being put back on vyvanse

[Shady Kaity]

I got taken off vyvanse. A few months ago. I believe it was the beginning of june. I'm not seeing a psychiatrist currently but since school is starting in about two weeks or so my primary doctor was nice enough to put me back on it, but right back on my dose I left off at which was 70 mgs.
Is this a cause for concern? What effects should I expect from this starting dose?

 

[NeighborhoodThreat]

70mg is what you were on before right?

Should be fine provided you're not mixing it with any other drugs. Are you currently prescribed any other medication and/or taking any other drugs?

 

[AlphaMethylPhenyl]

...why would you be concerned?

 

[Shady Kaity]

Cuz I haven't taken it in almost three months.

I am on other medications. I take cymbalta 60mgs, plaquenil 200mgs, topamax 100mgs, hydroxzine 50mgs 2x a day, and for right now prednnisoone 20mgs and 200mgs tramadol. As needed naproxen 500mgs and occassional suboxone 1.com5mgs at most.

Also, I've been having chest pains and my rheumatologist sent me for a chest xray and echocardiogram to check it out. So I just want to make sure after a three month break 70mgs is an okay starting dose is all.

 

[ErgicMergic]

Don't take 70mg Vyvnase with more than 50mg tramadol a day, even then you might be a bit overstimulated and have symptoms of physical anxiety.

You should not be mixing Cymbalta (SNRI) with any amount of tramadol due to risk of serotoin syndrome, let alone a full 200mg of it. The chest pains could be cause by mixing the tramadol and cymbalta, in which case adding the vyvanse will just make the peripheral stimulation worse.

Even though it comes in a tiny capsule, keep in mind that 70mg Vyvnase is quite strong (like 20 mg Dexedrine), so don't pop two of them if you "want to study." Instead, take your regular dose, or take one and a half (it's water soluble) if you absolutely HAVE to abuse it. I would start on a lower dosage, since your amp tolerance has dropped in 3 months.

Why did you discontinue it in the first place?

 

[AlphaMethylPhenyl]

You need to tell a doctor with knowledge of pharmacology (which is most doctors, I hope) about the medications you're taking.

Your Cymbalta and Tramadol have similar mechanisms of action, and Vyvanse will increase the bare stress posed by both of these chemicals.

If you're having chest pains and you think there might be a problem with your heart it would not be a good idea to start take amphetamine without consulting a physician, let alone the other two.

 

[NeighborhoodThreat]

As ErgicMagic and Ho-Chi mentioned, Cymbalta (duloxetine) and tramadol have similar methods of action and will potentiate each other and the Vyvanse. Even though dextroamphetamine (which Vyvanse is the pro-drug for) has mild action on serotonin, the fact that you're taking two other drugs that are both SNRIs means that you need to keep that in mind. The chest pains could be due to amphetamine use but they could be unrelated. Make sure you speak to the cardiologist about all three of those medications and their action on your cardiovascular system. This resource shows the possibility for major interactions between dextroamphetamine and duloxetine, tramadol and duloxetine, and tramadol and dextroamphetamine. That's not saying there will be an interaction, but the possibility is certainly there. Be careful

The hydroxyzine won't interact with those three but could possibly counter-act some of the stimulation caused by the Vyvanse. As mentioned, your amphetamine tolerance will have dropped quite a bit.

The real question here is this: Have all these things been prescribed by the same doctor? If not, is your doctor aware of all the medications that you're taking?

 

[Shady Kaity]

Thanks guys! And yes my doctors all know what I'm currently taking as prescibed. The chest pains came about after I stopped taking the vyvanse.
And I stopped taking the vyvanse in the first place because there's a chance I may be having seizures in my sleep. But I have a neurologist appointment this Friday so my doctor figured it'd be okay to start up again since ill be starting my second semester of college in two weeks..
What kind of interactions could these medication combinations cause? I'm assuming seritonin syndrome. And how would one recognize SS?

 

[NeighborhoodThreat]

Serotonin syndrome is one of the risks yes. Another (more likely) risk is general overstimulation (hypertensive crisis). Serotonin syndrome is sometimes used a "catch-all" for adverse drug reactions and/or interactions...but it is not always serotonin syndrome.

Symptoms include:

-Very high blood pressure/hypertension
-Extremely rapid heart beat or irregular heart beat
-Hallucinations
-Extreme nausea, vomiting
-Vertigo
-Dizziness, fainting
-Numbness
-Extreme chest pain, tightness in the chest
-Seizures
-Blurred vision
-Headache, migraine
-Anxiety, panic attacks.

Both serotonin syndrome and hypertensive emergencies are medical emergencies and if you experience these symptoms you should contact professional emergency medical help by calling 911 (or your local emergency telephone number) or a poison control center at 1-800-222-1222.