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Vyvanse: 10 Top Tips for ADHD Treatment

Updated on November 8, 2012

Vyvanse: 10 Tips for Easy Adjustment

Every new ADD/ADHD medication needs some time in the field to fully understand the metabolic patterns, the way it works best. Links for several previous posts on Vyvanse follow, and in this lens you will find a simple summary of those notes.

10 Tips for Easy Vyvanse Adjustment

First: New ADHD Medication Rules: Paying Attention to the Meds for Paying Attention Get the Meds Right - Check Out This Comprehensive PR Web Review on my New Book

Next: Precise Solutions for ADHD Medications Sign up for this complimentary summary of the problems and specific solutions-this link works

Notes on Finding the Correct Top of the Dosage The top is most important to measure. 

Notes on Vyvanse soon after starting to use it. 

Tips on Vyvanse after understanding more on how to adjust it.

Specific Vyvanse Ultratips for very low dosing strategies in sensitive individuals.

Notes on Why Protein Breakfast?

Dr Charles Parker: YouTube Short Video Explanations

Non-Stimulant: Info on Intuniv with Vyvanse - over 200 Comments

Vyvanse Tips: Vyvanse is a new medication for ADD, and shows considerable clinical effectiveness, safety, and fewer side effects

With a little bit of attention to dosing and duration of effectiveness Vyvanse can prove an excellent new alternative to other stimulant medications.

Vyvanse 10 Tips for Dosing Adjustment, With Your Doctor's Approval: Remember New Doses - Now in 20, 30, 40, 50, 60, and 70mg

These suggestions are posted to provide fresh information on dosing details and some interesting attributes of Vyvanse.

`1. Always start lower than expected, and go slower than usual.

`2. Vyvanse is a prodrug with a slow and forgiving delivery process: Rare AM agitation [see below], and often: no emotional drop in the PM [see below], - and, interestingly, often less agitation than Adderall.

`3. Clinical experience shows that it lasts longer as a single morning dose than any of the oral current stimulant medications. Shoot for 12-14 hr Duration of Effectiveness [DOE] carefully - at least 1 week between increases.

`4. The different prodrug delivery system provides a longer duration of effectiveness, with no need for a PM augmentation dose to complete homework or home chores. The "Bewitching Hours [from 4-8PM]," with few exceptions, are covered with that single AM dose.

`5. Methamphetamine addicts "don't like it" - as carefully studied and measured on a 29 point "likability scale." Because it is a "prodrug" and the release so measured, the immediate peak of plasma concentration is dramatically changed, even with an IV injection. This study demonstrates an excellent safety outcome, not previously reported with any stimulant in any package insert, and suggests a considerable disinclination for abuse.

`6. Start at the lower dose: 20mg which roughly equals Adderall XR 5 mg. They may have been on higher doses, even 40 mg of the Adderall XR, but go low and slow with the Vyvanse start, as it appears you will often need less to achieve remission from symptoms. The dose equivalences from the forced dose titration studies are often simply too much, and if they create a problem for that specific patient they may not wish to revisit this excellent medication.

`7. If the duration of effectiveness [DOE] is no longer effective at about 2-3 PM, the dose is one click too low. Move up to the next dose. 1 week is often enough to tell the DOE, 2 weeks you will be more sure regarding the DOE consistency.

`8. The duration of effectiveness [DOE] objective is 12-14 hrs, and most achieve that mark. Vyvanse has a surprisingly consistent run through the day, and recent studies show that optimum dose, reached in 5 weeks is maintained for 1 year... adjustments are rarely necessary.

`9. All psych meds are better tolerated and more effective with a protein breakfast,- please review my breakfast posts linked above. Proteins provide neurotransmitter precursors.

`10. For the Ultra Sensitive: [These suggestions apply for those who are unusually sensitive to medications, especially those young children who the treatment team feels will not tolerate new meds well - autism, Asperger's, brain injury, metabolic challenges, and the very young]. See the list here below:

The Ultra Tips for the Most Medication Sensitive

`a. Take the Vyvanse capsule, most often at the lowest dose, 20mg, break it 1/2 and pour the powdered contents into 2 oz of water in a measuring cup. Throw away the gelatin capsule.

`b. Stir, and don't worry about the small amount of material at the bottom.

`c. Give 1 oz in the AM, then put the other into the refrigerator, warn others not to drink it, - and if there is a concern for safety, throw it the other 1 oz away. No studies done on the reliability of this process or the efficacy of the drug in the refrigerator, it is off-label, yet patients are telling me this works easily and well for them.

`d. Give the other 1 oz the next AM.

`e. For very sensitive kids: take this plan one step further, and pour the 20 mg capsule powder into 4 oz of water, then spread the dosage of the next four days, giving essentially 5 mg/day - often these people do go up to 1/2 cap. [I have several patients, including one 45 yo adult [off label] engineer with brain injury and metabolic problems, who takes only 1/4 of the 30mg, and the DOE is a perfect 14 hrs. With ADD for many years, and significant sensitivity to medications he is very pleased with this unusually small dosage.

`f. No, you don't have to use water, OJ or apple juice will do. Acidic medium and variable transit times are not an issue for Vyvanse.

`g. No, there is no Vyvanse taste problem with touchy, taste sensitive folk, though I'm sure an exception exists out there, I haven't seen it, nor heard it reported from colleagues.

`h. Always check for protein breakfast. Protein is an essential precursor for neurotransmitters. Sorry to repeat, but we often have to say this more than once in the office.

Vyvanse and ADHD Videos - Let's review any options

Much discussion about these ADHD meds, so let's make a single place to talk specifically about Vyvanse

What's your experience with Vyvanse? - Doesn't matter if you are a doc or a client, please vote!

