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  • TDS Moderators: AlphaMethylPhenyl | paranoid android

Mental Health People's experiences with lisdexamfetamine (vyvanse, evanse)?

Switched to dexamfetamine yesterday and I'm tolerating it soooooo much better.

The excess stimulation is less noticeable and also far less long lasting even though the daily dose I'm on should be basically identical to the lisdex dose converts to. I have no explanation for this but as long as it works I dont really care that much why .
 
Guessing that's 20mg-30mg. If it's Dexedrine ER I've read it lasts for about 7 hours. Is it ER? Do you take it two times per day?
 
Nope that's just 10mg ir tablets, amfexa branded. I have been dosing 5mg at 9am and 5mg at about 1.30pm.

30mg lisdexamfetamine is equivalent to 9.8mg dexamphetamine.

I'm now being left to titrate my own dosage over the next two weeks up to a maximum of 40mg daily and then reporting back. Cant see myself going any higher than about 20mg at the moment.
 
So you take 5mg twice daily?

As far as I know, there isn't consensus on the conversion. Some say it's half lisdex:dex, some say it's more, some say it's less.

I'd stay at where you are now. The mood effect may wane a bit, but the side effect profile always goes up no matter how much you increase, even as the mood effect dissipates.

You already know this, though. Curious what your past use was like.
 
Past use of what?

I took 3x5mg today but they were a bit too close together (10.00am, 1pm and 3.30pm) and I also drank a big cup of coffee about 2pm and it set off my anxiety and I felt ovwrstimulated. Should have stayed at 2x5mg today rather than changing it up when I got the ok to titrate myself around lunch. Tomorrow i will do 8am, 11.30am and 3.30pm.

I'm very susceptible to anxiety (and worse) from stimulants due to past abuse and psychotic episodes so it's quite a hard balance to make. Cant imagine I will go past 20mg daily which is quite low, and think it's unlikely I will move past 15mg before my next review in two weeks.

I scored 80-90 on what I think was the conners cbrs scale, which apparently is a severe case with 90+ usually only related to head injuries.
 
Idk about that conversion. Like I said, there isn't a great deal of agreement on it. But it really comes down to what sort of therapeutic effect that you get from it.

I'm happy that you're dosing lower, even though this isn't really my home forum and over at MH we kind of have different rules.
 
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I don't understand a couple of things in your post, what chart are you talking about? The conners scale thing? What is the difference in rules you're talking about that relates to this thread?


My past use of stimulants is large....

mdma from 14, amphetamine from 15...did those regularly (most weekends at points) for years until I was about 20. Cocaine from 16, pretty regular recreational usage leading to...crack from the age of 19, habitual but on and off usage. From the age of about 21 I started to abuse cocaine and crack more heavily, injecting them either alone or in speedballs with smack. Daily usage for long periods, as well as other random stims like ethylphenidate and methamphetamine mainly IV or smoking during this early 20s phase. Went to rehab in my mid 20s and then relapsed and got addicted to crack, benzos and smack again. Started IVing cocaine and phet again. Didn't carry on with the stims for that long at this point for reasons I'll go in to below, but took a year or so to taper off the downers.

Then I was predominantly clean for a period of about five years, with just a handful of occasions of insufflated cocaine in there and a week long relapse on the pipe. About six months ago I relapsed again on crack and IV cocaine and struggled with that off an on through the early part of this year. Have put a couple of months between me and cocaine/crack at this point.

One thing that I was naughty in withholding from the psychiatrist is that I have suffered numerous fairly severe psychotic breakdowns including paranoid delusions, aural and visual hallucinations on the back of amphetamine and cocaine use, including fairly recently. I know I should have disclosed this but I had a pre-existing diagnosis, had talked medication over with my counsellor and knew I definitely wanted to try it and didn't want to spend all the money I was spending to be rediagnosed only for the doctor to tell me he wasn't going to script me because of that.

That should flesh things out for you a bit.
 
Some of that usage is pretty heavy as well, I smoked/IV'd about half an ounce of coke in a weekend not all that long ago.
 
I smoked most of it for precisely that reason.

What's really dumb is that I was doing it with a 23g spike.
 
THECATINTHEHAT said:
I smoked most of it for precisely that reason.

What's really dumb is that I was doing it with a 23g spike.
Click to expand...

I used to use 1 ml insulin syringes for IV coke but even those tiny needles couldn't find a vein after 3rd or 4th shot of a binge. Sadly where I live crack is not available so that alternative not an option. IV coke lots of fun but as far as harm goes I can't think of much worse besides maybe shooting pills.
 
I'm prescribed 60mg/day. It's a joke cause I'm a meth addict too and shouldn't be prescribed that, but I present enough ADD symptoms that I am.. it's a more common trap than a lot of people might realize. Just cant refill right now because I'm without ID (robbed/lost wallet two separate incidents) and need ID to refill.

It's an amazing drug if used properly. That's my gist of it. You'll feel more alert, engaged, expansion of mind, coping ability, reduced anxiety etc.. basically like meth but with much less side effects because ; a) it's a lesser amphetamine dose and b) it's regimented and (hopefully) taken properly has real value.

