![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by MB on March 18, 2002, at 16:10:17
OK, I need some advice. I am currently taking Adderall, Neurontin, Klonopin, and Serzone.
--Started with Gabitril then Trileptal as mood stabablizers, couldn't tolorate (especially when Prozac was added to Trileptal) so switched to Neurontin which seemed fine.
--Akathisia and anxiety on Prozac was so bad that added Klonopin.
--Never could tolorate akathisia on Prozac (even at 5-10mg/day) so switched to Serzone by my request (figured 5HT-2a blockade = less akathisia), but have yet to be able to get up to the 400mg requested by doc (stuck at 200mg: postural hypotension and akathisia).
--Titrated up to 45mg Adderall a day. This seems to be the only med of the bunch that has helped mood any.
P-doc's recomended dosing schedule screwed me up and I was left to titrate doing times and sizes of those doses for the past month as I only speak with him monthly (this sparse assistence with med management will change shortly).
Anyway, during the day, I sometimes come down with horrible sympathetic overstimulation (chills, cold sweats, goosebumbps, creepy/crawly scalp, etc). It seems that when the Adderall first "kicks in" it is nothing like this, yet later in the day, the stimulation becomes more "ephedrine-like", then gets better. Along with the "ephedrine-like" stage is usually a mood swing in the negative direction (irritability or start crying over nothing or feel completely dead inside).
Could this be the action of the l-amphetamine? I've been told that the pharmacokinetics of the four different Adderall salts is unknown (true?). The Dr's Assistent recommended Concerta. Methylphenidate, I've been told is even *more* peripherally active than Amphetamine. Am I wrong? Am I barking up the wrong tree if I ask tomorrow (my consultation) to be switched to dextroamphetamine?
--also, I'm wondering if Serzone could be increasing norepinephrine at such a low dose (i.e., exacerbating Adderall's sympathamimetic side effects).
I feel like the Doctor should have the answer, but instead it seems up to me to figure this out. Everything he's tried so far has made me sicker.
MB
Posted by reese1 on March 18, 2002, at 17:46:19
In reply to d-amphetamine vs. l-amphetamine?, posted by MB on March 18, 2002, at 16:10:17
i should have some point of view since i took adderall for four/five years. only stopping twice. just the second time being recently.
first. i can't write,speak,think, to academically so in terms of term a term b i don't know
what i am curious about is this
what mg are you prescribed?
since adderall comes in
10mg
20mg
30mg
and i believe 5mg but i can't remember that far back when i started on it.-since the dosing of adderall, for me, was always different day to day, in terms of the effect i would get. One morning i could take 20mg and it would work great. the next day i could take 20mg and nothing. One day i could tolerate 40mg at once, and that would be the dose that would be appropriate another day it would either be way to much or way to little.
you're right about the anti-depressant impact. but then again each person has a different response to every anti-depressant. i took celexa for a long time. this pushed me up sometimes. i remembering taking paxil years ago. it threw me into an incredible manic state. others have told me paxil has made them tired. so the serzone could be speeding you up? but as you know it's all a fucking guessing game
IN TERMS OF THE STAGES OF THESE TERRIBLE SIDE EFFECTSit seems like there are three but i could be wrong.
1- initial reaction which is positive
2- hell
3- actual come down which doesn't sound like a problem.
like i said i could be wrong but it seems like all the serious shit is hapening in the middle period. Especially the crying, the feeling that everything is just to ugly to look at etc/ then there is the other part which is the goose bumps/ itching which is totally physical in a sense.
my guess would be, since you are you're own doctor in some ways, experiment with the dosage. if you have tenmg pills take a half instead of a hole.
i think you said you were taking 45mg a day
how was this broken up?
3x a day?