My experience with Vyvanse has been excellent - let's see what others are saying:

What is your experience with Vyvanse?

See results

Vyvanse Experience - Dosing pattern recognition

All stimulants need some care with dosing, so what is your experience?

ADHD Medication Rules
ADHD Medication Rules

We may be the most scientifically advanced country in the world regarding identification and medical treatment of ADHD - but a serious medical inconsistency remains: too many simply don't pay enough attention to the meds for paying attention. Both public and professionals regularly overlook essential ADHD treatment elements, important scientific data points that outline more predictable treatment mapping strategies. From superficial diagnosis by appearances, to medication dosage management by cookie cutter strategies, the uninformed use of stimulant medications is too often based upon criteria that vary from whimsy to hearsay. "ADHD Medication Rules" is the only book available that spells out and simplifies those essential medication details for both patients and professionals. "ADHD Medication Rules" offers those medical answers in the form of understandable, practical solutions for everyday practice, for every medication review. "Rules" is based upon the latest brain science, and includes a variety of associated treatment topics that address the real complexity of ADHD medical management. The variables that effect medication effectiveness range from sleep, to breakfast, to biomedical interferences that can dramatically change the way medications burn in the body. Without "Rules" the possibility of missing potentially dangerous drug interactions and associated diagnostic challenges, such as depression and anxiety, adds to the greater possibility of treatment failure.A key objective for "Rules:" engaging your medical team in more participatory dialogue with more clear expectations for medication outcomes and improved discussion at every medication check. Your anticipated "Rules" net result: Saved time, saved money, more predictable improvement, with better understanding of the entire ADHD medication treatment process at any age.

 
New ADHD Medication Rules: Brain Science & Common Sense
New ADHD Medication Rules: Brain Science & Common Sense

New ADHD Medication Rules deals with the frequent over-medication, missed diagnoses and imbalanced medication treatments too frequently found today in the treatments for ADHD. Dr. Parker shows where and how these various imbalances can occur, provides the data and explanations for why treatments can prove ineffective, then simplifies and explains specific methods for adjusting and choosing ADHD medications. Rules address the too frequent missed communication opportunities for medical practitioners, for parents of kids, and for adults with ADHD.Rules is based upon the latest brain science, and includes a variety of associated treatment topics that address the real complexity of ADHD medication management. The variables that effect medication effectiveness range from sleep, to breakfast, to biomedical interferences that can dramatically change the way medications burn in the body - such as undiscovered immunity issues with milk and wheat. Without Rules the possibility of missing potentially dangerous drug interactions and associated diagnostic challenges, such as depression, anxiety, bipolar disorder and brain injury add to the greater possibility of treatment failure.A key reason to read Rules: to engage your medical team in more participatory dialogue with more clear expectations for medication outcomes and improved discussion at every medication check. Hard data brings associated improved accuracy.

 

And If Vyvanse Doesn't Work Correctly - Intuniv

Non Stimulants Reconsidered

One medication is not for everyone, and a variety of indications for comorbid conditions apply to the new medication: Intuniv

Intuniv is an alpha 2 agonist, meaning it turns on a specific different neurotransmitter receptor than the typical dopamine or norepinephrine post synaptic receptors... and that makes it very different. Think of all the people out there misdiagnosed as bipolar when all they have is an angry subtype of ADHD.

More here: http://www.corepsychblog.com/2009/07/intuniv-for-a...

Then think about what else you may wish to accomplish without using any medicine - just improving the neurotransmitters naturally by adding targeted amino acids. Amino acids are precursors for neurotransmitters, and now we can measure biomarkers that tell us a great deal more about brain activity.

More here: http://www.corepsychblog.com/neuroscience

Reader Feedback

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    • profile image

      anonymous and in need 11 months ago

      I bought your adhd medication rules book and listen to every video you put out. My story: in hs I was put on 15 mg of adderall xr and it worked amazingly. In college my doctor upped my dose and got me off track. From there I went on concerta and intuniv and wellbutrin. Another doctor put me on lexapro and 25 mg of adderall. This worked but very inconsistently as I couldn't take it more than 3 days in a row - I was overstimulated monday and got work done tuesday and wednesday. My new doctor has taken me off lexapro and now nothing is working. I just switched to vyvanse 30 mg - in which i still can't read. I've tried going lower to 10 and 20 and I just can't read a sentence. I went to 40 mg for a couple days and it feels like I am overstimulated. HELP. Also do you do skype sessions for new patients that don't live in the Virginia area?

    • DrParker LM profile image
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      DrParker LM 3 years ago

      @cassandra-jetter: cj-

      Rough equivalent of adderall 20 mg to vyvanse = vyvanse 50, so you would be under-dosed considerably on 40 - 2x20 = 2x50 could = 100mg of vyvanse, therefore would ask your doc for at least 70 mg watch the DOE as spelled out here on the PM drop series: http://www.corepsych.com/7videosPMDrop | May need an additional PM to cover the day: see this vid series: http://bit.ly/dosevids

    • profile image

      cassandra-jetter 3 years ago

      Hello dr parker. I am a 24 yr old female. I was recently switched from 20mg adderall ir twice a day(1 every 6-8 hrs) to one 40 mg vyvanse a day. The adderall had significant therapeutic benefits but was becoming unaffordable. I really want to give vyvanse a good chance because of the fact that it is more than 60% less expensive than adderall and I've heard such great things about it. However, I have had just about zero benefit from the vyvanse within the week that I've been taking it. I do take paxil 20mg daily and know it's known to inhibit stimulant medications but I'm having a hard time with that concept as it did not seem to apply when I was taking adderall ir. Could this be due to the difference in delivery systems of adderall ir and vyvanse? My doctor is very responsive and supportive of my concerns pertaining to my treatment but I am already exhausted with the guinea pig process-mostly the preauthorization every time anything changes. Thanks for any advice :)

    • profile image

      anonymous 4 years ago

      @anonymous: Main issue w any stimulant: must be *after* breakfast, not before. With these recipes here you can get the dose down lower, and sometimes that might help. Most folks w a touchy stomach do suffer w immunity issues over time. The three big ones are milk, eggs and wheat in the testing I do in my office. I don't recommend doing anything w/o testing first.