Take it the wrong way though, like in my case, it's just perpetuating an addiction. I have legitimate use for amphetamines, but shouldnt take them because I ABUSE them, hardcore. Even when I'm not on dope I'm on prescribed dope, same type.. it's fucked. Cautionary tale.
 
Settling in to meds nicely othst than......fucking abused some yesterday. Pretty upset.

Just have to behave myself from now and if it happens again then I might have to accept I'm not ready to be able to have this medication.

Oh well, mistakes were bound to be made. I'll see how things go for now but I'm ready to say no thanks if I cant behave myself.
 
Atelier3 said:
I used to use 1 ml insulin syringes for IV coke but even those tiny needles couldn't find a vein after 3rd or 4th shot of a binge. Sadly where I live crack is not available so that alternative not an option. IV coke lots of fun but as far as harm goes I can't think of much worse besides maybe shooting pills.
Click to expand...
IV ketamine habit is up there.....and I've had/done all of the above.

I usually would use an I sulin spike for IV coke but of course I'm the kind of idiot that has 25/23/21g spikes and 2.5ml barrels around for steroids and is too dumb to walk five mimutes to go and get some 1ml insulin pins from the exchange. In my defence it is harder at the moment with limited opening hours.

Still....that is route one to fucking your veins. Such dumb behaviour when access to clean works is so easy these days.
 
THECATINTHEHAT said:
Switched to dexamfetamine yesterday and I'm tolerating it soooooo much better.

The excess stimulation is less noticeable and also far less long lasting even though the daily dose I'm on should be basically identical to the lisdex dose converts to. I have no explanation for this but as long as it works I dont really care that much why .
Click to expand...

Vyvanse is close to 100% bioavailable, so you're always getting a full dose when you take lisdex. IR dex is subject to much poorer bioavailability, so you're getting probably 6-7mg from the 10mg tablets you've been prescribed (or 3mg x 2 per your dosing schedule), depending on what you're eating etc.
 
CFC said:
Vyvanse is close to 100% bioavailable, so you're always getting a full dose when you take lisdex. IR dex is subject to much poorer bioavailability, so you're getting probably 6-7mg from the 10mg tablets you've been prescribed (or 3mg x 2 per your dosing schedule), depending on what you're eating etc.
Click to expand...

Interesting, that would explain the difference.

Any idea why lisdex is 100% bioavailability but dex is so much lower?
 
OP much like you I found that Vyvanse was variable and often caused a lot of residual stimulation that made it hard to sleep even at only 30mg a day.

Because lisdex has to be metabolised into dex by your body removing the lysine molecule, how strong the drug feels depends very much on your metabolism on any given day.

I have found this still happens to some extent with dex, likely for the reason @CFC gives above, but it's far less severe. Some days 10mg will feel stronger than it did yesterday but, just to pull some numbers out my arse for a minute, the variation is more like 20% whereas on lisdex it was 80%.

So I never had any idea how lisdex was going to effect me on any given day and it's not like you can titrate the dose throughout the day because it takes two hours to kick in and lasts up to 12 hours... now with dex if I don't use it for a few days and am unsure how strong it'll feel, I can just redose as needed, or break a 10mg tablet in half, and so on. It's much more flexible and predicable and I find it to be superior medication for this reason.

That said being conscious of your history with stims, I do hope you can resist the urge to abuse them, because it sounds like they're doing you a lot of good medically.

As for others who've said the doc should have started him on IR, that's just not how it works in the UK. The medical guidelines in the UK state to try XR stims first as they're easier for patients (one dose a day) and are less prone to abuse. They like lisdex in particular because you cannot just bypass the time release by crushing it up, since it's a slow release prodrug you'd need to do some actual chemistry to bypass it.

I went through pretty much the same path as OP from another private specialist. I got Concerta (time release Ritalin) first, then Vyvanse, then dex. The dex is the best med in my opinion.

You cannot really get Adderall in the UK. Technically you actually can privately but it costs far more than it's worth and dex is cleaner anyway.
 
THECATINTHEHAT said:
Any idea why lisdex is 100% bioavailability but dex is so much lower?
Click to expand...

Lisdex, because it has the amino acid lysine attached, is captured by a specific amino-acid transporter in the small intestine that's very efficient and has excellent capacity. So pretty much everything you take gets sucked up into the bloodstream by this transporter. And then an enzyme in your red blood cells (which also has no real 'upper limit' of capacity for our intents and purposes) cleaves away the lysine, dropping off the d-amphetamine into general circulation. It's a marvellously efficient system and the guys who came up with it must have patted themselves on the back a few times ;)

Meanwhile regular dex can be easily protonated (the alkali amphetamine gets an acid added to it) in the acidic environment of the digestive system (especially when eating food). Which is kind of like creating a "pro-drug" in reverse from the active dex and thus reducing its effective bioavailability, as it needs to be unbound (active) to readily cross into the bloodstream. Once you bind d-amp to other things, it has a slightly higher tendency to get stuck in the guts or (later) excreted by the kidneys. Which is why binding it to lysine (which creates a chemical bond our digestive protease enzymes can't really break) to get it safely across the GI tract (and in a form which the kidneys won't flush out), and then getting it activated and released directly into the bloodstream by blood cells was such a clever move.
 
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