Thursday, December 18, 2008

Evaluation of Vyvanse for ADHD Treatment

A new drug called Vyvanse (Lisdexamfetamine) has entered the world of ADHD stimulant medications relatively recently. Vyvanse was originally marketed as an ADHD treatment for children, but has recently been approved by the FDA for adult and adolescent use this past April. A cousin of the popular ADHD medications Dexedrine and Adderall, Vyvanse includes some key modifications from these other meds. Some reports (unverified) suggest that Shire Pharmaceuticals, the makers of Vyvanse, are pushing this new drug aggressively over Adderall XR. While Adderall is a chemical mixture of amphetamine salts including enantiomers, Vyvanse only contains the one enantiomer thought to be more "active".

A quick side note on enantiomers: Entantiomers are essentially "mirror images" of the same chemical compound, like a person's left and right hand. The body, like most objects in nature, react differently to and often heavily prefer one "mirror image" over the other. Certain ADHD medications such as Focalin, have already employed this technique. Focalin is an isolation of only one of the two mirror images that make up Ritalin, another popular ADHD medication. In addition, the ADHD medication Dexedrine also employs this mirror-image selectivity regarding its composition.

The second major difference between Vyvanse and other amphetamines such as Adderall, is that Vyvanse is listed as a "pro-drug". A pro-drug is essentially an inactive form of a drug, which, when broken down or metabolized by the body, releases the active drug form. Vyvanse contains an amphetamine which is chemically linked to an amino acid (a building block component of proteins) called lysine. In the body, this chemical linkage is severed by special enzymes which separate Vyvanse into the amphetamine drug and leftover lysine fragment (which is easily disposed of, since lysine is a naturally occurring amino acid in its own right).


***Blogger's note: I will be citing a number of studies previously conducted on the drug lisdexamfetamine. Keep in mind that this is a relatively new drug, so it does not have the history of a drug such as methylphenidate. Nevertheless, I have tried to keep a good balance of sample studies on the drug to report on. The list of studies mentioned and referred to here, are by no means exclusive! While not all of the studies used the Vyvanse brand of the drug, I will be using the terms "Vyvanse" and lisdexamfetamine interchangeably throughout the post.

***Additionally, please do not take this information as official medical advice. I am simply trying to highlight some of the pluses and minuses of the drug and arm you with information so you can better consult with your physician on the merits of this drug.

This chemically-modified form carries several apparent advantages for Vyvanse:
  • Since the lysine link must be cleaved to release the active form of the amphetamine drug, Vyvanse naturally lasts longer in the system than do straight amphetamines. While most other stimulant medications rely on the capsules encasing the drugs to slowly dissolve and thereby slow down the release of the drug, Vyvanse already has what is essentially a controlled release built in to the drug itself. As a result, a single dose taken early in the day can last up until the evening hours, which allows individuals to avoid the hassle or stigma of needing to take the medication during the work or school day.

  • Most of amphetamines problems stem from their addiction potentials. Generally, the faster the amphetamine gets into the blood stream and gets into (as well as out of), the brain, the greater the "high", and the more addiction-forming the drug. Again, by its built-in slow release mechanism, Vyvanse enters the blood (as well as the nervous system) at a slower, more controlled pace, thereby reducing its addiction potential. Even when snorted or injected, lisdexamfetamine exhibits notably reduced addiction potentials, when compared to other amphetamine-based stimulants. For example, when injected via IV, subjects who took Vyvanse needed 1-3 hours to feel the drug effects while isolated d-amphetamine (analogous to Dexedrine) felt the effects in only 15 minutes.

  • Due largely in part to the fact that Vyvanse's drug effect needs to be "activated" biochemically, it is poses less risk for tampering and related abuses (i.e., crushing and snorting) as well.

Additionally, Vyvanse also carries some other distinctive advantages:


  • While many drugs effectiveness are often dependent on the level of acidity in the stomach and intestinal tract, Vyvanse appears to be only mildly affected. It dissolves quickly in the gastro-intestinal tract, and its solubility is minimally affected by digestive pH.


