![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by 3 Beer Effect on January 24, 2002, at 22:28:04
I am trying to find a dopamine agonist alternative to Ritalin for adhd/problems with 'focusing' on a single task. Ritalin because of the schedule II status & triplicate prescriptions is a major hassle since you can't get refills. I have found that dexedrine & adderall make my attentional/focusing problems worse but Ritalin works perfectly.
I noticed that Mirapex & Requip only seem to affect the D3 & D2 subtypes of Dopamine receptors. Which subtype of dopamine receptor does Ritalin affect & which subtype of dopamine receptor is implicated in adhd attentional problems?
Why would a dopamine agonist such as Mirapex & Requip have somnolence/sleepiness as a side effect? I noticed Ritalin/dexedrine/adderall/wellbutrin all cause insomnia.
Posted by Anna Laura on January 25, 2002, at 17:16:46
In reply to which dopamine D receptor subtype is ADHD?, posted by 3 Beer Effect on January 24, 2002, at 22:28:04
Which subtype of dopamine receptor does Ritalin affect & which subtype of dopamine receptor is implicated in adhd attentional problems?
>D4 dopamine receptors seem to be implicated in adhd.
Posted by IsoM on January 25, 2002, at 17:50:13
In reply to which dopamine D receptor subtype is ADHD?, posted by 3 Beer Effect on January 24, 2002, at 22:28:04
3 Beer Effect, I'm not pushing adrafinil/modafinil on you but am curious to its effect on you. Did you get side-effects from it, or did it simply not work? I'm also curious how long a trial you tried it for?
Hope you don't mind my curiousity. While both Dexedrine & Ritalin helped me focus, it's an entirely 'different' focus I get with adrafinil. It's funny to know that similar symptoms don't always respond similarly to the same meds.
I'll see what I can find regarding your question. I may find nothing but I'll give it a good try.
Posted by 3 Beer Effect on January 25, 2002, at 18:34:07
In reply to Re: which dopamine D receptor subtype is ADHD? » 3 Beer Effect, posted by IsoM on January 25, 2002, at 17:50:13
>IsoM,
I only tried one dose of adrafinil- 4 pills once and then lost all the adrafinil pills somehow during a move. I have an appointment with a new psychiatrist who is an expert in psychopharmacology, I will ask him for either Provigil or Focalin (the new improved d-isomer only Ritalin). But since I had no effect from that one dose of Adrafinil (4 pills) I am worried that I will try Provigil & it will be a waste of a month where I could have gotten alot more work done with Focalin- i've heard people on here complain that provigil didn't do anything for them. Did adrafinil take a couple of weeks to start working for you or did it work immediately?Also, I there is no reason to use Adrafinil anymore. I found a canadian pharmacy that sells Alertec, which is Canadian for Provigil. They only sell 100 mg pills for US $54 so you will have to buy $108 dollars worth to achieve the normal dose of Provigil 200 mg each morning, but shipping is only $10. Provigil is not only stronger than adrafinil but better for your liver.
3 Beer Effect, I'm not pushing adrafinil/modafinil on you but am curious to its effect on you. Did you get side-effects from it, or did it simply not work? I'm also curious how long a trial you tried it for?
>
> Hope you don't mind my curiousity. While both Dexedrine & Ritalin helped me focus, it's an entirely 'different' focus I get with adrafinil. It's funny to know that similar symptoms don't always respond similarly to the same meds.
>
> I'll see what I can find regarding your question. I may find nothing but I'll give it a good try.
Posted by IsoM on January 25, 2002, at 20:37:56
In reply to re: adrafinil Alertec (provigil) avail in Canada, posted by 3 Beer Effect on January 25, 2002, at 18:34:07
Thanks for answering. I've got a couple of packages of adrafinil now so I might as well use it up. I'll check out the other site, but I thought I'd need a prescription for the Provigil.
I had read that both can cause liver problems & should have liver enzyme tests after 3 months. If you can find the site that says Provigil is safer, I'd love for you to post it. Could you, please? Seeing I only take 1 1/2 pills per day instead of the recommended 2 - 6 pills, the possibility of liver problems will be cut down immensely. I still fully plan on getting liver ttests though. Interestingly, adrafinil forms 2 metabolites - one of them is modafinil. I wonder if the other metabolite is more the problem or perhaps both can cause problems at times?
I think you went about taking your adrafinil the wrong way by taking 4 pills at once, if you don't mind me saying. Both adrafinil & modafinil is supposed to take a while before it affects brain changes - like many ADs do. The literature I read mentioned that improvements continued increasing for about 3 months, at which point the effects were maintained. Tolerance didn't develop even in those individuals who took it for longer than three years!
This is the URL of the study done at the Division of Life Sciences, University of Toronto at Scarborough in CNS Drug Reviews, 1999, if you're interested.