15mgpossibly wake up with 10mg. wait two/ two and half hours then take the other 5mg or possibly take 5mg (which may be way to little) wait an hour/ hour and half and take the ten or just try taking 5, 5, 5, and splitting them up in 30-45 min intervals.
that's my idea
adderall was one of the few drugs that i found helpful. the only reason i'm not taking it now is i switched to a new docotor who wanted me off of it. in terms of the other meds, concerta and whatever it's called, before trying those i would try the adderall xr
then if it's still fucking you up then switch to something else
hope something i said is worth something
Posted by 3 Beer Effect on March 18, 2002, at 23:11:09
In reply to d-amphetamine vs. l-amphetamine?, posted by MB on March 18, 2002, at 16:10:17
Adderall is a mix of two amphetamines & two amphetamine salts. So, Adderall is 1/4 Dexedrine (D-amphetamine) & 1/4 Benzedrine (d,l racemic amphetamine). The other two amphetamine salts I am not that familiar with- I believe they have not been marketed by themselves in the last 50 years. Adderall used to be called Obetrol, an old DIET PILL until Shire pharmaceuticals bought it, renamed it, put it through ADD trials & now has captured an ever-increasing share of the ADD market.
Anyways, Benzedrine (d,l racemic amphetamine) was taken off the market long ago because it causes major peripheral stimulation (nervousness) without much CNS stimulation. It is also one of the most famous drugs of abuse of the 1960s. The Benzedrine asthma inhaler had a benzedrine pill in it that people would take out & snort, shoot, or just add it to their morning coffee. So it was taken off the market.
Dexedrine is far superior to Benzedrine since it causes 5 times as much CNS brain stimulation without as much peripheral stimulation as d,l amphetamine. This is because it contains only the good isomer, the d-isomer of amphetamine.
I do not know in which order the four different amphetamines of Adderall kick in. Adderall is designed to last 6 hours. But it sounds like you might benefit from a longer acting stimulant rather than a short acting one- as long as blood levels of amphetamine are rising, you experience a positive effect, but once they start coming down dysphoria usually sets in.
Keep in mind that Vitamin A, & anything acidic like fruit juices or cola increases the excretion, reduces absorptions & lessens the effects of any amphetamine. So it is best to drink water. Anything that reduces stomach acid or that increases the alkalinity of your stomach increases the absorption of amphetamines & lessens urinary excretion thus prolonging its duration of action. Baking Soda, which is very alkaline, is the best agent for this purpose- On the side of the Arm & Hammer box is a recipe for Baking Soda antacid. If you take this with your amphetamine you will notice a huge difference.
Ritalin, Focalin, Concerta- all forms of methyphenidate do NOT cause as much peripheral stimulation as Adderall or Dexedrine. (20 mg of Ritalin= 10 mg of Dexedrine). Methylphenidate is primarily a pretty selective brain stimulant with fewer peripheral & less prominent anorexic effects. But I noticed Ritalin makes you shy & introverted while Dexedrine & Adderall make you confident & outgoing. Concerta & Ritalin are good for ADD but not for mood (or as an anti-depressant).
If I were you I would ask for Dexedrine Spansules (available in 5, 10 or 15 mg dosages) or Adderall XR. Keep in mind, in order to maintain effaciousness, that when switching to a long acting amphetamine the dose is usually increased by atleast 20% of your daily dose of IR Dexedrine or Adderall. Because Dexedrine Spansules last 11 hours you have to be sure to get a high enough dose to be effective. (I think the peak effects are at eight hours post dose). The good thing about the Dexedrine spansules is that you only have to take your total daily dose once a day (in the morning). Dexedrine used to be called the "basic antidepressant" back in the 1950s. Either of these would probably be an improvement since there is less of a comedown & hence less dysphoria- I would recommend the Dexedrine Spansules because they cause more brain stimulation & less nervousness/peripheral stimulation than Adderall or Adderall XR. Spansule technology is an old technology, so I don't know how well it works, so I would ask for the highest dose you could and then titrate it down if its too high. Spansules supposed to release an effective dose immediately and the rest is released in 4? stages throughout the day. I myself am hoping to get rid of the 200 mg Provigil I am taking, which is a glorified $5 a pill version of extended release caffeine & switch to Dexedrine Spansules.
There is immediate release Dexedrine but it is only available in 5 mg tablets. Dexedrine lasts almost as long as Adderall (4.5 to 6+ hours) but you will still have the same come-down/rebound crappy feeling. Dextrostat is the exact same thing (d-amphetamine) except its cheaper & they offer both 5 & 10 mg tablets.