  • The presence of food only results in a slight delay in Vyvanse's absorption. When taken alongside a fatty meal (fatty foods generally impede the absorption process, as they themselves are slow to clear the gastro-intestinal tract) the delay in amphetamine release from Vyvanse was only about an hour. This was in contrast to around a 2.5 hour delay when Adderall was taken with fatty foods. As a result, Vyvanse appears to be less affected by the presence of food than other well-known amphetamines, suggesting an increased versatility as an ADHD stimulant medication treatment.

  • This next statement is the blogger's opinion and is not supported by direct evidence. Nevertheless I believe this is a topic worthy of investigation: In a previous blog post, we discussed celiac disease and how it can ravage the digestive tract and result in ADHD-like symptoms. While these symptoms are likely the result of a different path than ADHD caused by genetic or environmental factors, it may be worth noting that Vyvanse may alleviate some of these inattentive symptoms better than other ADHD medications, due to the fact that it may absorb better in a digestive system damaged by celiac disease or the pH changes which often accompany it (poorly digested carbohydrates can alter the pH in the digestive system immensely). While this will not treat the underlying cause of celiac disease, it may mask the some of the ADHD-like symptoms better than other medications. This assertion is simply a personal hypothesis and is yet to be studied or verified.

  • In addition to its resiliency regarding foods and digestive pH, it appears that Vyvanse may be less susceptible to negative drug-drug interactions than many other agents. Many medications target a key metabolic system referred to as Cytochrome P450. While to complex to discuss in detail in the limited scope of this post, the P450 system of proteins plays an integral role in drug metabolism, the body's antioxidant levels, and regulation of toxicities, it appears that the effects of the drug lisdexamfetamine on the P450 system are minimal. Since many drugs do operate via this system, Lisdexamfetamine should therefore pose less of a threat regarding negative drug-drug interactions.

  • The drug apparently has a good track record as far as behavioral improvements and attention span are concerned. A study was done using a rating scale called SKAMP (which stands for the initials of its creators: Swanson, Kotkin, Agler, M-Flynn and Pelham), which is used to determine classroom behavior. According to the study using this particular rating scale, measurable improvements were seen in both attention span and classroom conduct for periods of up to 12 hours after taking their last dose of lisdexamfetamine. Prolonged behavioral changes are typically not seen to this degree, and the fact that the subjects were diagnosed and medicated previously suggest the potential effectiveness of Lisdexamfetamine even for "stubborn" ADHD cases.

  • The same study also employed a mathematics-based test called PERMP (short for Permanent Product Measure of Performance). Notable improvements were seen in both both speed and accuracy on this test following a 5-week amphetamine treatment program. Lisdexamfetamine's positive effects on this cognitive task peaked around 4.5 hours after the last dose was administered and held relatively steady for the next 7-8 hours. The results of this study suggest that Lisdexamfetamine can improve the inattentive and behavioral symptoms of ADHD as well as enhance cognitive performance abilities for a prolonged period of time. This suggests great potential for use as a "school drug".

  • A study on adult stimulant drug abusers by Jasinski and Krishnan presented at the 2006 US Psychiatric and Mental Health Congress found that the study's subjects found Lisdexamfetamine to be much less "likable" than other amphetamines, further suggesting a reduced addiction potential for an already-at-risk group.

  • When taken around breakfast time (7:30-8:00 a.m.), Vyvanse showed remarkable "staying power" throughout the day, based on results from a behavioral rating scale taken in the mid-morning, afternoon and evening time (the last being around 6:00 p.m.). This is good news for teachers and parents, and suggests a more gradual tapering-off of effects, and a lesser "rebound effect", in which negative symptoms rapidly reappear, often within the hours of 4 and 6 p.m.

  • Amphetamine levels delivered via the lisdexamfetamine system are thought to stabilize within about 5 days. This is good news, especially since many ADHD medications can take up to 3 weeks to normalize their effects.

  • Lisdexamfetamine has also shown more consistency than many other drugs as far as less variation from patient to patient. While this is neither good or bad by itself, it does suggest a greater inherent stability in that it appears to be less susceptible to the effects of other bodily functions which are variable from person-to-person. As a result, I see this greater predictability will make it a preferable choice for many prescribing physicians. Of course, the flip side is that ADHD is an extremely complex and multi-faceted disorder, and clinicians may fall into the trap of seeing a "one-size-fits-all" solution and begin to treat Lisdexafetamine as a fall-back, default prescription.

