From 90mg adderall to 50mg vyvanse!!! WTF!

[Built240]

So my wife decided to tell my Dr I was snorting my adderall(sometimes) and he gives me vyvanse instead. Here is the problem. I was prescribed 30mg adderall IR 3x per day and he switches me to 50mg vyvanse and says I'll be fine because it's time released. So I take my first dose at 8am about 90min later I felt pretty good. I thought ok if I feel this way all day I'll be great. By around 12:30pm I felt like I had nothing in my system. I wasn't sick or had body aches like I get sometimes when I haven't taken addy but I was just exhausted. So after researching apparently addy is 75% d-amp and 25% l-amp. So with my 90mg in a day I'd be getting around 67.5mg d-amp and 22.5mg l-amp. Now if I researched correctly 50mg vyvanse converts to 16mg d-amp and no l-amp. This is nuts. So he basically drops me from 90mg amphetamines to a total of 16mg amphetamines. Does this sound right or am I off with something? I don't mind the vyvanse esp bc it forces me to not snort it but I feel like I should have been given more. 70mg vyvanse is what like 23mg amphetamine total? So at the very least I think I should take 70mg when I wake up at 8 then about an hour before I crash from it(around noon) take another at least 50-70mg to get me by until I crash from that around 3-4pm. At least I'd be done with most my day. We're my #'s off on anything? Doesn't this sound like a huge decrease?

 

[SS373dOH]

My knowledge of vyvanse is limited compared to other stims and drugs in general, but I think your math is accurate. However you'd think this conversion differs from person to person. It does sound like your doc "penalized" you, after your wife ratted you out. The duration of action of vyvanse is supposed to be about 12 hours, so it should have carried you until about 8pm, so yeah, you probably didn't get a high enough dose, this is something I would discuss with my doctor about.

On a side note, you said you get physical wd symptoms if you don't have a stim? I didn't even know that was possible, I know psychological wd symptoms occur..


- Hopeless 7nos

 

[_DankOpiAmp_]

If dopamine is low enough one can get temporary symptoms of parkinson's during withdrawal. Immediately divorce your wife since she would rather act behind your back then speak to you face to face. (your children are not likely all genetically related to you if you know what I mean). I have heard of doctors under-dosing when simply trying out the new brand (corporatism...) on patients already prescribed Adderall who weren't abusing them as well. He is either punishing you or idiotically assumes it is equivalent to pure d-amp.

 

[Kittycat5]

If dopamine is low enough one can get temporary symptoms of parkinson's during withdrawal. Immediately divorce your wife since she would rather act behind your back then speak to you face to face. (your children are not likely all genetically related to you if you know what I mean). I have heard of doctors under-dosing when simply trying out the new brand (corporatism...) on patients already prescribed Adderall who weren't abusing them as well. He is either punishing you or idiotically assumes it is equivalent to pure d-amp.

This is a bit extreme. Telling someone to divorce their wife when you dont know shit about them is ridiculous.

 

[Built240]

He also says it's extremely time released so I'll be fine. First off all vyvanse is is d-amp that has to be broken down by the liver to be active right? So after about 60-90 min my liver breaks it down and a measly 16mg d-amp is active. Well my metabolism is very fast so d-amp usually clears me in 2-3hrs so I don't get why they say vyvanse is so long acting. Isn't it basically the exact same thing as just taking 16mg d-amp? There is nothing in it that lets that 16mg stay active longer normal right?

 

[Kittycat5]

Its not broken down to d-amp by the liver. It happens in red blood cells and is very consistent from person to person in terms of rate and extent of the conversion. Still underdosed, but thats fairly common unfortunately.

 

[Built240]

But regardless it's only 16mg d-amp in a 50mg vyvanse right? So some may have the 16mg active for a longer time before it starts to taper and some could have like 1/2 of it already gone within an hour?

Wait did you mean consistent or inconsistent?

 

[Crack'r]

Not sure why you are prescribed it but call your Dr and leave a msg saying it's not doing what it's supposed to and you aren't getting relief of the symptoms it was prescribed for.