The only other choice would be Desoxyn (Abbott laboratories) which lasts for a long time- it is the pharmaceutical grade methamphetamine hcl. Unlike the street version, Desoxyn is a clean safe version & is sometimes prescribed for children with ADD. It is (much) more expensive & only comes in 5 mg tablets, but I believe it lasts atleast 8 hours. Most doctors won't prescribe it because of its generic name.
Posted by Ritch on March 19, 2002, at 0:35:31
In reply to d-amphetamine vs. l-amphetamine?, posted by MB on March 18, 2002, at 16:10:17
> Anyway, during the day, I sometimes come down with horrible sympathetic overstimulation (chills, cold sweats, goosebumbps, creepy/crawly scalp, etc). It seems that when the Adderall first "kicks in" it is nothing like this, yet later in the day, the stimulation becomes more "ephedrine-like", then gets better. Along with the "ephedrine-like" stage is usually a mood swing in the negative direction (irritability or start crying over nothing or feel completely dead inside).
>
> Could this be the action of the l-amphetamine? I've been told that the pharmacokinetics of the four different Adderall salts is unknown (true?). The Dr's Assistent recommended Concerta. Methylphenidate, I've been told is even *more* peripherally active than Amphetamine. Am I wrong? Am I barking up the wrong tree if I ask tomorrow (my consultation) to be switched to dextroamphetamine?
>
> --also, I'm wondering if Serzone could be increasing norepinephrine at such a low dose (i.e., exacerbating Adderall's sympathamimetic side effects).
>
> I feel like the Doctor should have the answer, but instead it seems up to me to figure this out. Everything he's tried so far has made me sicker.
>
> MBHi MB,
Well, I have finally had a chance to try out dexedrine by itself and I do like it better than Adderall. There isn't the "waviness" of energy levels during the day. BUT, you will probably have to multidose the stuff more so than Adderall-which might be a pain, but if you are already taking meds on a fairly militaristic regimen-it should't be any problem. In my case, I don't even take any of it when I get up. I just make some coffee, work-out, eat breakfast, and then *after* I get to work I take a small dose of the dexedrine, and that's it. I found it interesting that some kids with ADHD only take their pstims during school hours. On weekends, evenings, they take stimulant holidays-and interestingly with diphenhydramine. You might consider supplement add-ons like SAM-e and Flax oil, etc. Since you are seeing all of these exotic pdocs, you might try the new Focalin (dexmethylphenidate), and see how that works for ya.
Mitch
Posted by fachad on March 19, 2002, at 1:59:10
In reply to d-amphetamine vs. l-amphetamine?, posted by MB on March 18, 2002, at 16:10:17
In my experience, Adderall caused the most side effects, including dry mouth, and pounding heart, nervousness, etc of any of the stimulants.
Dexedrine caused less than Adderall, but more than Ritalin.
Ritalin has the fewest perephial side effects.
I don't think anyone would disagree with this ranking of the "harshness" of the pstims.
In my experience, Ritalin has the most positive effect on mood, but some think Dexedrine is better for mood.
> OK, I need some advice. I am currently taking Adderall, Neurontin, Klonopin, and Serzone.
>
> --Started with Gabitril then Trileptal as mood stabablizers, couldn't tolorate (especially when Prozac was added to Trileptal) so switched to Neurontin which seemed fine.
>
> --Akathisia and anxiety on Prozac was so bad that added Klonopin.
>
> --Never could tolorate akathisia on Prozac (even at 5-10mg/day) so switched to Serzone by my request (figured 5HT-2a blockade = less akathisia), but have yet to be able to get up to the 400mg requested by doc (stuck at 200mg: postural hypotension and akathisia).
>
> --Titrated up to 45mg Adderall a day. This seems to be the only med of the bunch that has helped mood any.
>
> P-doc's recomended dosing schedule screwed me up and I was left to titrate doing times and sizes of those doses for the past month as I only speak with him monthly (this sparse assistence with med management will change shortly).
>
> Anyway, during the day, I sometimes come down with horrible sympathetic overstimulation (chills, cold sweats, goosebumbps, creepy/crawly scalp, etc). It seems that when the Adderall first "kicks in" it is nothing like this, yet later in the day, the stimulation becomes more "ephedrine-like", then gets better. Along with the "ephedrine-like" stage is usually a mood swing in the negative direction (irritability or start crying over nothing or feel completely dead inside).