This blog, of course, is not designed to sound like some sort of promotional "infomercial" touting all of the benefits of Vyvanse while leaving out potential risk factors. To keep things balanced, I have included some of the negative attributes of this particular stimulant medication as well:

  • While the study by Jasinski and Krishnan on the reduced "likability" of Vyvanse was encouraging, it is not recommended for individuals with a history of drug abuse, as previous non-prescription drugs can interfere with its effectiveness.

  • Additionally, Vyvanse reduces the presence of a key enzyme in the body which is targeted by anti-depressants called monoamine oxidase. A number of anti-depressants called monoamine oxidase inhibitors (MAOI's) also target this enzyme and reduce its presence. Due to the potentially harmful combination of amphetamines and MAOI's, these MAOI drugs should not be taken alongside Vyvanse. Please note that certain substances, such as cigarettes, and even turmeric or curry (in large doses) can also have potentially negative effects with Vyvanse.

  • Slight elevations in heart rate and blood pressure (mainly the diastolic pressure, which is the smaller of the two numbers and represents the blood pressure at the "resting" phase of the heart) and slight changes in heart rhythms were seen with Vyvanse, especially in the upper dose (70 mg) levels. However, this is a relatively common occurrence within the family of stimulant medications. For further information, please see the earlier post Are ADHD Stimulant Drugs Bad for your Heart?

  • Like most stimulant medications used to treat ADHD, appetite suppression was also a common side effect (this is due, in part, to increased levels of free dopamine, an important signaling agent in the nervous system, which, also plays a role in the feeling of "fullness" in an individual. By artificially boosting free levels of this neuro-chemical, a reduction of hunger symptoms are often seen), even at the lower 30 mg doses. However, actual weight loss did not become a huge symptom until the upper levels (around 70 mg doses) were approached.

  • The "classic" side effects (that almost all medications now somehow seem to evoke!) such as headache, nausea, vomiting, etc. all remained relatively low until the 70 mg level was approached.

  • Keep in mind that this drug still functions as a stimulant, and is therefore inherently better-suited for the more inattentive or impulsive forms of ADHD. Given the negative interactions with the MAOI class of antidepressants and the fact that stimulant drugs in general can worsen depressive symptoms, I recommend that extreme caution be used when prescribing this medication for individuals with comorbid ("comorbid" means "occurring alongside of") depressive symptoms alongside their attention deficit disorder.

Medication Doses Available:

30 mg, 50 mg and 70 mg were the original strengths available, but recently 20 mg, 40 mg and 60 mg doses have been added. The amount of amphetamine delivered in Vyvanse compared to Dexedrine approximately a 5:2 ratio. For example, 50 mg of Vyvanse corresponds roughly to 20 mg Dexedrine, 25 mg Vyvanse to 10 mg Dexedrine, etc. 30 mg is often a starting point for children, but doses can be carefully ramped up under the guidance of a physician. In general, it appears that many of the negative side effects can be kept at bay by staying under the 70 mg amount.

A quick side note: For another good source of information on medication dosages, I recommend the blog of Dr. Charles Parker. His blog can be found here. Additionally, he talks about a paradox called the therapeutic window. This is interesting to note, because sometimes ADHD medications which are prescribed at too high of a dosage actually result in ADHD symptoms to re-emerge and give the false impression of underdosage. You can check out this blog article here.

With regards to upper limits and safety measures, based on the studies mentioned above, negative side effects tend to increase around the 70 mg mark. Nevertheless, studies have been done at levels up to 130-150 mg. It is interesting to note that once this high range was reached, the amphetamine concentration in the blood began to taper off. This is good news with regards to the potential for overdose and buildup of toxic levels (note the relatively efficient rate of clearance of Vyvanse mentioned earlier in this post).