    • profile image

      anonymous 4 years ago

      @anonymous: If you're tired w a stimulant med it likely is caused by too much med, even if the dose is very low. Try the water titration recipe here and it might work better at a lower dose.

      Thanks for your kind remarks! Details matter!

    • profile image

      anonymous 4 years ago

      My son is 6 years old and they have tried a lot of different ADHD meds on him he was on Aderall 20mg last and constantly complained about his stomach hurting really bad and wouldn't eat. They had then switched him to Daytrana about a week ago and it works good but the only side effect is the patches are WAY to sticky that they were pulling his skin off to so now I can't get him to wear them anymore. How likely is it that if I try Vyvanse that it wont hurt his stomach and is would it be less harsh if the capsule was mixed with milk?

    • profile image

      anonymous 4 years ago

      what does it mean when my vyvanse (only 20 mg) makes me VERY tired after 1.5 - 2 hrs? is my dose too low - or even too high? all other ADD meds made me anxious, i really want to give vyvanse a try, but it makes me so tired (i don't sleep i just stare or hyperfocus on rubbish on the internet) or calm i cannot function.

      btw great work doctor parker!!!!! thank you so much, you helped me realize that my anxiety was ADHD related!!!

    • DrParker LM profile image
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      DrParker LM 4 years ago

      @anonymous: Very likely that the correct, slow increase was indeed too much. You should feel better, not worse, I'd give it about a week and then discuss w your doc.

    • profile image

      anonymous 4 years ago

      I am a young adult and I started taking 30mg of Vyvanse daily as prescribed by my doctor for three weeks, finding it fairly effective at first and then started to notice a decrease in effectiveness shortly after the first week. After the third week of taking 30 mg, my doctor prescribed a dosage of 40 mg which I have taken daily for about a week now. From the first day I started taking the 40 mg I noticed the effectiveness to be drastically less, even less than the 30 mg dosage, I feel almost as I do unmedicated. I'm not sure what to think. Should I give it more time, before I bring my concern to my doctor?

    • DrParker LM profile image
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      DrParker LM 4 years ago

      @anonymous: The problem you describe could arise from several issues:

      1. Too much medication - see Top of the Window at CorePsych.com

      2. An associated depression could be aggravated by stimulants in the PM

      3. An underlying adrenal issue was fixed a bit by the meds but remains undiagnosed and untreated.

      These are a few guesses - each requires much more info.

      cp

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      anonymous 4 years ago

      I am an adult that has been on 60mg of Vyvanse for 7 months. I'm now having less episodes of anxiety, having more episodes of forgetfulness , any suggestions? visitor

    • profile image

      anonymous 4 years ago

      MY 10 year old son has been on vyvanse for 1 1/2 years. At first he was on 20mg and it was better than nothing but not pefect but when it was increased to 30mg we saw a huge change. he was no longer getting in trouble in school for sliding across the floor or poking people in the butt with a pencil, and he was able to get his work completed . that first year was so great. then over the summer he started getting defiant and angry for no reason in the afternoon. the doctor added intuniv 4 mg and amphetamine salts 10 mg (started lower but had to increase over the school year) and 2.5 mg melatonin to sleep. Now it seems like the vyvanse isn't as effective in the day and stops working about 2 pm instead of 5pm.Homework is now a nightmare again and he is in trouble daily at school. I am the doctor suggested at one point that the vyvanse be increase but I worry about taking so many meds in his little body and also about losing the weight he just reagained over the year. He also has some sensory issues with food so isn't getting the protein and nutrition he probably needs. Does this sound normal? How can I help my son?

    • DrParker LM profile image
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      DrParker LM 4 years ago

      @anonymous: If irritable at the outset reduce the dose working with your doc and these instructions. Far too many kids can take the Vyvanse but react to starting the dose at 30 mg. Oftentimes they go away over time, - but why put the child thru that operation?

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      anonymous 4 years ago

      My son has been on Vyvanse 30mg. for approximately a month. He has been having a lot of irritability, along with a decreased appetite and problems getting to sleep. I wanted to know if these symptoms decrease over time

    • DrParker LM profile image
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      DrParker LM 4 years ago

      @anonymous: CM, not enough info to take a shot, but agree with you generally speaking. Depression can significantly contribute to impulsive activity and prozac is my least favorite antidepressant... outlined in detail in my book "New ADHD Medication Rules" cp

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      anonymous 4 years ago

      My son (age 6) has ADHD and is on Intuniv (2mg) and Vyvanse (20mg). Recently a new doc said he was HF austisic/Asbergers and wanted to "calm him down" with Abilify (and stop other meds). This was a shock since no one in 6 yrs has thought he had austism ever, plus the drugs are sooo different. Is there anything we can add to ADHD drugs to calm his wild fits, like Prozac? or similar? Thanks. And yes we are asking his neurologist also.

    • DrParker LM profile image
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      DrParker LM 4 years ago

      @anonymous: The key questions: when is he tired, does he take it after breakfast, does he have digestive problems anyway? Consider IgG testing... SEARCH IgG on CorePsych.com for much more info

    • DrParker LM profile image
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      DrParker LM 4 years ago

      @anonymous: Quite likely, just speculating on this brief question, your dose was still too high even if your doc started low. Could also be that Vyvanse is not the med for you but another stim may work better.