Don't tell him you have been researching, just say it isn't working and let him make adjustments. If it still doesn't help call and tell him again and set up an appointment. Then maybe say you were curious about it and read that it lasts longer but that it's quite a bit smaller of an effective dose as compared to the same amount of adderall. It probably wouldn't hurt to apologize for snorting it a few times and you know it was wrong but that you were just trying to get relief and you are willing to try anything he suggests as long as it is effective and helpful and that you will work with him to figure that out.

Or something like that. It's always best to let them know it isn't working and make adjustments than it is to tell them what you want or how much you want. They like to feel like they are in control so let them be. It might take a little longer to get where you need to be but it's better than giving them a grocery list of what you want.

 

[mygreenbic]

d amphetamine pwns l amphetamine

I would say you're lucky. Adderall takes a toll on your mind and body... And imo it's that pesky l_amphetamine to blame. Damph seems so much more friendly.
I'm really getting pounded by that stuff atm.

 

[Built240]

Yah I love the amped up feeling l-amp gives me but the crash sucks. I think I'll see if I can get him to give me 2vyvanse like a 70 and a 50 or at the very least a 50 and a 50.

 

[theGirlWithBlueHair]

Dextroamphetamine gives peripheral effects as well. it's not that it's just CNS activity that like excludes from peripheral effecs: it's still has them. 50 mg of lisdexamfetamine is 15mg of base dextroamphetamine. Not nitpicking or anything lol but I just thought you'd like to know.

You could ask him to raise your dose. Vyvanse is, after all, mostly approved for use in children, and that's who the dosages were designed for. Mentioned this to him, or better yet print out the prescribing information and show it to him.

 

[belligerent drunk]

Not sure where you guys get your numbers from, but 50 mg of lisdexamphetamine metabolizes into approximately 25 mg of d-amphetamine, not 15 or 16 mg. Still, that is significantly lower than the previously used 67.5 mg, which explains why you're left dissatisfied. Overall, Crack'r gives pretty solid advice on how to approach the situation diplomatically.

 

[Pallyress]

I believe your doctor has miscalculated the relationship between those two meds. And even if it was a straight calculation, which it is not due to your body's ability to make the prodrug into the active drug.

Even so, the maximum recomended dosage for children is 30 mg/day for Adderall, and 70 mg/day for Vyvande.

Your doctor is misinformed if he claims 50 mg Vyvanse will give you the same effect as your previous medication. He clearly fails both math and a deeper understanding of how the different amps work.

I advice you to take it up with your doctor. The withrawal symptoms from cutting down therapeutic dosages too fast are psychological and may even in worst case scenario lead to psycosis and suicidal behaviour. If lucky it will be a few days, but it can also last on and off for weeks.

I've seen it happen to people I know, who ran out of meds due to lack of following up, doc was on holiday, an when meds ran out he crashed so bad he wasnt able to fix it or let anybody know. After some days he was able to ask for help, we got him to the ER, barely able to walk on his own due to the psychological strain.

Btw, wanting adhd/add patients to stay off drugs: cutting down their meds is probably the worst route to take. You would probably benefit of not being able to snort your meds, but you need the right dosage.

 

[Pallyress]

Btw, to get the most out of vyvanse, have proteins for breakfast, and avoid vitamin c in a couplecouple of hours before and after taking the Meds. I've benefited from following the advices when dosage has been in the lower part of the therapeutic window.

 

[theGirlWithBlueHair]

Keep in mind that he is taking 30mg three times a day. So he only has the 30mg in him at one time. So technically the Vyvanse dose isn't that off. It's not like he is taking the 90mg of the Adderall all at once.

 

[belligerent drunk]

The d-amp from lisdexamp also gets metabolized, and the prodrug->active reaction is also slow, so it's not a steady 25 mg for the whole day, but many times lower than that. He still used to take 67.5 mg per day, and now takes 25 mg per day. There is big a difference, no matter how you look at it.