As a final word of caution: Remember that Vyvanse is essentially a new delivery method of amphetamines. I have highlighted some of the positives such as lower addiction potential and prolonged modes of action. However, keep in mind that there is often a strong "publication" bias, in that studies which find a drug to be ineffective or even counter-effective are often not reported or published. I therefore urge you to take some of these "glowing" reports on the drug with a grain of salt. Nevertheless, I remain at least cautiously optimistic with regards to the potential merits of lisdexamfetamine for treating ADHD and related disorders. We will be investigating other ADHD medication options shortly in future blog posts.

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38 comments:

Nevada Mojo Rising said...

Hmmmm. I've been on Adderall for over 10 years. Think I will print this post out and share it with my doc next month to consider.

Thanks for your work!

ursulas on twitter

The ADHD Treatment Guide said...

Thanks for the kind words, Nevada Mojo Rising/ ursulas! Just remember, there is still a lot that we don't know about this drug, but I think there are a lot of positives associated with it from the info I've seen so far. I'm actually just finishing up a new post (should be listed above this one by later today) on how variations of a specific gene called "COMT" can affect how an individual handles stimulant medications such as Adderall or even the product of Vyvanse.

Best of luck to you, ursulas, and congrats on taking the time to look into things yourself. Please let me know if you have any specific questions!

aMorsel said...

Just found your blog. Good research on Vyvanse!

I thought I'd add some anecdotal evidence ... I've been on a few different medications, and for me, Vyvanse is hands-down the best!

I take 70mg per day for about a year now. If someone isn't getting a good outcome from their current medication, I'd recommend talking to your doctor about trying Vyvanse.

One word of caution ... make sure you have insurance, otherwise it's very expensive!

The ADHD Treatment Guide said...

Thanks aMorsel for your personal insight. Studies and research are fine, but at the end of the day, postive personal experiences win hands down. I'm glad Vyvanse is working well for you.

Unfortunately with most studies, cost is not a factor, but for actual individuals it is a whole different ballgame. If you have any questions or would like more research done/clarifications, please let me know. Thanks again!

docparker said...

Many thanks for the kind mention of my postings on the 'Window' - a little basic science can go a long way on dosing strategies - more notes on the way, took a break over the Holiday.

And I do look forward to your comments on COMT.. I have been talking about that gene variant for almost 6 years now, and would add two points regarding COMT and metabolic rate:

1. Is the polymorphism which can spin DA through that enzyme system much faster, making the person a fast burner of stimulants - see:

http://en.wikipedia.org/wiki/Catechol-O-methyl_transferase

- and

2. Often overlooked in the polymorphism discussion is the challenge of decreased methyl groups which forestall the rate and can through insufficient nutrition change matters - see these remarks on Phase II metabolism:

http://en.wikipedia.org/wiki/Phase_2_reaction

Thanks again,
Chuck

Karen said...

I have been taking Adderall for 10+ years. My doctor had me do a trial of Vyanase. I only took it for one day because I made me very angry and irritable. I went back to Adderall XR. It has worked for me.

nicole said...

Great research regarding Vyvanse - thank you for your sincere efforts! I'm 23 yrs old and I was on Adderall throughout college: 90mg by my sr yr - hated the effects - actually started to develop bizarre stress responses (pilomotor reflexes on ONE arm), constant anxiety, etc., but it was the most convenient option at the time for my ADHD - focused, thorough in my studies, etc.

I disco'd Adderall after graduation, but found I needed it for work - my dr has me on 60 mg Vyvanse and it's working wonders thus far (~6 months). I actually dont have any abnormal symptoms with Vyvanse (just the increased heart rate).

Since it's relatively new on the market, I was ambivalent about Vyvanse b/c there are no longitudinal studies, but I recommend it over Adderall any day! I am curious about the long-term effects though..

Thank you again!

Rachael said...

In middle school I had been prescribed Concerta but lacked the motivation and initiative to take it on a regular basis. I'm now 26 and recently stepped into a corporate position and found that I again need help with focus and concentration. My two younger brothers both take Concerta and gave me a weeks worth of their 27mg prescription. I had the most productive and satisfying week of work ever. I now have my own prescription, 20mg of Vyvanse. I've taken it for 5 days. The first 3 days I took one pill at 8am. Today and yesterday I added another pill at noon because I felt it had worn off.

