and not to fall short of anything that normally you would not do to your body. With sleep, exercise, diet, and most of all a low level of stress the symptoms will become little to none overtime.

Quote:
3) I have read about Strattera helping some people with my symptom profile very well. My doc mentioned potentially combining it with stimulants. I just like the reduced fatigue from the stims and am worried the Strattera might not do that as some complain about sleepiness. Anyone tried a combo?
IMO Strattera is horrible whether combined or by itself. I have tried combination's of different stimulants.

Adderall XR combined with Dexedrine IR
Adderall XR combined with Adderall IR
Vyvanse combined with Adderall IR
Vyvanse combined with Dexedrine IR

Quote:
At 40mg per day, should I bother increasing my Dex dose? My plan is next time I see the doc to get another Dex prescription and fill it with a different brand and maybe take Strattera at the same time because it takes weeks to build up. The reason I want to keep trying Dex instead of Adderall is because it doesn't make me jittery and it affects my heart less. I already take a whole foods multivitamin, kelp and fish oil.
Don't increase your dosage w/o seeking medical advice first. Contact your doctor and let him know that you are not benefiting from the current dose.
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Old 04-08-10, 12:39 PM
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Re: Barr generic Dex not working- how to continue treatment

Quote:
There are only 3 pharmacies that make generic dexedrine IR right now according to the FDA.

BARR, Mallinckrodt, and KV Pharm. There is also an oral solution (Liquadd) made by ProCentra. Although there is currently no generic. It is bubblegum flavored and comes in a 5mg dose.
I just wanted to clarify and update your information.

First of all, BARR is the ONLY current manufacturer of generic d-amphetamine, both instant and sustained release. Mallinckrodt and KV stopped production in 2008. The info on the FDA page is obviously outdated.

Liquadd does not exist anymore. ProCentra is the name of the drug, a liquid d-amphetamine which is produced by Tiber Laboratories:
http://www.procentraadhd.com/ It does not come in 5mg doses. It comes in 473 ml bottles, with 1 ml being equal to 1mg. You can take as much or as little as you want. Also, it IS considered a generic by many insurance companies despite its high price.

As far as the original post goes, I doubt switching to ProCentra or brand GSK Dex will be any more effective, perhaps just "cleaner" than the BARR. If the Dex isn't working, try something else (which it appears you have). I really have no idea what would be an effective alternitive since everyone reacts differently to different medicines.

I just wanted to clear up the mis-information. Nothing personal.
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Old 04-12-10, 11:18 AM
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Re: Barr generic Dex not working- how to continue treatment

Do not take Strattera. Imagine having a cardboard box over your head with no stimulating effects. Thats what you get. If you think you aren't getting stimulated enough, you may want to try Desoxyn, which is dextromethamphetamine.
My friend needs a lot of meds to work for him, its because he has a liver enzyme that metabolizes stuff differently. I have no idea how you check that, but you ought to look into stuff like that to try to get something that will work.
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Old 04-12-10, 02:12 PM
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Re: Barr generic Dex not working- how to continue treatment

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Originally Posted by Naussicaa View Post
Do not take Strattera. Imagine having a cardboard box over your head with no stimulating effects. Thats what you get. If you think you aren't getting stimulated enough, you may want to try Desoxyn, which is dextromethamphetamine.
My friend needs a lot of meds to work for him, its because he has a liver enzyme that metabolizes stuff differently. I have no idea how you check that, but you ought to look into stuff like that to try to get something that will work.
I am not that quick to write off Strattera. In fact, because stimulants don't seem to work for me, but they do for most people, that just shows that everyone reacts differently to various meds. And although I have heard many bad stories about Strattera, there are also a lot of positive ones, or people for whom that is the only drug that works. So I guess you have to try it out.
As for Desoxyn, I am not sure if my doctor would prescribe it, he has never mentioned it as an option and I would feel weird asking about it because of the whole stigma thing. He seems to be of the type that thinks if three different stims don't do any good, then a fourth one probably won't either, especially since I have tried two amphetamines already without success. I don't know if there are people though, who only do well on Desoxyn and not the others
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Old 04-12-10, 06:50 PM
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Re: Barr generic Dex not working- how to continue treatment