>
> Could this be the action of the l-amphetamine? I've been told that the pharmacokinetics of the four different Adderall salts is unknown (true?). The Dr's Assistent recommended Concerta. Methylphenidate, I've been told is even *more* peripherally active than Amphetamine. Am I wrong? Am I barking up the wrong tree if I ask tomorrow (my consultation) to be switched to dextroamphetamine?
>
> --also, I'm wondering if Serzone could be increasing norepinephrine at such a low dose (i.e., exacerbating Adderall's sympathamimetic side effects).
>
> I feel like the Doctor should have the answer, but instead it seems up to me to figure this out. Everything he's tried so far has made me sicker.
>
> MB
Posted by christophrejmc on March 19, 2002, at 4:59:07
In reply to Re: d-amphetamine vs. l-amphetamine? » MB, posted by Ritch on March 19, 2002, at 0:35:31
> some kids with ADHD only take their pstims during school hours. On weekends, evenings, they take stimulant holidays-and interestingly with diphenhydramine.
Do you know the significance of the diphenhydramine addition? When I was younger, my doc prescribed it with my Dexedrine; I don't remember why.
-chris
Posted by fachad on March 19, 2002, at 10:19:37
In reply to Re: diphenhydramine » Ritch, posted by christophrejmc on March 19, 2002, at 4:59:07
I don't know for sure, but I'll bet it's to product calmness and sedation so the rebound hyperactivity isn't so bad.
Posted by Ritch on March 19, 2002, at 10:44:09
In reply to Re: diphenhydramine » Ritch, posted by christophrejmc on March 19, 2002, at 4:59:07
> > some kids with ADHD only take their pstims during school hours. On weekends, evenings, they take stimulant holidays-and interestingly with diphenhydramine.
>
> Do you know the significance of the diphenhydramine addition? When I was younger, my doc prescribed it with my Dexedrine; I don't remember why.
>
> -chris
Probably what fachad mentioned. This is *very* weird, but I found that diphenhydramine has a very strong anti-panic effect to it. The panic I tend to get is a hyperactive autonomic thing (with lots of GI distress), then I react to all of the autonomic arousal and then get panicky. The anticholinergic effect of the diphenhydramine seems to "shut-down" my GI tract and it seems to take out that feedback *loop*. Also, anticholinergics reduce motor side effects (restlessness, dystonia, etc., from antipsychotics, SSRI's, etc.(extrapyramidal symptoms-EPS).Mitch
Posted by christophrejmc on March 19, 2002, at 18:12:32
In reply to Re: diphenhydramine » christophrejmc, posted by Ritch on March 19, 2002, at 10:44:09
Yeah, that would make sense, but I'm ADD - not ADHD (and I had no problem tolerating the stimulants). Maybe he was just running out of ideas.
Posted by 3 Beer Effect on March 20, 2002, at 1:25:03
In reply to Re: diphenhydramine, posted by christophrejmc on March 19, 2002, at 18:12:32
i've read that diphenhydramine (Benadryl) causes an increase in dopamine & so do ADD stimulants so that could be the reason, not sure.
More likely, it is to sedate their kids so they are easier to deal with (it seems like there is something morally wrong with that to me)- heck they might as well give them one of those heavy duty insane asylum tranquilizers so they just sit in the corner & drool on themselves, which would make the job of parenting much easier (for the parents).
Posted by djmmm on March 20, 2002, at 11:10:58
In reply to Re: diphenhydramine/dopamine, posted by 3 Beer Effect on March 20, 2002, at 1:25:03
> i've read that diphenhydramine (Benadryl) causes an increase in dopamine & so do ADD stimulants so that could be the reason, not sure.
>
> More likely, it is to sedate their kids so they are easier to deal with (it seems like there is something morally wrong with that to me)- heck they might as well give them one of those heavy duty insane asylum tranquilizers so they just sit in the corner & drool on themselves, which would make the job of parenting much easier (for the parents).
H1 antagonists have some effect on dopamine reuptake...but I tend to agree that they are most likely use to sedate.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8791174&dopt=Abstract
This is only one study..I have also read about a diphenhydramine/opioid and a diphenhydramine/norepinephrine connection...