The more I read about Vyvanse the more I like it compared to Concerta. However, I don't feel like I am getting the results I thought I would. Throughout the day, I don't notice that I've taken anything. I have trouble coming back to a task or project and knowing where to pick-up again, even within minutes of the break. Essentially, I'm not getting the same results I did with the Concerta and wanted to know if it might be a dosage issue.

Long story short, do you have any suggestions to determine dosage or just trial and error? Is there anyway to judge based off of the 27mg Concerta I had taken?

Thanks for your time and for your postings!

The ADHD Treatment Guide said...

Hi Rachael,

Great question about the Concerta vs. Vyvanse dosage conversion.

This is a bit more tricky than Adderall/Vyvanse since Concerta (methylphenidate) is more chemically dissimilar to Vyvanse than is Adderall.

Nevertheless, from what I've been reading, 36 mg of Concerta matches up roughly with 30 mg of Vyvanse. Since you're on the 27 mg of Concerta, the 20 mg of Vyvanse you mentioned seems to be the best fit, based on convention.

However, one factor, which I've only touched briefly on is the fact that Vyvanse must be "activated" by enzymes in the liver to get the active form of the drug. In some individuals (often due simply to genetic reasons), these enzymes are not as potent as in the general population. As a result, it may be possible that a higher percentage of the Vyvanse drug is simply passing through your system in the non-activated form. At the moment, I don't know the exact percentage of people who have this difficulty, but I definitely believe that this may be one of the potential shortcomings of "pro-drugs" like Vyvanse.

Go up to 30 mg? Possibly, but obviously run this by your doctor. However, for several people I've had discussions with, Vyvanse simply was ineffective for their needs. Great question though, and thanks for the kind words. Best of luck to you!

Adrian said...

My 12 year old son currently takes 2 - 54 mg Concerta per day. He has been on this dose for several years, but we have been noticing a decline in the effectivness for the past several months. His Dr said we could try Vyvanse, but only prescribed 50 mg. After reading your information about dosage from Concerta, do you think this will be enough? Thank you for your information!!

The ADHD Treatment Guide said...

Hi Adrian,

From what I've read, 50mg of Vyvanse approximates 72mg of Concerta. Given the fact that your son takes 2x54 mg doses of Concerta (108 mg total), the 50 seems a bit low, at least on a comparison basis. Vyvanse does come in the 60 and 70 mg dosage levels. However, sticking to the bi-daily routine, the 54 mg of Concerta would then approximate a 40 mg dose of Vyvanse, so on a strict dosage level basis, 2x40 mg of Vyvanse would match up with this.

Having said this, however, we need to keep in mind that the retention time for the two drugs can be very different. Vyvanse typically stays in the system longer, so it is almost always administered only once per day. One of the problems, as mentioned in the blog post on this topic, is that some of the negative side effects of Vyvanse start to creep up around the 70 mg level (and perhaps even the 60, which is a "newer" dosage). This may be why your physician was hesitant to go above the 50.

Nevertheless, it is also possible that the dosage may be too high and not to low. This is somewhat a paradox with stimulant meds, but sometimes the dosage can be overshot and overdose symptoms can actually falsely appear as underdose ones.

One of the troubles with Concerta (and possibly Vyvanse) is that a ramping effect is often needed to maintain the desired effects throughout the day. With methylphenidate (the active drug in Ritalin, Concerta, Metadate and Daytrana), an increase in concentration is needed, so that the late afternoon levels should be around double those of the early morning. Vyvanse, due to its different mechanism of action, does not follow the exact same release profile.

Did your doctor give a reason for the switch to Vyvanse in particular? If not, one more possibility may be going back to Concerta with concurrent zinc supplementation. I did an earlier post on how zinc may possibly boost the effectiveness of Ritalin (which has the same active component as Concerta, see link below):

http://adhd-treatment-options.blogspot.com/2008/11/using-zinc-to-boost-ritalins.html

It may be a long-shot, but it has worked in some cases. The next time you see your doctor, it might not hurt to ask about this, but there are still a lot of questions surrounding this procedure. I have a feeling he/she would be somewhat skeptical to this treatment strategy.

