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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by ed_uk on January 14, 2005, at 16:27:09
To all stimulant users...
What dosage regimen do you find to be the most effective and tolerable???
How many hours per day do you attempt to 'cover' by use of the stimulant? eg. 12h, 16h etc.
Do you find that the efficacy of your stimulant decreases throughout the day?
Do you suffer from insomnia?
About methylphenidate (Ritalin)....
'In addition to the morning and noon doses commonly used in hyperactivity disorders, studies have shown improved clinical outcome with little adverse effect on sleep patterns if a third late afternoon dose is given.'
But acute tolerance may be a problem if stimulants are used to 'cover' a larger fraction of the day........
Clin Pharmacol Ther. 1999 Sep;66(3):295-305.
Acute tolerance to methylphenidate in the treatment of attention deficit hyperactivity disorder in children.
OBJECTIVES: To evaluate the efficacy of several drug delivery patterns of methylphenidate and to determine whether acute tolerance develops to this widely used stimulant medication in the treatment of children with attention deficit hyperactivity disorder. METHODS: Double-blind trials were conducted in a laboratory school setting in which multiple measures of efficacy were obtained frequently in the morning and afternoon across the school day. In study I, relative efficacy was determined for three dosing patterns of methylphenidate: a standard twice-daily profile, a flat profile, and an ascending profile. In study II, tolerance was assessed by comparison of three-times-a-day regimens in which the time of the middle dose varied. RESULTS: In study I, the efficacy of the ascending treatment increased across the day, and in the afternoon it was equal to the efficacy of the twice-daily treatment, indicating that an initial bolus was not required for efficacy. The efficacy of the flat treatment declined across the day, and in the afternoon it was significantly less than in the twice-daily treatment, suggesting that tolerance may be developing. In study II, acute improvements in efficacy were reduced to the second of two closely spaced but not to two widely spaced bolus doses, suggesting that shortly after exposure to high concentrations, efficacy is reduced to given concentrations of methylphenidate. In a concentration-effect model, a tolerance term was needed to account for counterclockwise hysteresis. CONCLUSIONS: Acute tolerance to methylphenidate appears to exist. This should be considered in the design of an optimal dosing regimen for the treatment of children with attention deficit hyperactivity disorder.
Posted by lars1 on January 15, 2005, at 16:00:57
In reply to Stimulants, acute tolerance, number of daily doses, posted by ed_uk on January 15, 2005, at 13:47:19
> How many hours per day do you attempt to 'cover' by use of the stimulant? eg. 12h, 16h etc.
As many as possible, consistent with being able to sleep at night.
> Do you find that the efficacy of your stimulant decreases throughout the day?Not if dosed properly (see below).
> Do you suffer from insomnia?
Initially, yes. Less so as time went by. When I have it, I just take Ambien. I was wary of that at first, since it's a scheduled drug and the label says that it's for short-term use only, but after doing some web research, it seems that people can and do use it long-term, and it works and doesn't really cause any problems. You might have some rebound insomnia the first few nights after stopping, but that's about all.
> But acute tolerance may be a problem if stimulants are used to 'cover' a larger fraction of the day........This is an issue with Adderall, too. The subjective duration of effect is usually only 4-6 hours, even though the elimination half-life is about 12 hours. I assume that acute tolerance is the reason. It's not really a problem, it just means that you need to dose in such a way that the drug concentration gradually rises through the day. Concerta is designed to do this automatically.
Lars
Posted by bimini on January 16, 2005, at 13:25:55
In reply to Stimulants, acute tolerance, number of daily doses, posted by ed_uk on January 14, 2005, at 16:27:09
> What dosage regimen do you find to be the most effective and tolerable???
How many hours per day do you attempt to 'cover' by use of the stimulant? eg. 12h, 16h etc.Concerta 54 with Provigil 50 in the morning, Provigil 100 after lunch has been best solution for me to avoid tremors. The cover depends greatly on what I am doing. I would say I get 6 hours. I did not want to increase dose of Concerta and did not want to add Strattera.
> Do you find that the efficacy of your stimulant decreases throughout the day?
No, I think the increased cogitation causes agitation and fuzz out. In other words the stimulants prevent my body from telling me to take it easy.
> Do you suffer from insomnia?
No, the opposite. Concerta keeps me awake for ~12 hours. Provigil won't keep me awake alone, there is 2-3 hour dip, after that I'm ok again.
bimini
This is the end of the thread.
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