Adrafinil: A Novel Vigilance Promoting Agent- http://www.nevapress.com/cnsdr/full/5/3/193.pdfAn illustration: Say your house is cold, only 10ºC & you want to warm it to 20ºC. Turning the thermostat up to 30º won't warm it any faster, the furnace will burn fuel at the normal set rate. It seems like adrafinil/modafinil works the same. Taking more initially won't make it work faster but will only be more likely to cause unwanted side-effects.
I ran out after I finished my first package from an ordering mistake of mine. The next order took forever to come due to X-mas rush. I'm once again taking it & have been for a week, but I'm only beginning to notice anything today - less sleepy & yawning. I don't expect to see any real improvement for another week. It's infuriating to have the progress so slow when a while back I'd felt so good. But I'm willing to wait - the effect of feeling alert, focused, & with a good memory is so much better than what the regular stims give & last throughout the day.
By the way, I continued with Dexedrine while waiting for my adrafinil to kick in both times. Tomorrow, I'll stop the Dexedrine & see how adrafinil alone does. It's the weekend & I don't need to be as focused. You could probably do that with Provigil & Ritalin so you wouldn't be addled during the wait. If Provigil works for you (I'm ADHD too), I'd bet anything that you'll prefer it over the other stims. :)
BTW, Dr. Bob will probably remove the URL you gave. I think it's against policy. And one more thing, you'd be amazed at the number of different meds that can cause liver damage. Just because it does for one person, doesn't mean it will for another. My pharmacist said that if acetaminophen had to pass the rigourous testing that meds do now, it would never make it & yet it's one of the commonest used drugs around. One of its metabolites, N-acetylbenzimidoquione is a toxic substance, pure & simple.
Posted by Ritch on January 26, 2002, at 0:50:49
In reply to Re: re: adrafinil Alertec (provigil) avail in Canada » 3 Beer Effect, posted by IsoM on January 25, 2002, at 20:37:56
Hi, IsoM,
I see that Provigil is now avail. in Canada. I saw my pdoc this week and my idea was not well received (swapping my low-dose Wellbutrin for low-dose Provigil). I read the posts about the liver probs. I read the monograph for modafinil and it doesn't appear to be very *liver friendly*. The CYP3A4 situation is likely to tinker with my clonazepam and citalopram blood levels. Also, I noticed that they enrolled only *healthy* volunteers-nobody had any dx other than narcolepsy for the trials. I wonder if they gave modafinil to a random sample of the general population or in a trial for depression how different the side-effect profile might be??
I am willing to try it the next time (my pdoc is considering), but I wonder if could be a bad idea for comorbid bipolars.
Mitch
Posted by IsoM on January 26, 2002, at 1:47:07
In reply to Re: re: adrafinil Alertec (provigil) avail in Canada » IsoM, posted by Ritch on January 26, 2002, at 0:50:49
Mitch, the P450 Interactions software says that Provigil can both increase & decrease the effect of Celexa 'cause their one or more uninhibited CYP pathways. But both clonazepam & citalopram are metabolised by CYP 3A & modafinil induces or increases 3A so more is available to metabolise the clonazepam & citalopram theoretically lowering the blood levels of them. Seeing induction doesn't happen immediately, I don't suppose it would make any difference in the timing of your meds. I'm nowhere knowledgable enought to hazard a guess.
Incidently, I take Celexa along with adrafinil. I have no idea, sorry to say, how Provigil affects bipolars. I'm simply unipolar with ADHD & narcolepsy.
Posted by kregpark@yahoo.com on January 29, 2002, at 3:22:00
In reply to Provigil Interactions with other meds » Ritch, posted by IsoM on January 26, 2002, at 1:47:07
> Mitch, the P450 Interactions software says that Provigil can both increase & decrease the effect of Celexa 'cause their one or more uninhibited CYP pathways. But both clonazepam & citalopram are metabolised by CYP 3A & modafinil induces or increases 3A so more is available to metabolise the clonazepam & citalopram theoretically lowering the blood levels of them. Seeing induction doesn't happen immediately, I don't suppose it would make any difference in the timing of your meds. I'm nowhere knowledgable enought to hazard a guess.
>
> Incidently, I take Celexa along with adrafinil. I have no idea, sorry to say, how Provigil affects bipolars. I'm simply unipolar with ADHD & narcolepsy.Interesting. If you mean bipolar low I'm impressed that adrafinil is stimulating enough to offset Celexa and then some. I think it is likely more stimulating than provigil, which I take.
On Provigil interaction with Klonopin, the eeffects I get is that more Provigil leads me to take less Klonopin. My guess had been Provigil slowed metabolism of Klonopin. Go figure.
Posted by Michael D on March 7, 2002, at 16:31:23
In reply to re: adrafinil Alertec (provigil) avail in Canada, posted by 3 Beer Effect on January 25, 2002, at 18:34:07
> > Hope you don't mind my curiousity. While both Dexedrine & Ritalin helped me focus, it's an entirely 'different' focus I get with adrafinil.
Can you expand on this.
What effects does it have on your demenor and your feelings?
Michael Dewolf
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.