Adrian said...

I wanted to give you an update on my son. He has been on the 50 mg of Vyvanse for 3 days and I have noticed a big difference. He is able to focus better and complete tasks on his own. (He even did some house cleaning after school without being asked! This is not like him at all.) I am hoping that this is due to the medicine change and not just my son playing tricks on us. As for negative side affects; he mentioned he is having some headaches and he can tell his appetite has decreased.

The Dr. wanted to try Vyvanse because Concerta just did not seem to be doing the trick anymore. Before changing to Vyvanse, the Dr. had us try decreasing the dosage of Concerta to see if he was getting too much. That did not seem to help at all; he was very distracted and making a lot of unnecessary noises. So, she thought Vyvanse would be worth trying since it stays in the system longer.

So far, I would say I am happy with the results. I know 3 days is not a long time, but something has changed in our son, for the better!! Thank you for your comments.

The ADHD Treatment Guide said...

Adrian, that's great to hear about your son, it's a great feeling when the medications/treatment strategies finally "click" isn't it?

Thanks for the update. As mentioned in the post, there's often about a 5 day window for adjustment for Vyvanse, but I'm glad that it took less time to see positive changes in your son.

Could you keep us posted on how both of you are doing? As much as I enjoy reading scientific journal articles and clinical studies, I enjoy hearing about personal success stories even more!

Best of luck to both of you.

Lauren McDill said...

Thanks for the info! My daughter was on Vyvanse the entire school year last year but considering that she is now 9, and in 4th grade, I thought maybe she could try to be more attentive on her own... After the first month of school under the belt, her teacher informed me that there was 2 weeks worth of work in her desk and that she is not staying on task at all. As bad as I hoped she could manage without medication (for reasons like no appetite and her father passed away this past summer from a prescription drug overdose) I realized that she can't. Today was her first day of school back on the Vyvanse 20 mg. She took a reading fluency test yesterday and scored very low, the teacher asked if she could re-take the test today and the principal let her and DO YOU KNOW... she passed in the TOP 3 of her whole class!!! 26 students!!! The medicine works!

scribe nimby said...

Great post as always. You do a really good job with all of this.

My favorite 17 year old has been taking Adderall IR since age 8, and always needed a much higher dose than anyone had ever heard of. (Like mother, like daughter.) Over time, the duration of effectiveness (DOE, per Dr. Parker) decreased until she was taking it every 3.5 to 4 hours. She also took Adderall all the way through bedtime, as it had proven to be the only thing that enabled her to go to sleep (self regulation at all hours). (She had tried Adderall XR twice and didn’t like it, and I no longer remember why not.)

When Vyvanse came out, she was eager to try it because it is the same molecule as Adderall, which worked, and because of the extended DOE inherent in the drug itself. She found it to be "smoother," which one can guess is a result of its chemical structure as well as that, as she put it, she was no longer married to the clock. Further, she found it to be significantly more effective in terms of improved cognitive efficacy and reduced cognitive instability.

Vyvanse has been an excellent medication for her. Unlike most of the people studied, however, she noticed after nine hours a marked loss of effectiveness. Now, she takes it every eight hours around the clock. Sleep problems are resolved almost entirely with this schedule, though sometimes she needs melatonin for sleep as well.

Current dosing schedule is this. 7 am - 150 mgs, 3 pm - 60 mgs, 11 pm - 60 mgs. During menstruation she increases it somewhat. I write all of this because while most people's requirements are far less, this is an example of how individuals are very different and how the dosing of stimulant medication has to be completely personalized.

Gina Pera said...

Interesting theory about celiac and Vyvanse. I appreciate bloggers who think and make connections. :-)

Gina Pera, author
Is It You, Me, or Adult A.D.D.?

Gina Pera said...

Interesting theory about celiac and Vyvanse. I appreciate bloggers who think and make connections. :-)

Gina Pera, author
Is It You, Me, or Adult A.D.D.?

Jake said...

I was wondering if you’ve seen in the literature or your experience if Vyvanse has less of an impact on blood pressure than a commiserate amount of methylphenidate in Concerta?

Anonymous said...