Posted by Bekka H. on March 21, 2002, at 0:45:54
In reply to Dexedrine vs. Adderall pharmacology, posted by 3 Beer Effect on March 18, 2002, at 23:11:09
Keep in mind that Vitamin A, & anything acidic like fruit juices or cola increases the excretion, reduces absorptions & lessens the effects of any amphetamine. So it is best to drink water. Anything that reduces stomach acid or that increases the alkalinity of your stomach increases the absorption of amphetamines & lessens urinary excretion thus prolonging its duration of action. Baking Soda, which is very alkaline, is the best agent for this purpose- On the side of the Arm & Hammer box is a recipe for Baking Soda antacid. If you take this with your amphetamine you will notice a huge difference.
>
************************************************Hi 3 Beers, it's good to see you here again.
I don't mean to nit-pick, but you wrote Vitamin A up there. Did you, by any chance, mean Vitamin C?
I think this acid-base problem has to do with urinary acidification and urinary alkalinzation. The pH of the stomach is very low (i.e., highly acidic), so the problem isn't there; otherwise, the medicine would be destroyed immediately. I'm pretty sure that much of the amphetamine is excreted unchanged in the urine, and it the pH of the urine that either hastens (if acidic) or delays (if basic) elimination. Oops! I just re-read your post and I see that you said that. I was confused by your comment about "anything that reduces stomach acid."
And, yes, even sodas can increase the acidity. One reason many sodas, even sugar-free ones, are bad for your teeth, is that most of them (especially the colas and diet colas) contain phosphoric acid, which is supposed to do a lot of damage to the teeth. I have to check on the pH of phosphoric acid. I wonder how it compares with fruit juices as far as acidity is concerned.
By the way, this urinary acidification/urinary alkalinzation problem does not occur with Ritalin and other forms of methylphenidate because MPH is metabolized by the liver to inactive products.
Anyway, this is a problem for me because I find dexedrine very helpful, and I really like fruit juice in the morning. So much of what I eat/drink is acidic. I really have no desire to drink or eat baking soda or TUMS all day long!
Posted by BLPBart on March 21, 2002, at 22:58:30
In reply to Re: Dexedrine vs. Adderall pharmacology, posted by Bekka H. on March 21, 2002, at 0:45:54
I have a question for you all. I am taking wellbutrin sr 300 mg/day for depression. Had to go to it because on prozac I was a zombie and doing nothing but sleeping. When I switched to wellbutrin, the fatigue decreased somewhat but was still a problem for me. While I was in-between dr appointments, I was reading on here and started seeing references to some of the ADD pstims, did some research and determined that I might fall into the inattentive and definitely not hyperactive ADD. I discussed this with my doc who agreed that I met the diagnostic criteria for ADD. He put me on 10 mg/day dexedrine spansules and I hardly noticed anything. We went up to 30 mg/day and I still didn't really feel anything so he switched me to concerta. I didn't like it at all. It made me edgy and gave me that butterflies in the stomach feeling you get when you are getting ready to do something you really dread. I also have a habit of chowing down when I get nervous and I noticed I was doing that. I quit the concerta and tried 40 mg of the dexedrine spansules. At that dosage I don't get any kind of euphoric or high feeling. I just feel good. I am alert, have enough energy to do the things normal people do and have found that I have been able to concentrate more at work and particularly have been able to focus more on one thing at a time than before when I was trying to do 50 things at once. I guess at this point, I've read all this stuff about the stims wearing off and having to increase your dose. Based on the way I'm feeling now, I want to stay on this indefinitely. Is that possible? At some point does a doc say enough is enough?
Posted by 3 Beer Effect on March 22, 2002, at 0:42:05
In reply to Re: Dexedrine vs. Adderall pharmacology, posted by BLPBart on March 21, 2002, at 22:58:30
Your dexedrine spansules should work for a long time if you do the following: If you feel you are building up a tolerance then stop taking the Dexedrine for a week. You will probably be depressed, but can somewhat offset that feeling by drinking/taking lots of caffeine during that week. After about a week without a psychostimulant, be it Dexedrine, Adderall, or Ritalin you are just about back to square one & have no tolerance anymore.