    • DrParker LM profile image
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      DrParker LM 4 years ago

      @anonymous: Each of those two drug hits different neurotransmitter systems - all described in detail in my book: "New ADHD Medication Rules" less than 10 bucks at Amazon.

    • DrParker LM profile image
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      DrParker LM 4 years ago

      @anonymous: This is a serious problem, I agree, that's why I wrote "New ADHD Medication Rules." see at corepsychblog.com

    • DrParker LM profile image
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      DrParker LM 4 years ago

      @anonymous: Sorry to be so late with this, just missed it in my inbox: Yes, clearly stimulant meds work well with other meds... except those they have drug interactions with like, especially, Prozac and Paxil. I have a video over at YouTube drcharlesparker on the subject of these drugs and another on depression and ADHD.

    • profile image

      anonymous 4 years ago

      My son with mild ADD is trying Vyvanse at the lowest possible dose (20mg). He complains of tiredness and lack of appetite, even on a half dosage (10mg) in his milk. The tiredness is a big problem because he plays sports every day for 1-1.5 hrs (swimming/soccer - a way to help ADD kids settle down and learn better). Other drugs (concerta) cause him to throw up. What can we do ??

    • profile image

      anonymous 4 years ago

      I think all prescribing psychiatrists should have to take the meds they prescribe, just in order to gain some insight on how profound and powerful and at the same time primitive these tools are. The brain is a complex thing, and downstream effects from a course of a single medication may not even be experienced until days after the med has been discontinued. And in light of this, I have seen many so called doctors, no better than street corner pushers in my book, prescribe multiple meds from the get-go, as if their superior knowledge is able to tease apart the intricacies of an individual's response to being thrown onto a roller coaster that is now in essence constructed on top of another roller coaster, possibly moving in an opposite direction.

    • profile image

      anonymous 4 years ago

      My son who will be 9 has been diagnosed with ADHD. He has tried adderall with side effect of great anger,concerta which did nothing and now vyvanse. Dr started him on 30 mg my son Lost too much weight had eating and sleeping and stomachs

      issues. Now he is taking vyvanse 20 mg but it doesn't seem to be working very well at all. The dr now recmds that my son take 1mg of intuniv with the 20 mg of vyvanse. I am not understanding why both meds Mystic be used especially since the vyvanse is not working. PLEASE HELP.

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      anonymous 4 years ago

      Hi Dr.Parker, I just have one question. Would you recommend Vyvanse for individuals that are on other medications, especially ones for mental disorders? I am a 32 year old female with bipolar disorder, and have been taking the meds basically all my life since I was a teenager, and have tried Vyvanse, but unfortunately found that it made me very angry, but it was also helping me change my life in good way as in organization and motivation. If you could help me wth any advice. Thank youso much.

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @anonymous: Your problem very likely is that your doc is kind, trying to help you out, but has no or limited experience with Vyvanse. It's very likely not the Vyvanse but the dose, and if not the dose, and it can't be dialed in correctly, you likely have, even though you sound fit, some specific metabolic challenges interfering with predictable outcomes on the back end.

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @anonymous: No standard of care for blood work is necessary. No long term problems have been found.

    • profile image

      anonymous 5 years ago

      I have been on Vyvanse for almost 2 months. My Dr. and I are trying to get a good dosage set. For the 1st month I was on 30mg. and the very first day I took it i felt like a million bucks. SO in the moment and focused it was amazing, like i could accomplish anything. However, I never had that again, actually I haven't felt any effects from it since. After that month He moved me to 40mg and still nothing. Now I'm wondering if the dosage is still wrong or is vyvanse just not right for me. I don't know if it matters with this type of medicine, but I am 27, 5'4" male weighing about 130, I exercise 3 or 4 days a week. The reason my doc and i agreed to try it wasn't so much of full on adhd, but I have a hard time with focus, I have a million thoughts going on and I over think everything. Its really frustrating. lol At times I feel like I'm getting dumber, things I've done before with no Issues seem to be much more difficult. Any thoughts?

    • profile image

      anonymous 5 years ago

      Hi Dr. Parker! I am a 53 yr old woman with ADD and have been taking 50mg of Vyvanse and 2 mg of Intuniv for about three years since diagnosis with excellent results. My question is to you should I get any blood work done such as cholesterol, CMP/CBC, and Vitamin D, 25 Hydroxy, LC-MS every six months to ensure the rest of my body suffers no ill effects?

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @anonymous: Very typical, glad it worked for you, unlikely to cause anxiety, if it does you have an additional comorbid issue.

    • profile image

      anonymous 5 years ago

      I was just prescribed Vyvanse. For the past 10 -15 years I've taken SSRIs for OCD and finally a counselor suggested I may really be suffering from ADD or a combo of both. What you talked about where I couldn't remember anything or think straight with SSRIs was dead on. I look forward to seeing if this med works better. I am afraid of experiencing more anxiety.

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @anonymous: Too many variables to come close to an intelligent prediction... I have a very few patients on that dosage but only after careful consideration of many other contributory variables.

    • DrParker LM profile image
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      DrParker LM 5 years ago

      No prob, thanks for dropping by!

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @Spiderlily321: Many thanks back, don't forget to connect with CorePsych Blog for more depth of info, and CoreBrain Training for programs that teach management from students leaving high school to physicians learning the new complexity for applications with their own clients.

    • Spiderlily321 profile image

      Spiderlily321 5 years ago

      Thank you for the great info! I really like your lens. I have added it to my list of favorite featured lenses on ad/hd. My lens was created to create a virtual support circle and to also provide information to parents of children with special needs . Thanks for sharing. Here is the link: https://hubpages.com/family/my-circle-of-amazing-m...