Interesting post, thank you. I am discouraged that most positive reports from Vyvanse users have been those who have recently begun taking the drug, or haven't stopped. Typing in "Vyvanse withdrawal" in a search engine and I stumbled upon a forum that had pages of negative feedback of struggles with withdrawal and symptoms relating to withdrawal.
Can the author comment on this? Is Ad. XR in the blood stream as long as vyvanse, and would the time difference of brain exposure to amphetamine over a prolonged period account for these stories?


As far as the one young man who was contemplating the long-term effects of Vyvanse - just look to Dexedrine studies, if you can find them. I've been having trouble locating any longitudinal studies that look at ADHD medication consumption for more than a year. But the point is - it's dextroamphetamine with an amino acid tag, nothing more. Lysine is a component of everything from histones in our DNA to collagen. The d-dextroamphetamine part - that's all man made - but I suppose it's encouraging that it's been around since the turn of the 20th century. That said - I wouldn't personally feel comfortable ever taking more than 50mg, and I don't intend on it unless I've got the exam of my life in front of me and tolerance dictates/demands it. I am hoping to keep at 30 and take 3 month "holidays" from the medication when possible - if I decide to stay on at all... medication is a double edged sword for sure.

Anonymous said...

My recently diagnosed inattentive ADD 13 yr old son will begin Vyvanse next week. I am very nervous and I am seeking advice. One previous poster mentioned "anger and irritability" and "went off it in one day". Since my son is in the throes of puberty and those emotions are ramped up to begin with, I would like to know if there is any evidence, anecdotal or scientific, showing that this effect wears off in time. If so, how long do I wait for this to stabilize? Using Vyvanse one day and quitting seems a bit abrupt. Thank you and I am bookmarking this blog -- it's great!

Anonymous said...

I just started Vyvanse 4 days ago. Day one, I felt great..focused and motivated at work. Day 2 was a little less positive, but I was still a tad better at work than normal. By Day 3 and 4, I felt no more focused than I did before I started the medicine, but I felt totally irritable, drowsy but jittery on the inside, and just downright crappy. I am taking 50 mg now, and don't know what to do. I feel like I am a grump about to snap! Has anyone had the same experience? Or does anyone have any advice? Thanks!

Margaret said...

I have an important question concerning vyvanse versus concerta b. My seven year old son is taking concerta b. My friend has mentioned that she had a family member on concerta b who exhibited a disorder called "act on impulse" which caused him to act without thinking. She says he is now on vyvanse and is doing much better. Can anyone comment on this? Thanks.
Margaret

Anonymous said...

My son has been on varied mg of concerta high morning and another low in the afternoon, also a low dose of wellbutron and several low dose of clonidine throughout the day forever. This combination even though not always consistant it was better than when he missed any of his doses or we trialed with higher or lower doses of them. He is now showing signs of high blood pressure. How could the vyvanse change this combination, if in any way. Less Medication is always better.

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Budman01 said...

My son was recently put on Vyvanse 30mg. I must say that he is doing very well with this med. The is the first ADHD med that his doctor has tried him on but to show how well his is doing on this he originally took a reading test for school and scored an 8%, Yep 8% out of 100%. In between the first test and the retest he was placed on Vyvanse. He was being treated for about three weeks before the retest. Upon taking the retest he made an 88% !!!! Long story short he was voted by the teachers as the most improved student for the school. To us Vyvanse is a wonder drug.

accompagnatrici roma said...

This can't work in reality, that is exactly what I suppose.

Anonymous said...

My husband took Vyvanse for a few months, stopped taking it, and became angry, manic, and violent, threw things, and behaved inappropriately in social settings. As real a problem as ADHD is, I would rather have the man I married with all of his quirks than a maniac kicking doors in calling me names. I have read repeated accounts of this stuff inducing anger in its users and I think you ought to attend to that in your blog. Even the manufacturer discloses that it can cause some huge mental health problems such as these.

Anonymous said...

