Vyvanse/adderall with high blood pressure (and ADD)?

[fairyfeathers]

Hi there,

A friend of mine has the worst untreated adult ADD in the world. But he is 43 and takes propanolol for high blood pressure. The propanolol controls his blood pressure well, but because it used to be high, his doctor won't give him any kind of speed for ADD. He has a source for small amounts of adderall or sometimes vyvanse, and has used it specifically to get tasks done that he otherwise wouldn't be able to focus on. He doesn't abuse it - as a general rule just takes one 15mg adderall or a 30mg vyvanse, maybe once a week, which also seems to prevent tolerance. This guy doesn't want to have a heart attack, though, so I'm hoping to get him some input on whether this is really a dangerous practice? Of course everything you look up online just says not to take it with HBP, and he doesn't want to ask his doctor for obvious reasons. Can anyone help? Also, has anyone had success treating ADD with something that ISN'T speed?

 

[fairyfeathers]

Just bumping, hoping someone will see this and have advice...

 

[Kittycat5]

Hypertension does not immediately exclude ADHD treatment with stimulants but it surely will be difficult in finding a doctor to prescribe them together, the liability is just not something most doctors would chance.

Conventional thinking also says beta blockers like propranolol and amphetamines should not be mixed. There is some debate that the risk is overstated, but again really hard to find a doctor who will prescribe them together.

There are no stimulant alternatives for ADHD though. Both clonidine and guanfacine are used and they were originally intended to treat high blood pressure so these may be an alternative. Strattera is a non-stim treatment but can also negatively impact blood pressure. Both Wellbutrin and Provigil, while not approved expressly for ADHD, have been used but again, may not go well with hypertension, Wellbutrin probably worse than Provigil.

I think it comes down to a few things. First, is his BP well controlled and he is compliant with his medication, has regular visits to his doctor, and makes the appropriate lifestyle changes to help keep his BP in check. Second, does he have any other risk factors that would make his risk for having a cardiovascular event in the next 10 years likely. These would include things like smoking, diabetes, prior heart attack or stroke and others. Here is a quick tool for judging the risk from one of the longest ongoing cardiovascular disease studies.

http://cvdrisk.nhlbi.nih.gov/

And last, are his symptoms of ADHD really that bad, are they affecting his daily life, job, relationships and has he seen a psychiatrist to be properly evaluated.

If the answers are Yes, No, and Yes, I think he needs to be treated, whatever the therapy may be.

 

[fairyfeathers]

Hi there,

Thanks so much for the input! To clarify, it's probably obvious I'm talking about myself. Realized on another thread that people aren't doing the whole "SWIM" thing here, so I'll just drop it too. So I'm actually female, but I am 43 and on propanolol. Yes, my BP is well controlled, and I take my meds every day. I don't have any other risk factors - I'm vegetarian and don't drink soda much, cut back a lot on alcohol because of the sugar and risk to BP. I haven't seen a psychiatrist in years, mainly because my doctor basically told me that no one would give me stimulants if I'm on BP meds. But have recently thought I should go, because maybe a psychiatrist would be willing to let me try a low dose stimulant at least. I can't decide if I go if I should explain to them that I have tried vyvanse and that it works wonderfully for me, or if this will make me look like I'm trying to get something to use recreationally. I'm really not.

My ADD is very bad, but I've found tricks to work around it at work in particular - I work on a computer, and luckily my employer doesn't check our history, because the only way I can get my work done is by watching documentaries or other stuff minimized on my screen all day while also doing my work - otherwise I get completely distracted from what I'm doing and get nothing done. The worst part of it for me is really at home. I am completely disorganized and forget things constantly. So I'm constantly forgetting to have my kids do stuff for school (luckily my mom lives with us and pays attention to this stuff too, so it's not impacting them so much), forgetting events even when I write them down, and my house is totally out of control. It is like actual magic when I take a Vyvanse (or, to a lesser degree, Adderall) - I don't even get high or anything - I just feel totally normal, and it's like my brain is finally functioning like a normal human being. So I like to have one on Saturday, during which time I get a bunch of tasks done I otherwise cannot do - like organizing all the closets and cabinets, folding all the laundry and putting it away (I normally can't finish tasks when I start), going through all my papers and making sure everything is taken care of, etc.

My original question was, assuming I can't get an actual prescription for these, how dangerous is it to take these literally one day a week? I know that mixing beta blockers and amphetamines isn't recommended, but given the whole one day a week thing, is it super dangerous? I don't want to endanger myself, but if we're talking about a risk like drinking coffee or eating too much salt, I'd probably risk it since my BP is under control. I just wish I could find something else that would make me feel normal without a risk. Hmph.

Hypertension does not immediately exclude ADHD treatment with stimulants but it surely will be difficult in finding a doctor to prescribe them together, the liability is just not something most doctors would chance.

Conventional thinking also says beta blockers like propranolol and amphetamines should not be mixed. There is some debate that the risk is overstated, but again really hard to find a doctor who will prescribe them together.

There are no stimulant alternatives for ADHD though. Both clonidine and guanfacine are used and they were originally intended to treat high blood pressure so these may be an alternative. Strattera is a non-stim treatment but can also negatively impact blood pressure. Both Wellbutrin and Provigil, while not approved expressly for ADHD, have been used but again, may not go well with hypertension, Wellbutrin probably worse than Provigil.

I think it comes down to a few things. First, is his BP well controlled and he is compliant with his medication, has regular visits to his doctor, and makes the appropriate lifestyle changes to help keep his BP in check. Second, does he have any other risk factors that would make his risk for having a cardiovascular event in the next 10 years likely. These would include things like smoking, diabetes, prior heart attack or stroke and others. Here is a quick tool for judging the risk from one of the longest ongoing cardiovascular disease studies.

http://cvdrisk.nhlbi.nih.gov/

And last, are his symptoms of ADHD really that bad, are they affecting his daily life, job, relationships and has he seen a psychiatrist to be properly evaluated.

If the answers are Yes, No, and Yes, I think he needs to be treated, whatever the therapy may be.