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Adderall (four amphetamine salts)

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Old 07-25-10, 08:17 AM
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Post Adderall Dosing Guidelines and FAQ

In searching for my own answers I have noticed an abundance of questions regarding dosing. How much should I take? What is the maximum dose? How will I know?

Your first and best source is your doctor, however if your doctor is light on information or you just want to see it in writing, here is what I have found.

** Disclaimer: My entire medical training has consisted of watching House reruns, however a little research yielded some good guidelines that helped answer my questions. So, be sure to confirm anything you may glean from this post with your doctor before taking it to heart.


How Much Should I Take?:

The following dosing guidelines were published by Dr. Joseph Biederman, Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital, and Professor of Psychiatry at the Harvard Medical School



Typically, the dosage for Adderall is shown as 10mg-60mg, however this guideline fails to take into account the effects of body weight. The same dosage does not necessarily make sense for persons weighing 100lbs and 280lbs.

Therefore, your dosage should range from 0.3-1.5 x your body weight in kg (1kg = 2.2lbs)

For example, if you weigh 175lbs (75.5kg) your dosage should start around 20-25mgs (0.3mg x 75.5kg = 23.5 mg/kg) to a maximum of 115mg (1.5mg x 75.5kg = 113.25 mg/kg)


How Will I Know When It’s Right?

The ideal dosage is the minimum necessary to be effective. The best way to find the proper amount is to start low (10mg for adults, 5mg for children) and increase by 10mg every 1-4 days until symptoms are under control. If you have found a dose that seems to work, but you are unsure that it is the best amount you can continue to increase the dose. Increasing the dose over the proper amount will increase the occurrence and intensity of side effects and in most cases will not increase the effectiveness of the drug. If nervousness or over-stimulation occurs, always REDUCE the dose.

It is important to note that in the first days of taking Adderall you will experience a euphoria which is much closer to a “high” than what you should be looking for when finding the proper dose. Therefore, it may make sense to disregard the first few days to avoid disappointment when the drug no longer seems to work.

Side Effects:

There are a number of possible side effects when using amphetamine based stimulants, some of which can be quite dangerous. Be sure to tell your doctor if you have a history of seizures or heart problems as amphetamines have shown increased danger of tachycardia, increased blood pressure and seizures. That being said, for most healthy people these should not be an issue and occurrence is statistically low.

The most common side effects include:

Decreased Appetite
Insomnia
Emotional Lability
Abdominal Pain
Weight Loss
Dry Mouth
Headache

*Side effects that peak around 6 hours from dose are most likely due to the medication. Dose needs to be reduced.

*Irritability and tiredness/fatigue that occurs more than 6 hours after last dose are more likely due to medication wearing off (rebound effect). Dosing may need to be adjusted by adding an extra dose or by increasing the dose.

Rebound Effect
The “come down” or “crash” from amphetamines will often be strongest in the first two weeks and decrease with time. The effects can include psychosis, depression and a return of ADHD symptoms but in a temporarily exaggerated form. If you find that you are experiencing rebound effect without any of the positive effects (greater focus and concentration) your dose may be too low.


Effectiveness

Urinary and stomach pH levels can have a strong effect on amphetamine excretion and absorption. An acidic stomach and GI pH will decrease the absorption of Adderall, and acidic urine levels will decrease the reabsorption of the drug through the renal system. Acidic substances (e.g. citric acid) cause decreased renal reabsorption of amphetamine, while alkaline agents (e.g. antacids) may cause a marked increase in renal tubular reabsorption. The increased reabsorption can increase the retention of amphetamines, potentially resulting in dangerously high serum levels.

Therefore, it is best to avoid taking multivitamins containing certain vitamins (Vitamin C - Ascorbic Acid) and eating or drinking acid foods immediate before or after taking amphetamines. E.g. Soda, Citrus Juice

It is also important to note that antacids will have a magnifying effect on amphetamines, increasing absorptions and retention. Take caution when using any acid neutralizing medication.

Studies have also shown that high fat diets may have a significant impact on the absorption of Adderall XR. A report published in Current Medical Research and Opinion showed that subjects who took Adderall after a high fat meal had a 55% decrease in their blood levels of amphetamine during the first four hours following dosing, compared with those who took Adderall after fasting.


Common Interaction Cautions

Decongestants: may increase the risk of cardiovascular and CNS stimulatory effects
Caffeine: may increase the risk of cardiovascular and CNS stimulatory effects
Bupropion (Wellbutrin, Zyban): may increase risk of seizures
Cannabinoids: may increase risk of tachycardia, hypertension, cardiotoxicity

Safety and Monitoring

Pregnancy: C
(Animal Studies show adverse fetal effects but no controlled human studies or no animal studies. Weigh possible fetal risk vs. maternal benefit)

Lactation: Possibly Unsafe
(Available animal/or human data demonstrates potential or actual adverse effects to infant/breast mile production; consider alternatives or weigh risk/benefits)

Monitoring Parameters:
For patients with risk factors, your doctor will perform a baseline cardiac evaluation; Blood Pressure, Heart Rate at baseline, after dose increase, then periodically

For Children: height, weight at baseline, then periodically


And just incase you thought I was making any of this up, here are some sources:
http://pn.psychiatryonline.org/content/37/15/19.2.full
http://ajp.psychiatryonline.org/cgi/reprint/136/2/226
https://online.epocrates.com/noFrame...veSectionId=10
http://en.wikipedia.org/wiki/Adderall
http://en.wikipedia.org/wiki/Amphetamine
http://www.askdrjones.com/adhd/how-to-take-adderall/
http://www.askdrjones.com/blog/my-br...starting-dose/
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