Yes, that is the main concern with Desoxyn, very few doctors will choose it over another simply because of the stigma that it has. It is stronger with less side effects for most people, and has been described as even smoother. What effects do you feel the stimulants lack? For me, I feel very goal oriented, and decide on things to do, still more distracted than I am when I use Adderall (I'm answering your question instead of my daily reading!), but I enjoy not having the racing heartbeat more than a little more focus. There is rarely a perfect medication.

Strattera is an NRI, which has had less research and proof, in my opinion, it is not worth looking into, but like you said, everyone is different! I however, have never heard of an anecdotal story where it was successful, it seemed to bring out more bouts of depression.

Have you looked into Wellbutrin as well? I believe it combines much better than Strattera would.
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Old 04-13-10, 05:24 AM
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Re: Barr generic Dex not working- how to continue treatment

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Originally Posted by Naussicaa View Post
What effects do you feel the stimulants lack?

Strattera is an NRI, which has had less research and proof, in my opinion, it is not worth looking into, but like you said, everyone is different! I however, have never heard of an anecdotal story where it was successful, it seemed to bring out more bouts of depression.

Have you looked into Wellbutrin as well? I believe it combines much better than Strattera would.
1. Adderall makes me feel more alert and energized which is great. Helps zero with focus, motivation, attention though. Dexedrine makes me feel ultra-relaxed, mildly energized and also does nothing for my focus. So that I guess is what they lack. The fact that I don't seem to get any of the benefits from them that other people get except increase in energy. Also, it seems that I need a much higher dose of Dex than Add. to feel anything (slight energy). It has less effect on my heart rate, but with that high of a dose, my appetite goes from normal (actually my normal appetite is excessive) to almost non-existent. Although I would be willing to put up with that, it just doesn't help. Sometimes it makes me feel dizzy and weird.

2. Actually, I have read a lot of anecdotal evidence of people's success with Strattera. There is a website somewhere with hundreds of reviews. Granted, it doesn't get as much good feedback as the stimulants, but still it seems to be a lifesaver for some people.

3. My doctor has mentioned Wellbutrin and possibly combining meds next time I see him. So I assume we will go for either Wellbutrin or Strattera plus Adderall or something like that.
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Old 04-14-10, 09:54 PM
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Re: Barr generic Dex not working- how to continue treatment

Ah yes, it might not even be worth taking anymore in that case (unless you like its current effects).

By anecdotal, I mean my friends and I (not online). Sorry for any confusion.

Good luck, I hope to hear any beneficial updates! It sucks that you don't respond well to Dexedrine. :/
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Old 04-15-10, 02:03 PM
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Re: Barr generic Dex not working- how to continue treatment

I personally know two people using Straterra to extremely good affect right now. If you are thinking of going down that path, you need to remember that it will take six to eight weeks to be fully effective in your system. I know one man who has been on Straterra for some time and is thinking he might want to add a small amount of stimulant to the mix. Another woman I know moved from Concerta to Straterra and finds the Strat to be MUCH smoother. Your mileage may vary.

Tink, you are absolutely correct. All of us are very different when it comes to what works best for us.
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Old 04-16-10, 11:34 PM
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Re: Barr generic Dex not working- how to continue treatment

Hi, I too am thinking of Straterra. I am not overly impressed with Dex. Today I even asked my doctor if I could stop taking it. She suggested I keep with it, and increased the dosage from 30-40mgs. So I will see if this works.
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Old 04-16-10, 11:50 PM
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Re: Barr generic Dex not working- how to continue treatment

Hi Wairoa,

I ended up feeling so crappy on Dex after increasing the dosage that I just couldn't take anymore of it and instead took the rest of my previous prescription of Adderall. The Dex just made me feel weird, dizzy, too relaxed. I am surprised that I could handle a much higher dose of Dex than of Adderall since I thought you had to take less of it.