Very informative post, great research! Vyvanse works wonders for me, I'm finally able to focus on and work on tasks attentively for extended amounts of time. It really is a miracle drug, for me anyway. BUT, even on the 30mg dose I still experienced some of its negative effects:
- bouts of heart palpitations
- serious trouble sleeping (multiple involuntary all-nighters were the result)
- constant dry mouth
- drastic loss of appetite, which was the strongest of all the side effects. I had to force myself to eat, and even then it was mostly just soup and light salads. Solid foods like breads and meats were very hard to eat and I ended up losing a scary amount of weight in a very short period time.

The 2 weeks of lack of sleep combined with an extremely poor diet, as well as the stress of beginning university caused me to have a bit of a breakdown (I also suffered from a sports-related concussion during that time which further exacerbated my condition) and I felt very depressed/dull/anxious. Looking back on that time, my mental state was completely skewed, my personality was unrecognizable and I wasn't thinking rationally.

I stopped taking Vyvanse and immediately went back to normal. My grades really suffered but I was wary of trying again so I didn't go back on it until 3 months later (now) because there's no way I will pass any of my exams without it.
This time, my experience with Vyvanse has been a lot better -- I don't take it on weekends which is fine since I primarily need it for school/work anyway. Melatonin helps to sleep. I follow a rigid meal schedule to make sure I'm eating enough, just the routine of it helped bring up my appetite (and Vyvanse allows me to stick to that routine!). My point is, the side effects can be relatively strong even in low doses, but for me personally, the benefit of Vyvanse was so great that I had to modify other aspects of my lifestyle to make it work for me.

Anonymous said...

I have been on Vyvanse for 3 years, and it has proven to be a wonder-drug! After company layoffs (and resulting loss of medical insurance), I went without it for 5 months -- expensive when paying out-of-pocket. The change in me was drastic while not taking my meds. I would've pulled my head from my rear happily, except I couldn't focus long enough to find my own rear -- much less, my head. I've been back on Vyvanse for 3 months now, and I feel "normal" again. To the woman who posted about her husband getting "violent" -- perhaps he had issues other than ADD. Comments like those bother me, because I feel they stigmatize medication that I, and many others, legitimately need! It's bad enough the pharmacist looks at me like I'm some addict looking to "score." I'm sorry Vyvanse didn't for him... but it's helped a lot of people, like myself.

Elina said...

Have you ever tried Doxiderol? It is now very popular as vyvanse alternative, contains all natural ingredients like bacopa, caffeine etc.

Ashley Wells said...

Same here, even if I don’t have ADHD I understand how it feels like to have one especially to parents who have ADHD child. But it would be great to know a lot of information about the disease just in case. I think that there are a lot of alternative treatments or techniques that can help a child’s focus/attention and concentration, it won’t cost you a lot of money too. But it all depends on parent’s support. Great post you have here!

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Anonymous said...

This is true my girlfriend has been taking this for years and I begged for her to stop taking it because she can become randomly violent with that medicine, she stopped cold turkey which was not good to stop it like that because then she became depressed but at least she was not violent anymore and was the sweet person I once met, she went back on vyvance as she couldn't handle being down, and now the has hit me again in the face, all her personality changes with that pill, I feel afraid of her but at the same time I know she is another person and is because of the pill. Vyvance I think is an experiment and even tho makes her be more proactive at work it also makes her a short tempered very violent person. If she was to quit the pills by reducing dosage maybe she could have been out of it but now she feels there is no other option and if this don't change I will have to leave her.

Anonymous said...

There maybe people like you but many other cases like the woman who posted about her husband, I have suffered from the violence of someone who was not violent before the Vyvance is destroying me and my relationship and is sad, so don't get angry because this pill still an experiment.

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Mike Maher said...

So I have been on vyvanse for about 3 years now and I take 60 mgs every morning when I wake up for school I've noticed that it causes a major burst of focus and motivation after missing 3 days off of the medication and then taking it again but the effectiveness starts to wear off after 4-5 day of being on the medication, I also notice that the side effects come into play as well. is that even possible? why does it happen? The side effects include
-zoning out
-unmotivated
-exhaustion
-irritability
-depression
When I miss a dose after all this I don't have these symptoms anymore and the whole cycle starts over again. Could it have anything to do with the dosage I take? Or maybe it has something to do with my chemical imbalance (ADHD)? Please help.

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