    • profile image

      anonymous 5 years ago

      @anonymous: My son is on 50mg, he is 11 and plays hockey 4 plus times a week. The vyvanse has not affected his performance at all. I'd look deeper.

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      anonymous 5 years ago

      if someone would take 2 70 mg vyvanse what could happen to them?

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @anonymous: Follow up with your doc is always the first line of action.

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @anonymous: Catherine,

      You raise several points that may seem small or inconsequential that are likely to significantly contribute to your daughter's paradoxical challenges with Vyvanse and Rowing.

      The short answer on most of the questions is yes, it might be reasonable with your doc's input to stop the meds before races, no harm. But the fact that she is 15 and suffering with hypothyroid does raise a more important question about immunity, food allergies and physical deterioration from that undiscovered challenge,

      The easy step: adjust the dosage with your doc. The more complicated but likely even more productive step would be look more deeply into immune issues like Transit Time [sounds funny but can reveal significant challenges - Search @ CorePsych Blog for download instructions]. That one is no cost, and only possibly useful. The other more direct and scientific view would be to assess IgG qualitative for foods - type in IgG into the Search there for much more info.

      If she has a food allergy she is slowing down based upon that issue, not likely the Vyvanse.

      cp

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @anonymous: Jake, In all my correspondence to readers, either at CorePsych Blog or here, I always advise against starting at a dose that "might" be right down the road. Your concerns likely arise from the dose starting too high, but without an exam I am only conjecturing based upon this small report. The reason I go slower: about 30-40% of the time unpredictable metabolic challenges hide under the surface and slow the medication's metabolism creating a relatively high dose with side effects.

      The good news is, and I apologize for time lag in this response, those early side effects most often diminish. The bad news: often the person misses the opportunity to work with the drug in question as they formed a negative opinion that is not the fault of the drug, but the process of getting started.

      All of these issues are covered in details in ADHD Medication Rules with specific recommendations for dosage strategies.

      cp

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      anonymous 5 years ago

      My 15 year old daughter was diagnosed with ADD 2 months ago. She began treatment with an initial dose of 20mg of Vyvanse for the first week and then was bumped up to 30mg. She has remained on 30mg since then with remarkable results. She loves the way that the Vyvanse quietens all the overwhelming noise in her head. She takes the 30mg of Vyvanse at 7:00am (after a high protein breakfast) and it seems to wear off at about 2:30pm when school ends. It tapers off gradually without irritability or a crash. Her academic performance at school has improved a great deal both because she can focus longer while studying and what she studies seems to âstickâ better. Her grades improved with her January exams!! She is also able to stay better organized and keep track of her belongings better â her prior lack of these abilities used to be a serious problem and it drove me nutso. She has suffered no significant side effects other than an increased heart rate and decreased appetite. She did lose some weight in the first few weeks but now it has stabilized and she eats healthier than she ever did! This is the good news.

      The not-so-good news is that the Vyvanse seems to have decreased her athletic performance. My daughter rows competitively and trains daily at a very high level. She takes it extremely seriously. Read â rowing is way more important to her than school! Since the Vyvanse, she isnât able to drive the same power with her legs while erging (aerobic exercise on ergometers or rowing machines) and she canât seem to maintain the same level of stamina that she used to have. The coaches have noticed this too. Interestingly, while doing weights and core exercise (non-aerobic), she has continued to advance her leg power and her core is developing nicely as well. She feels that when she is erging, her heart is beating too fast and it frightens her. Iâm not sure if this is a real danger for her or if it is a perceived danger.

      Last week, she had blood work and an ECG done as part of the initial monitoring of her response to Vyvanse as well as monitoring of her thyroid function. (She is also hypothyroid and takes 100 ug/day thyroxine to control it.) All the tests came back normal, except that she is Vitamin D deficient (wintertime in Canada the cause?). Thyroid, ECG, blood sugar were OK.

      I have some questions.... If the Vyvanse is indeed causing the decrease in athletic performance, is there a real concern that her heart rate is elevated beyond safe levels during aerobic exercise? What is a safe level?

      Iâm wondering if the âperformance enhancingâ nature of ADD stimulants only work as an enhancer to someone who does not have ADD and that it has the opposite effect on someone who does have ADD. (ADD stimulants are a banned substance in high level sport.)

      Would there be any advantage to stopping the Vyvanse a few days or a week prior to a competition and then resuming it again afterwards? Would that upset the applecart with respect to her otherwise positive response to the drug? If stopping it prior to a competition, what would be the appropriate number of days? (Not taking it the day of makes no positive difference to her.)

      Are there other ADD meds out there that would be as effective for the focussing yet wouldnât result in the elevated heart rate and decrease in athletic performance?

      Sorry for the long post. Many thanks for your input!

    • profile image

      anonymous 5 years ago

      @anonymous: IVE BEEN ON 20 MILLIGRAMS FOR ABOUT 2 WEEKS NOW, VERY FIT... STILL SPRINT, RUN AND LIFT WEIGHTS. you should be fine. follow up with ur doctor.

    • profile image

      anonymous 5 years ago

      @anonymous: IVE BEEN ON 20 MILLIGRAMS FOR ABOUT 2 WEEKS NOW, VERY FIT... STILL SPRINT, RUN AND LIFT WEIGHTS. you should be fine. follow up with ur doctor.

    • profile image

      anonymous 5 years ago

      Having recently realized that ADD would pretty much explain my entire life up to this point and getting close to losing my IT job from lack of focus - I decided to look up a psychiatrist to get some help.

      Long story short, having never been on any type of ADD drug before, the Dr started me at 70mg. I feel fairly good and have a mental clarity that I've never had before, however I am worried from the research I've done after getting the rx that this is way too high of a dose to start with.

      I'm also fairly jittery, heart's definitely pumping, and within hours of taking the drug for the first time lots of blood vessels in my face burst (all the way to the edge of my ears).