 

[theGirlWithBlueHair]

http://www.secinfo.com/d12Pk6.v9Ac....nfo&cd=3&hl=en&ct=clnk&gl=us&client=firefox-a

The charts demonstrate that lisdexamfetamine and the way it releases d amphetamine, although it does have a slower onset, does maintain similar blood levels.

The prodrug to the active drug occurs within two hours and then all of the dextroamphetamine is converted by then.

But that dose is maintaining a constant blood level that equals the dosage of the vyvanse. I was just pointing that out. Maybe that's what the dr was thinking.

 

[Pallyress]

Keep in mind that he is taking 30mg three times a day. So he only has the 30mg in him at one time. So technically the Vyvanse dose isn't that off. It's not like he is taking the 90mg of the Adderall all at once.

Yes, but also no.
I agree with the Adderall statement. The Adderall he used was instant release.

Vyvanse is extended release, meaning that it will much longer, 12 hour half life if my memory serves me right. It slowly builds up to a peak, and slowly goes out of the system over the next two days or so. The first few days the meds will increase their effect, after a week or two a stable level and effect is reliable. That means that the active drug released from the prodrug is spaced out over a longer time period.

Meds are marked with the amount of active ingredient. Slow release means the plasma concentration will be much lower, compared to the same dosage in an instant release medication.

It's not a bad idea to start at 50 mg Vyvanse, but it seems like a very risky plan to stay there, without planning to increase the dosage.

Shire has some conversion tables between Adderall and Vyvanse. Roughly 30 mg Vyvanse equals ~10 mg Adderal.
~30 mg Adderal equals 70 mg Vyvanse.

That is d-amph, leaving the l-amp out. OP is very entitled to feel withdrawal.

Sorry for being very nerdy about it, I have felt the transitions between meds, and been through the same crap. It is horrible, and I sympathise a lot with him.

 

[belligerent drunk]

http://www.secinfo.com/d12Pk6.v9Ac....nfo&cd=3&hl=en&ct=clnk&gl=us&client=firefox-a

The charts demonstrate that lisdexamfetamine and the way it releases d amphetamine, although it does have a slower onset, does maintain similar blood levels.

The prodrug to the active drug occurs within two hours and then all of the dextroamphetamine is converted by then.

But that dose is maintaining a constant blood level that equals the dosage of the vyvanse. I was just pointing that out. Maybe that's what the dr was thinking.

The way I interpret the charts is that, as you say, the PK of free d-amp and lisdexamp are actually quite similar, except lisdexamp has a slightly slower onset and slightly longer duration. The amounts are in correct proportions (100 mg lisdexamp, metabolized into ~51 mg d-amp, corresponds to about same levels as 40-45 mg free d-amp) when equivalent stable levels are considered. So from this it would follow that the OP would need around 140 mg lisdexamp prescribed (to maintain the same levels as ~70 mg d-amp spread throughout the day), not the 50 mg they are. The dosage difference is still many-fold and that's what the doctor didn't consider, which was my initial point.

This is not the first time I see this type of thing, and I don't know if the doctors are unfamiliar with simple chemistry and maths, but this kind of gross dosage miscalculation seems pretty common when switching between d-amp and lisdexamp.

E: I realize that perhaps I illustrated my point poorly. I will say it this way: the OP were taking ~69 mg d-amp (90 mg 75%/25% ) spread into 3 doses each day, so that is say 23 mg d-amp per dose, 3 times a day. Then they got switched to 50 mg lisdexamp once a day, which (assuming roughly similar PK per mg d-amp as shown in the charts) equals about 25 mg d-amp equivalent - once a day. They were taking 3 times ~23 mg, now they're taking once 25 mg. There is the difference.

 

[manboychef]

This is something I would not rest on. I would make an appointment with your doctor immediately.

The fact your wife did that is another matter. Have you sat down and talked to her about it? Hopefully she was acting out of care for you, and not in a vindictive or spiteful manner.