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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by theo on November 28, 2005, at 17:06:36
Which of these in standard/low doses is safer for long term use in terms of poop out, blood pressure, dopamine depletion and in general?
Posted by med_empowered on November 28, 2005, at 17:33:19
In reply to Which is Safer: Adderall XR or Concerta?, posted by theo on November 28, 2005, at 17:06:36
I'd say concerta, although I think there are liver toxicity issues with Ritalin. Ritalin withdrawal is generally kinder and gentler than amphetamine withdrawal, which is probably because Ritalin doesn't deplete dopamine as much. On the other hand...I personally found Ritalin treatment intolerable (it heightened my anxiety, and there seem to be lots of "peaks" and "valleys" during the day, even using an extended release product such as Ritalin LA). I guess it really depends on you...personally, I think Adderall has the potential to cause some problems, but treatment seems more effective, so as long as the dosing is worked out (not too high nor too low, preferably with the total dose spread out over the day instead of 1 xr tab in the AM), I'd opt for that. As always..your mileage may vary. If you're stuck deciding between the two, I'd look at your insurance; one reason I switched from Ritalin LA+Focalin to Adderall XR+Adderall was the much lower cost of Adderall treatment (less than 1/2 that of Ritalin) in my insurance price scheme.
Posted by theo on November 28, 2005, at 17:41:41
In reply to Re: Which is Safer: Adderall XR or Concerta?, posted by med_empowered on November 28, 2005, at 17:33:19
If you're stuck deciding between the two, I'd look at your insurance; one reason I switched from Ritalin LA+Focalin to Adderall XR+Adderall was the much lower cost of Adderall treatment (less than 1/2 that of Ritalin) in my insurance price scheme.
My insurance covers either Concerta or Adderall XR the same price. What dose of Adderall XR are you taking? What's the normal starting dose of the XR version?
Posted by med_empowered on November 28, 2005, at 18:39:56
In reply to Re: Which is Safer: Adderall XR or Concerta? » med_empowered, posted by theo on November 28, 2005, at 17:41:41
I dont take anything anymore. I started at Ritalin LA, 20mgs. Then went to Ritalin LA 30mgs. Then went to Ritalin LA 40mgs plus a 10mgs Focalin tablet. The co-pay was ridiculous--$80/month for the two meds combined. Plus, the results weren't spectacular. So, I asked my doc for a switch (Adderall XR is only 25 on my insurance;the generic Adderall IR is only 10), and he started me out on on Adderall XR 30mgs plus a 10mgs Adderall IR generic tab around noon or so. Thats a pretty high starting dose, but apparently 60mgs ritalin is roughly equivalent to 40mgs Adderall, so it was more of a conversion than a starting dose per se.
I think the usual way to go is start with Adderall XR 20mgs--at least thats what I see in my friends; I imagine it really depends on what the med is for (lower doses for depression, I think) and other factors. The FDA recommendation for dexedrine/adderall is to max out at 40mgs/day for ADHD; 60mgs/day for narcolepsy. In practice, dosages vary wildly...I ended up on 60mgs/day for ADHD.
I think Ritalin is usually first-line for ADHD, but that might just be for kids. I think Ritalin is pretty much the stimulant of choice (first-line) for depression and some forms of anxiety.
Good lucK!
Posted by alohashirt on November 28, 2005, at 22:13:12
In reply to Which is Safer: Adderall XR or Concerta?, posted by theo on November 28, 2005, at 17:06:36
> Which of these in standard/low doses is safer for long term use in terms of poop out, blood pressure, dopamine depletion and in general?
Here's a long answer:
Concerta has less effect on blood pressure, has a more sophisticated, smoother release mechanism. Methylphenidate, the underlying active substance doesn't produce tolerance as quikckly as amphetamines mot is it affected by food / orange juice, stomach PH, fatty breakfasts, etc. So generally safer and more consistent. Since it doesn't contain an amphetamine it has marginally less social stigma. Some people report that methylphenidate makes them feel more anxious than the amphetamines. I found it created a "stuck in a rut thinking pattern" that made it hard to context-switch quickly.