      The positive effect made work today totally do-able for the first time I can remember in a long time, maybe ever. However the side effects are a little scary. The Dr never called me back, and I was considering for tomorrow diluting half the pill in water. Not even sure what I'm asking here lol.

      Also, is it safe to exercise on this stuff? I'm scared to run hard or lift weights and die of a heart attack at age 30.

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @grainne: You missed the point entirely, but did get you link on there which this lens were blog, I would spam.

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      grainne 5 years ago

      It is an informative lens but I want to highlight what is ADD as there are some people that donât know about this. It is an attention deficit disorder. The diagnosis criteria of ADD, includes patientâs behavior.

      Save Water

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      sarahrk lm 5 years ago

      very informative. looking for new treatment

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @anonymous: Glad it worked for you and your son Tammy!

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      anonymous 5 years ago

      @DrParker LM: Well after reading about titration I tried it today and my son did so much better! He was very well behaved and his teacher noticed an improvement in his work. He wasn't as tired as before.. he was a little emotional but I figure that will resolve over time. I was also reading that dosage isn't based on weight anymore.. more of metabolic rate. So his weight should not be a deciding factor in medication? Thanks for taking the time to read and respond. This website has helped us so much!

    • DrParker LM profile image
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      DrParker LM 5 years ago

      @anonymous: 1. Try it after breakfast, not on an empty stomach

      2. Dose sounds reasonable on the front end, but on the back end sounds like too much, suggest speaking to your doc about a lower dose.

      cp

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      DrParker LM 5 years ago

      @anonymous: While I make no medical recommendations for people I haven't seen in the office, it would be quite reasonable to download these remarks and pass them along to your doc to seek his approval. Sounds like your guy is on too much - and that "too much" could be caused by a number of issues. Best to follow up with a visit to CorePsych Blog and type "metabolic" in the search there.

      cp

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      anonymous 5 years ago

      Hi my son is 6 years old and he is small for his age.. 39 pounds. He is severely ADHD and we tried bioneurofeedback to no avail.. we started with focalin but I thought he became too angry.. we used the patch (daytrana) and liked it but his skin became too irritated. Now we have 30 mg of Vyvanse.. but for the only two days I've given it to him he sleeps and the other day he was completely passed out and I couldn't wake him. I stopped immediately and now I'm wondering can I try the recipe I read about about cutting the 30 mg in half?

      Thanks

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      anonymous 5 years ago

      I have been on alderall xr30 for a few years with no complaints Vyvance was suggested so I tried 40 mg I was told by everyone that I was real aggressive and nasty so I went back any suggestions.

      V

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      Yardbird 5 years ago

      Excellent Lens, good information on a new medication that I had not heard about!

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      DrParker LM 6 years ago

      @UKGhostwriter: Solid, thanks!

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      DrParker LM 6 years ago

      @Desty: Quite simply the dose, as is obvious in retrospect, was likely too high, even tho it was OK on the package insert. When you have probs like this the best is to drop back to a lower dose. Atypical reactions almost always need metabolic review to manage metabolic variations.

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      Desty 6 years ago

      My son was first put on Vyvanse. The first two days were horrible, he was violent and very aggressive, but after those days, it was a WONDER. We loved it so much, but discovered that it was causing him to lose weight, 7 pounds in one month. Too much for a six year old. He's on a different med now, but it doesn't do half the job Vyvanse did.

    • UKGhostwriter profile image

      UKGhostwriter 6 years ago

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      anonymous 6 years ago

      @Addy Bell: I've experienced this problem as well! At 39 years of age I had never had a cavity in my life. At my very next dentist visit after I started taking Vyvanse, I had several cavities and several more "watch" areas. I also had a cavity at the visit after that. My dentist did not believe the medication was linked to the tooth decay, but I was still suspicious. Thirty nine years is a long time to go without tooth decay and the only change in my routine was the medication.

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      anonymous 6 years ago

      I'm sorry but it looks like you are just trying to promote your products. I don't like promotional Lenses, you don't know if the content is true or if it is just made up to sell the product!

    • DrParker LM profile image
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      DrParker LM 6 years ago

      @anonymous: Completely agree with your observation that other interventions can prove significantly helpful - my take on the question from a traditional psych point of view... let's get the evidence first then think about supplementation. At this page I go into those details -

      http://www.corepsychblog.com/neuroscience

      cp

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      anonymous 6 years ago

      Another solution to A.D.D. I don't know, it might be just me, but sometimes I feel like A.D.D. patients are not diagnosed properly. They are normal people who don't need a diagnosis. We all have trouble concentrating from time to time, but it doesn't mean it's a disorder.

      Travacor

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      DrParker LM 7 years ago

      @Addy Bell: Good point, - not common, but certainly a possible issue.

      cp

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      Addy Bell 7 years ago

      I've been on Vyvanse for almost a year. It's been almost perfect -- except that I experienced some serious, unexpected tooth decay as a result of the dry mouth it caused. Anyone taking stimulants needs to be absolutely vigilant about this. Tell your dentist, get extra x-rays, chew gum with xylitol. This has been the only flaw in an otherwise great med.

    • DrParker LM profile image
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      DrParker LM 7 years ago

      @anonymous: Pearlean, Lip and mouth events may be a very odd side effect, I just don't think so from my experience. Sounds like your guy is not eating breakfast - see these remarks to help with that issue: http://www.corepsychblog.com/2007/02/power-breakfa...

    • DrParker LM profile image
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      DrParker LM 7 years ago

      @anonymous: Tiffany, Short and sweet, absolutely, it's my favorite by far - but about 5% of folks just can't take it. You have a 95% chance that it will work, just go low and slow as indicated here.