Now my doc started me on Strattera with a very low (children's) dose of 18mg. I took it this morning after a good night's sleep and within a couple hours I was so exhausted I took a two hour nap. Then later I took another one hour nap. I heard people get fatigued on this, but I am a bit surprised on such a low dose. Hopefully I will get used to it. Many people take it at night for that reason. I won't take it tomorrow because I have a long day of physical work to do and am afraid I would fall asleep on the trail if I take it in the morning. In a few days I am supposed to add Adderall to it so I am curious to see how it works out.
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Old 04-17-10, 06:51 PM
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Re: Barr generic Dex not working- how to continue treatment

Tink, it isn't unusual to have that fatigue given that you have just stopped stims. It should go away in about a week as you give your system a chance to wash it out.

One gal I know takes her Straterra at bedtime to avoid daytime sleepiness.
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Old 04-26-10, 09:38 PM
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Re: Barr generic Dex not working- how to continue treatment

This fatigue thing only happened the first day, never again since. Also, I don't seem to have withdrawal effects from stims, like tiredness. I never even experience any sort of crash when they wear off which I find weird, since many on here seem to experience that every day. My doctor says it's because my dose isn't high enough, but I now take 20mg Adderall and before took 25mg Dexedrine 2-3 times a day. Those are pretty decent doses, yet I never experienced any crash.

Now I am still taking Strattera at 36mg and slowly working my way up. Not feeling any positive or negative effects from it. I hope it will eventually do something once my dose is higher. I am starting to get frustrated. What if no medication works?
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Old 04-26-10, 11:16 PM
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Re: Barr generic Dex not working- how to continue treatment

Walgreens apparently can order GSK Dexedrine! Check out my thread, see if you can get it!

Yeah not a lot of success for regular (ADD) people on Strattera IME. Its junky stuff. If you get the feeling that you have a cardboard box over your head with no stimulating effects, its working as many people experienced.

Sucess rates IME from worst to best are:

Strattera (groce)
Welbutrin (helps with stopping smoking too)
Ritalin/Concerta (Crash!)
Adderall (#1 prescribed for good reason)
Dexedrine (Best)

And I assume that Desoxyn is at the top, although I have never tried nor have my friends tried it.

One of my friends had Adderall stop working for him and switched to 10mg IR Focalin. I did not include it in the list because this is the only case in which it occurred, therefore I can't really back it up with just one experience.
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Old 04-27-10, 07:36 AM
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Re: Barr generic Dex not working- how to continue treatment

If amphetamine generic and brand quality is an issue or if you feel that amphetamines are not working anymore or experiencing side effects


maybe you should go back to Ritalin type stims. Ritalin and its refined cousin focalin. they are immune to conditions in your stomach (ampth absorption can vary by up to 55%)

Plus, many brand companies manufacture ritalin type stims (brand quality) in many forms (tablet, capsule, chewable tablets, liquid, and batches). Adding to that with the exception of concerta many are not expensive brands compare to brand amphetamines (dexedrine, adderall, xr, and vyvanse) even the generic for these medications is more expensive than brand Ritalin stims.

they also come in many forms of extended release (different release rates):

1. tablets and chewable and liquid are instant release (ritalin tabs, methylin, liquid methylin)

2. Ritalin SR (mid way between instant and extended)

3. ritalin LA and Focalin XR (half instant and half 4 hours later)

4. concerta 22% instant and build up after that (opposite to LA and focalin XR where their release declines with time).

5. metade and ....


if the Ritalin makes you nervous decrease the dose or switch to extended release or switch to focalin which is smoother and has less PNS effects. Get the brand for focalin though. generic is no good.


if you go back in history

Ritalin was invented as a "safer alternative" to amphetamines.

chemically. the active ingredient in ritalin stims (methylphenidate) actually cost more to produce than amphetamine


below is an ad from the 50s. THE CLAIMS WERE WITHDRAWN by ciba (Now novartis) but just to give you a sense.


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