Adderall is arguably a "dirty medication" in that some of the amphetamine salts it contains are less effective on ADHD symptoms. I belive dexedrine is superior, smoother, has less blood pressure effect. Both dexedrine and Adderall sometime sseem to produce clearer thinking and less hyperfocus than methlyphenidate. They also can have a noticable euphoric effect and can make you "talkier." I'd recommend trying dexedrine spansules (long acting brand not generic) ahead of Adderall if your pdoc is open to it.
ANother medication worth considering is Focalin. This is basically 1/2 of methlyphenidate - only the isomer that has the positive effect which means that in theory a dose of 50% a Ritalin dose will produce the same benefits without the side effects. I find the new Focalin XR to be "sharper" than Concerta. Remember that dosage is individual. When I took 72mg of Concerta I knew someone who was taking 125mg and another friend who takes 18mg - we're all 200lb guys who don't drink or smoke.
What are you taking at present? Good luck!
Posted by theo on November 29, 2005, at 7:53:16
In reply to [LONG]Re: Which is Safer: Adderall XR or Concerta?, posted by alohashirt on November 28, 2005, at 22:13:12
> What are you taking at present? Good luck!
>Well, I'm a 185 pound guy who doesn't drink or smoke either. Used to drink alot but been sober for 2.5 years now.
Anyhow, my pdoc wanted me to try a low dose of Abilify before stims, which I'm currently taking with some positive results at first, but now I'm experiencing anxiety after 4 weeks use and am going to stop it. My pdoc is so wishy washy. A while back she mentioned me trying Concerta, but a week ago at my last appointment she mentioned Adderall XR as her first choice!
I tried Concerta before under my general doc, but only for 2 weeks due to it not being covered by insurance. Now I have good insurance which covers any name brand stim for $45.00/month. I really don't think 2 weeks was a fair evaluation of Concerta, but part of me wants to try a different one before trying it again. I have never really understood long term use of amphetamines. If an individual were to take 15-20mg of Adderall XR long term, could that cause dopamine depletion, etc. or do most problems occur at the higher dose range?
Also, when I took Concerta I only took 18mg which was enough for me. Based off of this, what would a good starting dose for Adderall XR or Focalin XR be based off of your stim experience?
Posted by alohashirt on November 29, 2005, at 22:55:19
In reply to Re: [LONG]Re: Which is Safer: Adderall XR or Concerta? » alohashirt, posted by theo on November 29, 2005, at 7:53:16
> > What are you taking at present? Good luck!
> >
>
> Well, I'm a 185 pound guy who doesn't drink or smoke either. Used to drink alot but been sober for 2.5 years now.
>
> Anyhow, my pdoc wanted me to try a low dose of Abilify before stims, which I'm currently taking with some positive results at first, but now I'm experiencing anxiety after 4 weeks use and am going to stop it. My pdoc is so wishy washy. A while back she mentioned me trying Concerta, but a week ago at my last appointment she mentioned Adderall XR as her first choice!
>
> I tried Concerta before under my general doc, but only for 2 weeks due to it not being covered by insurance. Now I have good insurance which covers any name brand stim for $45.00/month. I really don't think 2 weeks was a fair evaluation of Concerta, but part of me wants to try a different one before trying it again. I have never really understood long term use of amphetamines. If an individual were to take 15-20mg of Adderall XR long term, could that cause dopamine depletion, etc. or do most problems occur at the higher dose range?
>
> Also, when I took Concerta I only took 18mg which was enough for me. Based off of this, what would a good starting dose for Adderall XR or Focalin XR be based off of your stim experience?18mg Concerta is approx equivalent to 10mg Focalin XR or 10mg Adderall XR or 10mg dexedrine spansules
Posted by theo on November 30, 2005, at 21:19:37
In reply to Re: [LONG]Re: Which is Safer: Adderall XR or Concerta?, posted by alohashirt on November 29, 2005, at 22:55:19
With Adderall XR is it okay to take vitamins as long as you take them in the evening? I understand vitamin c can reduce effects, but it would be okay to take it 12 hours between right?
Posted by gromit on December 1, 2005, at 10:52:05
In reply to Question about Adderall XR with multivitamins » alohashirt, posted by theo on November 30, 2005, at 21:19:37
> With Adderall XR is it okay to take vitamins as long as you take them in the evening? I understand vitamin c can reduce effects, but it would be okay to take it 12 hours between right?