If you keep asking your doctor to increase the dose, especially past 40 mg, he will probably get nervous & worry that you might be abusing your Dexedrine & then he will probably want to withdraw it altogether. Constantly asking to increase the dose (especially of a schedule II stimulant) is a classic sign of drug seeking behavior that doctors learned about in their medical school textbooks.- i'd say better to take the stimulant holidays once in awhile but don't say anything about the holidays to your doctor. When he asks you how the dexedrine is working say fine- it helps mood, concentration blah blah blah, but don't get too excited about it & say it is wonderful or he might be suspicious. If he asks about tolerance say that you haven't really noticed any.
Posted by what? on January 23, 2003, at 20:37:32
In reply to When tolerance builds take a stimulant holiday, posted by 3 Beer Effect on March 22, 2002, at 0:42:05
how much were yu taking when you just stopped for a week? Explain...
Posted by kellog on July 16, 2003, at 14:11:04
In reply to Dexedrine vs. Adderall pharmacology, posted by 3 Beer Effect on March 18, 2002, at 23:11:09
I think you should run an informational website. Your writing is so clear and direct.
I have been having atatcks of yawning and shortness of breath on 20mg Adderall XR and someone suggested I try Dexedrine spansules instead. I thought they were the same thing only name brand and generic. But I see now what you are saying about the extra salts and the two different kinds of amphedimine.
Gotta say though. Yawning is better than losing every object I own, irrational mood swings, and compulsive chit-chatting.
Thanks for the help.
~Kelley, newly treating undiagnosed childhood ADHD
Posted by Dr. Ace on December 28, 2008, at 14:57:12
In reply to Dexedrine vs. Adderall pharmacology, posted by 3 Beer Effect on March 18, 2002, at 23:11:09
3 Beer Effect Say's
"Keep in mind that Vitamin A, & anything acidic like fruit juices or cola increases the excretion, reduces absorptions & lessens the effects of any amphetamine. So it is best to drink water. Anything that reduces stomach acid or that increases the alkalinity of your stomach increases the absorption of amphetamines & lessens urinary excretion thus prolonging its duration of action. Baking Soda, which is very alkaline, is the best agent for this purpose- On the side of the Arm & Hammer box is a recipe for Baking Soda antacid. If you take this with your amphetamine you will notice a huge difference."That's good info, I just want to add. Only use the box that has Arm & Hammer Pure Baking Soda on the front of the box, it has instructions ie. a 1/4 tsp baking soda and 4 oz water. DO NOT use Arm & Hammer Fridge-N-Freezer Baking Soda it say's Don't use it to Bake with, Eat, Drink, on teeth, etc. on the box.
Legal Disclaimer:
These statements have Not been evaluated by the Food and Drug Administration.
This information and/or products is/are not intended to diagnose, treat, cure, or prevent any disease.
Posted by JadeKelly on December 28, 2008, at 16:12:44
In reply to Re: Dexedrine vs. Adderall pharmacology » 3 Beer Effect, posted by Dr. Ace on December 28, 2008, at 14:57:12
> 3 Beer Effect Say's
> "Keep in mind that Vitamin A, & anything acidic like fruit juices or cola increases the excretion, reduces absorptions & lessens the effects of any amphetamine. So it is best to drink water. Anything that reduces stomach acid or that increases the alkalinity of your stomach increases the absorption of amphetamines & lessens urinary excretion thus prolonging its duration of action. Baking Soda, which is very alkaline, is the best agent for this purpose- On the side of the Arm & Hammer box is a recipe for Baking Soda antacid. If you take this with your amphetamine you will notice a huge difference."
>
> That's good info, I just want to add. Only use the box that has Arm & Hammer Pure Baking Soda on the front of the box, it has instructions ie. a 1/4 tsp baking soda and 4 oz water. DO NOT use Arm & Hammer Fridge-N-Freezer Baking Soda it say's Don't use it to Bake with, Eat, Drink, on teeth, etc. on the box.
>
> Legal Disclaimer:
> These statements have Not been evaluated by the Food and Drug Administration.
> This information and/or products is/are not intended to diagnose, treat, cure, or prevent any disease.
