A recent ADD/ADHD treatment question came up on another post comment, and I thought to share it with all of you.
So many are wondering how to get Vyvanse correctly titrated – and good news: Shire has the new doses out – just last week. [I have updated the pages at this Squidoo lens on Vyvanse for additional easy reference]
Doses now available 20, 30, 40, 50, 60, 70 mg – may have to wait at the pharmacist for a few days, but they can be ordered. No more messing around with all of the water titration strategies.
This recent question from a reader:
“My 14 yr old son has been on Vyvanse 70 mg. of about 3 weeks. He was on Adderall xr for a couple of
years and it didn't seem to be working as well as it used to, so the dr. switched him to this vyvanse and he has been more irritable and his sensory issues seem to be more pronounced. I upped the Vyvanse to 100 mg. for a couple of days and he seemed to do better. I called the doctor and she said to stay at 70 mg. for a little longer, that there
are no studies that have been done over 70 mg., I called Shire and asked about 100 mg., they also said no studies over 70mg.
Do you think it would effect him in a neg. way, by taking 100 mg.? There was such a difference in him those couple of days that I had him on 100 mg., but if it's not safe, there's no way. He's 6 feet and weighs 128 lbs.”
The description of “isn't working” sounds like it may be the *bottom of the Therapeutic Window*
For the important answer to the question of *Duration of Effectiveness – DOE* needed to get the dose dialed in most precisely – see this post on DOE
As noted in several posts: weight, age, gender, level of hyperactivity… none of these characteristics will help with the dosage individuation necessary to get the right dose for the specific rate of metabolism with any person. No groups have specific characteristics – so his size and age are truly unimportant. Each person, each dose pattern must be customized.
Important details follow:
What is important:
1. Even though no “studies have been reported” we have experienced in our office, and heard many reports from colleagues that 100 mg Vyvanse is not “too high” a dose – if it is titrated correctly, as indicated in these previous posts. I have several folks on 140 mg, all are adults, but they are the exception rather than the rule, and only arrived at that dosage after much care with titration.
2. Your doctor is the final common pathway… I can only report what is working, and add this common-sense point: 100mg Vyvanse = about 40mg Adderall XR – 40 mg of XR is well within the standard of practice.
3. Vyvanse tends to work consistently better than Adderall, but there are some exceptions wherein individuals [for reasons I have not yet heard reported or understood myself] actually need a bit more Vyvanse than the expected dose based upon the previous rate of metabolism with Adderall.
4. Always remember the theme here at CorePsychBlog: ADD is almost always more than *just ADD.* Metabolic differences occur for many different medical, nutritional and biological reasons – so if your medical team is having a problem always look for other factors rather than simply chalking up problems to the medication itself.
5. With other concurrent *metabolic problems* the therapeutic window narrows, and until the associated conditions, from gluten sensitivity, to brain injury, to heavy metal intoxication, will create a situation wherein “nothing seems to work right.” The only solution: complete analysis of comorbid conditions.
These new dosage sizes significantly improve the necessary titration strategy, and will make it even easier to “start low and go slow.”
The low and slow idea is timeless in application, specific in time measurement.