I find this issue confusing, drinking something like orange juice is supposed to reduce the effect of amphetamines. But while orange juice is acidic it apparently raises the ph of your urine. I thought a higher ph in the urinary tract decreased the rate of elimination, it doesn't make sense to me. I've read vitamin c dosen't lower ph in the urinary tract very much unless maybe you take mega doses.
FWIW when I took adderall and an antacid together it seemed to boost the effect while drinking something acidic or taking vitamins didn't seem to reduce it.
Rick
Posted by vbAgent on December 3, 2005, at 5:02:19
In reply to Re: Question about Adderall XR with multivitamins » theo, posted by gromit on December 1, 2005, at 10:52:05
Adderall is an amphetamine mixture, and because amphetamines are a basic (NOT acidic) drug, urine pH influences excretion/elimination. Acidifying the urine (e.g., with Orange Juice or Cranberry Juice) hastens the elimination of Adderall, whereas urinary alkinalization (e.g., with sodium bicarbonate or antacids) extends the half-life of Adderall so it becomes reabsorbed in the bloodstream. The average half-life of amphetamine is ~12 hours, but alkinalizing the urine (making it less acidic and more basic) can increase the half-life up to 30 hours. Every 1-unit increase in urine pH (acid --> base) produces an average 7-hour increase in amphetamine half-life.
Just food for thought...Enjoy! =)
Oh, and to answer your question: I think you can safely take your multivitamin whenver you want. The possible danger here (if there is any) is if you purchase a liter-sized bottle of chewable vitamin C at GNC and carry it around with you as something to snack on every 30 minutes.
Posted by alohashirt on December 3, 2005, at 20:46:33
In reply to Question about Adderall XR with multivitamins » alohashirt, posted by theo on November 30, 2005, at 21:19:37
> With Adderall XR is it okay to take vitamins as long as you take them in the evening? I understand vitamin c can reduce effects, but it would be okay to take it 12 hours between right?
In addition to the pH effects there is also the issue that Adderall (compared to Ritalin/Concerta) seems to have greater variability of effect. I believe this may be a food effect - I eat very different breakfasts from day to day.
Posted by vbAgent on December 4, 2005, at 1:08:47
In reply to Food effects (e: Question about Adderall XR, posted by alohashirt on December 3, 2005, at 20:46:33
Adding to my previous post: It behooves anyone taking Adderall or Dexedrine to avoid antacids. Doing so will just increase the side-effects.
Posted by gromit on December 5, 2005, at 14:15:04
In reply to README! - Question re Adderall XR w/ multivitamins » gromit, posted by vbAgent on December 3, 2005, at 5:02:19
> Adderall is an amphetamine mixture, and because amphetamines are a basic (NOT acidic) drug, urine pH influences excretion/elimination. Acidifying the urine (e.g., with Orange Juice or Cranberry Juice) hastens the elimination of Adderall, whereas urinary alkinalization (e.g., with sodium bicarbonate or antacids) extends the half-life of Adderall so it becomes reabsorbed in the bloodstream.
That was my understanding too, but to quote from this page http://www.ctds.info/acidic-foods.html
"The effect foods have on urine pH may be quite different than the pH of the foods themselves. For example, orange juice is a highly acidic food due to its high citrus acid content, but after being metabolized it will cause urine to become alkaline".
So I was confused until I just found this http://www.rxlist.com/cgi/generic/amphet_ad.htm
"Acidifying agents - Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines".
"Urinary acidifying agents -(ammonium chloride, sodium acid phosphate, etc.) Increase the concentration of the ionized species of the amphetamine".
So it seems a higher ph in your tummy will increase absorption and higher urine ph will slow elimination. I apologize if this was obvious to everyone but me.
Rick
Posted by vbAgent on December 6, 2005, at 22:54:14
In reply to Re: README! - Question re Adderall XR w/ multivita » vbAgent, posted by gromit on December 5, 2005, at 14:15:04
Thanks to Rick for clarifying. The bottom line is that acidifiers decrease effectiveness and alkalinizers potentiate the effects. So, taking high amounts of vitamin C (ascorbic acid) antagonizes the efficacy because it lowers the absorption of amphetamines.
This is the end of the thread.
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