>
>
>
Hello,Does this apply to small dose (5mg ritalin) as well? Also taking Parnate
Thanks,
~Jade
Posted by Dr. Ace on December 28, 2008, at 18:05:47
In reply to Re: Dexedrine vs. Adderall pharmacology, posted by JadeKelly on December 28, 2008, at 16:12:44
pH level is usually not a major determinant of drug absorption. Usually little drug absorption occurs in the stomach.
Further down the alimentary canal is the small intestine, the first 6 inches or so of which is the duodenum. The majority of nutrients, vitamins, and drugs, etc. are absorbed in this section of the gastrointestinal tract.
The total surface area of the stomach is much less than that of the small intestine (where most drug absorption occurs). The lining of the small intestines is composed of many villi, or "fingers" that cause a very large surface area that provides better absorption.
The passage of a drug through the intestines is usually slow enough to allow complete drug absorption into the body.Legal Disclaimer:
These statements have Not been evaluated by the Food and Drug Administration.
This information is not intended to diagnose, treat, cure, or prevent any disease.
Posted by Deputy 10derHeart on December 28, 2008, at 22:24:32
In reply to Re: Dexedrine vs. Adderall pharmacology » 3 Beer Effect, posted by Dr. Ace on December 28, 2008, at 14:57:12
Hello Dr. Ace,
Since you've chosen a posting name that implies, or could lead others to believe, you are a doctor, could you please contact Dr. Bob, the site owner/administrator, and verify your credentials?
His email is: bob@dr-bob.org
Otherwise (if you are not actually a doctor) could you please change your posting name?
Thanks for helping us enforce the site guidelines as stated in the FAQ.
http://www.dr-bob.org/babble/faq.html#pick
- 10derHeart, acting as deputy to Dr. Bob
Posted by Robotron2084 on July 14, 2010, at 9:46:02
In reply to Re: Dexedrine vs. Adderall pharmacology, posted by Dr. Ace on December 28, 2008, at 18:05:47
> pH level is usually not a major determinant of drug absorption. Usually little drug absorption occurs in the stomach.
> Further down the alimentary canal is the small intestine, the first 6 inches or so of which is the duodenum. The majority of nutrients, vitamins, and drugs, etc. are absorbed in this section of the gastrointestinal tract.
> The total surface area of the stomach is much less than that of the small intestine (where most drug absorption occurs). The lining of the small intestines is composed of many villi, or "fingers" that cause a very large surface area that provides better absorption.
> The passage of a drug through the intestines is usually slow enough to allow complete drug absorption into the body.
>
> Legal Disclaimer:
> These statements have Not been evaluated by the Food and Drug Administration.
> This information is not intended to diagnose, treat, cure, or prevent any disease.
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Hello (long running thread!)Thanks 3 beers for some great information. First, Adderall® according to you, is not specially formulated for ADD/ADHD symptoms. If dexedrine stimulates my left frontal lobe into action more locally and with less peripheral stimulation, it's more logical a medication for ADD/AADHD symptoms (than Adderall). Unless Adderall is found to be tolerated better by an individual with effective results, or for some reason just works better for an individual, or at a much lower dose (though I don't know why it would, though it may I suppose). Some people "crash" but I don't really feel too bad when my regular generic adderall wears off and I take 40mg, I just start to feel a little tired or worn out, start to get restless and want to maybe do something more passive like read a novel or god forgive me turn on my Television. I started Dexedrine 20mg a week ago and it's better I think. But as it wears off in effect, some people may feel worse than with the mixed salts formulation, if that has ingredients with elimination rates that "let you down" more gradually. I'm just guessing,throwing the notion out there. I stand to be corrected. My problem with the prescription change is I don't think 20mg Dextro is enough vs the 40mg Adderall I was taking. It is also extended release Dexedrine, my doctor prescribed it that way by accident I think, because "dexedrine spansules" apparently are only made in extended release form, although that to me at least isn't obvious, I thought spansule just means "capsule". I'm not even looking that up, correct me if I'm wrong but spansule doesn't mean extended release i'm sure. It should be called dexedrine ER or XR, and in fact that's what my bottle says because I got the generic replacement. Otherwise I would not have known, which is kind of wrong. That means it's very different in its action, adderall's effects on me lasted much longer than the typically stated 8 hours. more like 12 or 13 even sometimes. Instead of taking them spaced about 4hrs apart I'd take both 20mg pills in the morning if I sensed that this night might be worse than usual for my sleeping or knew for sure it would for some reason. Or take just one pill, this also making me feel in control over it, knowing I could be snorting centigrams of it up my nose like it were coke. (It'd last a lot lot longer than coke tho and I'd be hearing voices in my head after the 5th day sitting in the same chair not eating and designing a time machine or something, clenching my teeth. So don't try that please. Even snorting your regular dose, know what might happen? You go to bed, and there's some residue in your nostrils or nasal cavity, especially if you smoke, and it trickle down now that your lying down. Make other plans 'cause you ain't sleepin' tonight!)
