Your therapist’s dosing strategy is just making things worse.
[Disclaimer, I have no professional credentials. Just got fed up and desperate and spent a few hundred hours researching various topics online. And jaded that all relevant info for my medication approach and issues is tied up in research and not known by therapists. I.e. Again, no professional credentials, but do have a lot of opinions. And don’t have all the links to everything which makes it harder to verify content]
But first,
Vyvanse, you can open the capsule and take a portion of the medication with something like applesauce if the dose is too high. They open the capsule and kids take it this way if they can’t swallow capsules. You can buy empty capsules online at Amazon.com or I’m sure you could find other places that sell them. Can put the unused portion in there. DO NOT CRUSH OR CHEW THE SPANSULES FROM THE CAPSULE. Can also buy scales on line and weigh a specific dose that way. But need to base it on fraction of total weight of capsule contents since the dose only represents the active ingredient, not all the other ingredients with it.
Second, do a search of the forum for memantine and strattera. Should find another response I made that mentioned how memantine or strattera can potentially reduce your amphetamine tolerance over time. I also mentioned that generic brands can be any where from therapeutic to useless. So go back and check that you are getting the same brand as what was effective to begin with. I don’t know the generics market in other countries. But in the U.S. it sucks with most amphetamine based meds generics being useless garbage. And the FDA and DEA in denial. GRRRRRR
Third, in the U.S.A Dexedrine Spansules is extended release dextro-amphetamine. They discontinued immediate release Dexedrine IR. In which Zenzedi took over that space and is now the name brand immediate release replacement for Dexedrine IR. generic Dexedrine spansules is called Dextroamphetamine ER or dextroamphetamine spansules and generic Zenzedi is dextroamphetamine IR.
It sounds like maybe your brain rapidly downregulates from the medication. But, that is just a guess. Or you are a very fast metabolizer. Genetic tests are not definitive. For things like this they just say what propensity you have, which is not absolute. You can still be a fast metabolizer. Can also take a blood test so see if your urine is unusually acidic which eliminates amphetamine faster.
If amphetamine based meds start off too strong in the morning and wear off very fast, it is the wrong drug for you to be on. Unless you tried everything else and they were worse.
This link I post below explains the role of “acute tolerance” and the effect on doses of MPH and Adderall IR. Explains the dosing strategies based on acute tolerance which went into consideration in the design of Concerta and Adderall XR. And, since Vyvanse is amphetamine, it applies to that also.
Our brains naturally try to counteract exogenous changes, like meds that change our neurotransmitter levels. It does this by shutting down receptors, which reduces the receptor density, and reduces the effectiveness of the level of neurotransmitter in the synapse (Have to at least understand what a synapse is to understand so may need to look that up if not familiar). Which means, your “therapeutic dose” starts to change right away and decreases during the day as more receptors shut down. The amount of active pharmaceutical ingredient (API) has to be above the minimum therapeutic threshold at any given time of the day to be effective.
These downregulated receptors require the API to be low and out of our system long enough for our brains to upregulate those receptors back into play. If not able to upregulate all of them, after a while they get permanently removed (replacements can be made but need to be off the drug for an extended amount of time), which is one route to long term tolerance and dosage escalation.
So, as an example, Adderall IR, recommended to take second equivalent dose 4 hours after first. Which nearly doubles the Blood API Concentration (BAC) just to maintain the same therapeutic effect as during the morning for the afternoon. Otherwise it wears off too fast. And the BAC level in the afternoon that it feels like it is wearing off, can actually be higher than that BAC level that was great to start your morning off with.
For most people with a proper vyvanse dose, it should be effective I think 10 to 14 hours. In which they try to account for acute tolerance issues in the design.
Quick explanation of Vyvanse. Forget the “prodrug” aspect. It is a gimmick and done because they get better patent protection by modifying the base molecule than they do with simply changing the release rate. So, they could have skipped adding a lysine molecule onto the D-amphetamine molecule and not had an hour delay for it to start working.
It is the long slow extended release that is important. Which there is a lot of confusing info about online. Vyvanse is preferred due to its lower occurrence of side effects and less chance of causing tolerance than other amphetamine meds. This is because the long sustained release method results in a much lower peak BAC curve and having a lower BAC curve means less side effects, less acute tolerance, and less long term tolerance.
Also, vyvanse converts to less than half its dose into the actual therapeutic ingredient d-amphetamine. So, 70mg results in about 30mg actual D-amphetamine, and spreads out the release over many many hours keeping peak BAC a fraction of Dexedrine, Zenzedi, Adderall IR or XR, etc.)
By adding other amphetamine based products with a much higher peak BAC curve, that causes faster and more acute tolerance. By having that later in the day, you are just keeping the API in your blood stream too long and not having time with it out of your bloodstream to upregulate those receptors for the next day. Even worse, may be enacting the other ways amphetamine can cause tolerance which are harder to get back under control. And the worst of all, when your amphetamine tolerance is too high, no other ADHD medication would be therapeutic at any prescribable level. So, won’t be able to switch meds, be stuck on amphetamines, which would likely be ineffective in a short time at the max dose since it looks like dosage escalation is a problem for you. I’ve already been down that road and it sucks.