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      anonymous 7 years ago

      Im on ritalin and i don't think it helps at all and my doctor just keeps raising the dose. I have ADD do you think vyvanse would be good for me?

    • DrParker LM profile image
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      DrParker LM 7 years ago

      @anonymous: Ask your doc to start the dose even smaller, as outlined here, and always give after breakfast-

      cp

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      anonymous 7 years ago

      just started 11yr old on Vyvanse. His stomach hurts alittle, but his lips are burning and he has small bumps developing around mouth. Is this normal? If so, what can i do to ease the side effects?

    • DrParker LM profile image
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      DrParker LM 7 years ago

      @work1282: work1282: When you have someone starting with the lowest dose of Vyvanse still having symptoms of too much [insomnia, headaches, stomachaches] two interventions to consider: 1 lower the dose by the water titration strategy outlined above in this lens, using 1/2 the dose to start by diluting the dosage. 2. Make sure she takes it with a protein breakfast -*after* that protein breakfast, outlined on my blog with the link at the very top of this lens - Best wishes! cp

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      work1282 7 years ago

      I am a teacher, but I'm posting as a mother. I just placed my 8 year old daughter on 20 mg ov Vyvanse. Today is the fifth day. She's still experiencing headaches, sleeplessness at night, and stomachaches most of the day. I know the sleeplessness will be a problem for a long while, as I have an older daughter who has taken meds for several years. But do the stomachache and headache symptoms subside soon?

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      DrParker LM 7 years ago

      @anonymous: Nurse, Should only be about 30-45 min, no prob. If longer than that it could be either too little, but also can be actually too much, both needing a run back to the doc.

      cp

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      DrParker LM 7 years ago

      @anonymous: Sorry to be so late getting back: ASD always, always needs to go more slowly, and even at 9 I start at 1/2 of 20 mg as noted above. If he has reaction to that one, go down to 1/4 of 20mg, and watch the DOE as noted.

      cp

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      anonymous 7 years ago

      I am a middle school nurse and have a student that takes his Vyvanse upon arrival to school. How quickly should the effects of the medication be anticipated?

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      anonymous 8 years ago

      My son has not been diagnosed ADD, but he has been diagnosed Autistic. He is 9 years old and he started Vyvanse 30mg once daily about 3 weeks ago. My concern is his mood swings and aggression that was virtually non-existent until he started this medication. We started this med in an effort to help him focus more in school, now I'm not so sure. Should I try cutting the dosage down? I don't like the chabge in behavior, but this is the first med we have ever tried and I want to give it a chance. He does seem more focused but at what cost?

    • DrParker LM profile image
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      DrParker LM 8 years ago

      [in reply to Moss] I usually start slower with smaller dose than 40 - at that dose more likely to have appetite problems, but if the dose is correct they will be gone within a week,

      cp

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      anonymous 8 years ago

      My 13 year old boy just started on Vyvanse at 40mg, no previous meds, and no test for ADD or ADHD. The Dr. diagnosed him through questions as ADD, yet with research, I'm seeing that this drug seems to be for ADHD, should I question that? Also, how long should his loss of appetite last? I read that it should be temporary. He's only been on it for a month, and showing great improvement, yet we are worried that he hardly eats. I have to force him to eat some days.

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      anonymous 8 years ago

      Lori,

      When you say that you need two of the Vyvanse 70mg capsules in the morning for it to even kick in, I suspsect you are looking to feel that buzz which you most assuredly felt after taking 60mg of Adderall XR all at once. Problem is, Vyvanse was not designed to kick, it was designed to work. If you chase the buzz by increasing the dosage, you will push the dose much too high and give yourself side effects. Vyvanse was designed to provide all the efficacy you need without the buzz. Instead of waiting to feel Vyvanse kick in, keep track of how focused you feel on only one of the Vyvanse 70mg, or even 50mg for that matter. If you wait for Vyvanse to "kick" you will conclude it's not working. 60mg of AXR is a monster dose and is very rare. It must've kicked like a bronco after taking it in the morning all at once. Why did your doctor push AXR so high? Why did he switch you? Is it possible you are comorbidly depressed?

    • DrParker LM profile image
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      DrParker LM 8 years ago

      [in reply to Freshstartamc]

      My opinion: you are exactly right about many who write for ADHD without thinking about the med consequences. Many use the current limited diagnostic categorization which psychiatrists themselves are currently revising - and wonder why the meds don't work because the simply don't understand the implications of correct dosing strategies.

      Many problems do exist, but studies show that it is under diagnosed when one compares the incidence in the general population with those treated.

      The reason for this site and my many blog posts regarding Vyvanse and stimulant drugs is simple: an informed public can make more informed choices, and can themselves better understand the treatment parameters. Precise treatment, improved diagnostic objectives will correct the problems you correctly note in your comments.

      tnx

      cp

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      Freshstartamc 8 years ago

      Methamphetamine users don't like it? Is that really a reason to be up in arms for a product like Vyvanse? I understand that these kinds of medications are becoming more and more popular as more and more people are "diagnosed" with ADD and ADHD but I don't understand why anyone would recommend such a product to anyone. I had a psychologist who told me I was ADHD and instead of putting me in contact with someone who would give me a prescription she helped me with exercises I could do to increase my ability to function as a regular person. I don't disagree that some people need medications, but I do think that ADD medications are being over prescribed into the general population and that is a cause for concern.

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      anonymous 8 years ago

      Thank you so much Dr. Parker. That's rather spooky about taking the combination.

      Let me ask another hypothetical. If a person is taking adderrall or any ampethamine compound for more energy and not for ADD, is it a given that a tolerance will be built up and if so, will laying off of the stimulant on the weekends,as I do, slow the progression of the buildup of tolerance? Can people with ADD taking an ampethamine compound also build up a tolerance?