Adderall XR I think was developed for profit alone. 2 different prescribers really tried to push it on me after I'd been taking regular generic adderall for 3 years and was completely happy with it. My insurance is paid for by state and federal taxes so I had ethical concerns about taking basically the same medication that, I have not recently checked, but it's significantly more expensive than generic amphetamine salts. I was taking 20mg pills usually about 4 hours apart. The extended release supposedly does the same thing--except, what if I don't WANT a second dose 4 hours later, or plan on a longer working day than usual and want to stretch the dosages out for longer. These aren't unusual situations for me- far from it. I want to control my own medication.
The American Journal of Toxicology has I think 4 published studies on this issue of absorption/excretion. Essentially dosage vs urinalysis, however each study shows enormous variance in excretion levels, and the most recent attributes this both to individual metabolism as well as gastrointestinal acidity.
That info sheet you get for patients warns against taking antacids with adderall. Also you're told that drinking acidic beverages may affect absorption of it. Specific examples of some acidifying and alkalizing chemicals are listed both for stomach and urinary ph. I have not read the pharmacokinetic datasheet.
It perhaps is a rare medication to have its absorption and excretion be so moderated by stomach and urinary Ph, but as a magic 8 ball said "all signs point to yes".
Posted by SheSaidWhat on April 4, 2014, at 11:42:36
In reply to Re: Dexedrine vs. Adderall pharmacology » Dr. Ace, posted by Robotron2084 on July 14, 2010, at 9:46:02
Hi all. Long time reader, first time posting. Am enjoying this thread. I've been reading about the differences between d-amp vs l-amp. (After struggling for decades, I recently sought treatment for what I came to believe was ADD, primarily inattentive). My doc is great. She took me seriously and suggested Vyvanese or Adderall. Insurance didn't cover Vyvanese so Adderall it was. I like the idea of using an IR tablet so I can control my dose as needed. One month later, I clearly see that a stimulant had immediate impact on my symptoms. However, there are side effects of the Adderall that I don't care for. Mainly a very achy-body feeling. It gets worse, almost like I am a wrung-out washcloth by days 3,4,5. Anecdotally, I've read others who feel the same way have switched to Dexadrine. Some report it feels "smoother". Perhaps it is the lack of the l-amp? Everyone is different, so time will tell. But it has been great to find useful information shared in a place such as this forum with no judgement. Out in the world, I'm discovering that if I am overheard discussing adult ADD, Adderall or amphetamines, I get that "you are a druggy" look from the sheeple.
Posted by Louisiana Sportsman on April 15, 2014, at 12:18:37
In reply to Re: Dexedrine vs. Adderall pharmacology, posted by SheSaidWhat on April 4, 2014, at 11:42:36
I'm one of the few that may prefer Adderall due to the added l-amp over Dexedrine, but I'm currently on Dexedrine IR because I believe the absence of l-amp is better for my sporadic hypertension. Have you considered extended-release clonidine (Kapvay) or guanfacind (Intuniv) as a treatment option to augment?
I think first-line treatment should be Adderall IR or Dexedrine IR depending on the patient's cardiovascular health. It makes more sense to me than using an extended-release formulation stimulant that limits time of dosing and blood plasma levels.
ER should be administered only if the patient sees a need for it based upon their IR trial. While I'm solely prescribed Dexedrine IR, I could see how someone also might find the IR formulation useful as a "booster dose" when the ER effect dissipates.
Likewise, it is nobody's business that I take IR tablets. I think the societal aspect of not having to dose during the day possibly around peers plays a large part in the fact that ER meds seem to be used as first-line treatment more often, and that may not be the most therapeutic option.
This is the end of the thread.
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