Vyvanse: 10 Top Tips for ADHD Treatment

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.

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-adhd-understanding-tenex-guanfacine-and-alpha-2/

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