      Thank you again.

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      anonymous 8 years ago

      [in reply to Glenn] Your question is so interesting, and a prime example of a little appreciated drug interaction - prozac and any amphetamine product are simply incompatible. I have written about this interaction extensively at my website and refer you to the following post:

      http://www.corepsychblog.com/2006/11/adderall_proz...

      Adderall and Vyvanse are both amphetamine compounds and react the same way with Prozac - talk to your doctor, have him look up the drug interactions through CYP450 2D6 [prozac plugs that path]

      It looks like you are developing tolerance - that it isn't working - and yes, it isn't working because you are accumulating it, it is blowing your thinking out the top of the Window descriptively discussed in point number 4 on this article:

      http://ezinearticles.com/?ADD-ADHD-Treatment---7-T...

      This article doesn't cover the interaction with Prozac, but several other posts do over at my blog site,

      cp

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      anonymous 8 years ago

      I am 61 and am taking 30 Mg/day along with 40 Mg/day of Prozac. I'm taking it to help combat severe fatigue. I don't know if you would recommend this combination or not for depression. However, it has helped me tremendously at work to have the enthusiasm back and focus which I have lost.

      My question: To help ensure I don't lose the positive effects of Vyvanse,occasionally go for 3-4 days without taking it with the reasoning that I won't build a tolerance to it as quick. Is this accurate and advisable? I miss taking it. Is this putting off bulding a tolerance to it or should I take it every day? Thank you.

    • DrParker LM profile image
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      DrParker LM 9 years ago

      Lori,

      Difficult to say exactly what the problem actually is. Without more careful review, and although not approved for the higher dosage, it does sound like you are quite right - not enough.

      Here is a link to read more about the *top of the window*... watch carefully for #4 in this article... - too much, but looks like too little:

      http://ezinearticles.com/?ADD-ADHD-Treatment---7-T...

      Best bet: go over it more carefully with your doctor - I have seen some who need unpredictably more, a higher dose equivalence.

      cp

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      anonymous 9 years ago

      I DO NOT LIKE VYVANSE AT ALL

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      anonymous 9 years ago

      I AM AN ADULT, 40 YRS. FEMALE AND HAVING TROUBLE FROM SWITCHING FROM ADDERALL XR TO VYVANSE. MY DR. STARTED ME AT 70MGS SINCE I WAS AT 60MGS WITH ADDERALL;BUT I HAVE TO TAKE 2 70 MGS IN THE MORNING FOR THEM TO EVEN KICK IN. I HAD TO START TAKING VYVANSE BECAUSE I WAS USING PATEINT ASSISTANCE AND SINCE THEY DO NOT HAVE THE ASSISTANCE ANY MORE FOR ADDERALL I HAVE TO USE VYVANSE AND I AM REALLY FEELING LIKE I AM GOING DOWNHILL

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      anonymous 9 years ago

      I AM AN ADULT, 40 YRS. FEMALE AND HAVING TROUBLE FROM SWITCHING FROM ADDERALL XR TO VYVANSE. MY DR. STARTED ME AT 70MGS SINCE I WAS AT 60MGS WITH ADDERALL;BUT I HAVE TO TAKE 2 70 MGS IN THE MORNING FOR THEM TO EVEN KICK IN. I HAD TO START TAKING VYVANSE BECAUSE I WAS USING PATEINT ASSISTANCE AND SINCE THEY DO NOT HAVE THE ASSISTANCE ANY MORE FOR ADDERALL I HAVE TO USE VYVANSE AND I AM REALLY FEELING LIKE I AM GOING DOWNHILL

    • DrParker LM profile image
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      DrParker LM 9 years ago

      New voting shows that 57% like Vyvanse better than any other previous stimulant medication, and 27% are having some of the problems we address here.

      Stay tuned over at http://www.corepsychblog.com for updates on forthcoming articles about titration, diagnosis, and a new book about bringing all the meds together effectively.

      See ya there, thanks for the comments here, you are welcome to add any details you wish!

      cp

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      anonymous 9 years ago

      Thanks for the note Dr Jones,

      We have seen other interventions work, perhaps not with the consistency of the stimulant meds.

      We share a concern about the inappropriate dosing and often overlooked additional problems.

      cp

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      HerbalRemedies 9 years ago

      Hi,

      Very nice lense on ADHD you've put together.

      You've obviously put a lot of time and care into it, thank you!

      How to Treat Attention Deficit Disorder in Teens Naturally.

    • profile image

      anonymous 9 years ago

      Very interesting website, noble ambitions and likely very helpful at a low cost for many. I will send you a note offline to see how we might connect-

      Tnx

      Chuck

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      DrJones 9 years ago

      Hi

      I did my PhD on CBT for kids

      I made www.AnimalAgentz.com

      Parents are finding it can be used for ADHD.

      Please check my web site

      We do not have money for marketing etc

    • DrParker LM profile image
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      DrParker LM 9 years ago

      Hey Vyvanse Squidoos -

      Do click on any of the posts above for updated comments.

      The only voting today is on the fact that some are having trouble getting the dose right... All the details are addressed in many comments on several posts on Vyvanse.

      And feel free to drop a note here as well!

      cp

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      anonymous 9 years ago

      Thanks Baylor,

      Have some inside news that the smaller [1/2] doses will be out in the second quarter... should make it all easier, and yes, can put it in applesauce if they can't swallow the pill. Water at this point seems easier for most I have discussed this with.

      Thank you-

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      anonymous 9 years ago

      Chuck,

      Great comments. I think this will help many. We could also try a powder packet dose with this if needed for those "finicky" patients.

      Thanks again,

      baylor

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      anonymous 9 years ago

      very useful Chuck. Thanks for including me in introduction to this posting.