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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by brender on August 22, 2003, at 14:12:41
Hi y'all,
I was wondering if anyone knew what the approximate equivalent doses are between the different kinds of stimulants, or is that even a calculation one could make? I was taking 20mg adderall XR once a day. It was OK--for a few hours after it first started working (maybe three) I would be able to think clearly, with more focus and concentration than I was used to. Then I would think about the same as unmedicated for a couple hours, maybe a little better. But then I would crash--one medium short crash around 3-4PM with a little rebound and a then hardcore one around 7. Both with intense sudden exhaustion and the second one accompanied by pretty solid depression/anxiety, which would last the rest of the evening. Then, right when I should be going to sleep...rebound, and I'm up until 3:00AM. At another point I had been on 25mg adderall XR and that was clearly too high--when it was at it's peak I became zombie-like and so focused I couldn't remember anything except the exact thing I was looking at. I couldn't remember the beginning of the sentence by the time I got to the middle, for example. But I made it to the end of the day without a crash and could go to sleep when I needed to.
Anyway, I described those crashes to my doctor and he thought maybe I would do better on just dexedrine. He prescribed 15mg twice a day (once in the morning and once at noon.) The pharmacy gave me the generic version of dextroamphetamine ER, which I assume is equivalent to the spanules version? Anyway, I was wondering if now that I am taking 30mg total of stimulant it means I am taking 50% more than I was taking before (20mg adderallXR), or if, because adderall is a combo of dex and ritalin, those two dosages are roughly equivalent. Or am I really taking less?
I feel pretty spacey on my second day of it, which may just be a side effect that will go away. The problem is I feel spacey when I take too much or too little of a stimulant, in my experience, so if this isn't the right dosage I don't know in which direction I should go.
Is anyone familiar with this, or has made a similar switch? What doses seemed equivalent to you?
Posted by Ame Sans Vie on August 22, 2003, at 16:14:18
In reply to equivalent doses of adderall and dexedrine, posted by brender on August 22, 2003, at 14:12:41
Adderall, Dexedrine and Desoxyn are all equivalent regarding dose, for the majority of people. That is Adderall 10mg = Dexedrine 10mg = Desoxyn 10mg.
Oh, and Adderall isn't a combination of amphetamine and Ritalin. It's a combination of four amphetamine salts -- dextro-amphetamine sulfate, dextro-amphetamine saccharate, levo-amphetamine sulfate and racemic amphetamine aspartate -- in equal amounts. So in 10mg Adderall, for example, there is 2.5mg of each of these. Also, Ritalin isn't an amphetamine -- it's in the same chemical class as amphetamines, the phenethylamines, but so are Nardil, Parnate, Wellbutrin, and Effexor.
Posted by Zenclearer on August 22, 2003, at 16:16:11
In reply to equivalent doses of adderall and dexedrine, posted by brender on August 22, 2003, at 14:12:41
I've taken both (at low doses) and I'd say for me, they are about the same, with different effects. On the whole, I found I could take more adderal than dex. But had more physical fatigue with dex, although no anxiety or nastiness.
I certainly know what you mean when you say that you could barely remember the beginning of a sentence. Over time, I have felt that all stims do that if I continue to take high doses.
Sometimes, not always, my clearest brain was when the med wore off. Only problem is that the "clear" effects are hard to predict.
Posted by brender on August 22, 2003, at 16:55:17
In reply to Re: equivalent doses of adderall and dexedrine, posted by Ame Sans Vie on August 22, 2003, at 16:14:18
> Adderall, Dexedrine and Desoxyn are all equivalent regarding dose, for the majority of people.
Thanks! I guess this spaciness I feel is because it's way too high then. 25mg adderall was too much for me. For some reason my doctor seems to tend to overshoot--start high and move down--or else I'm just very med sensitive. So now my question is--to you or anyone who knows--can I experiment with lesser amounts by dumping some out of the capsule? The bottle says "swallow whole; don't crush..etc." I know there is some mechanism behind the time release part that is different in different drugs. I'm sure that I couldn't do it exactly, but if I dumped out approximately one third, would I have a good chance of getting a similar effect to 10mg, or would the time release part be too much of a variable? (This is the generic dextroamphetamine ER, btw.) I have three months before I see my doctor again and one month before I can get a refill, so I'd like to have a good idea whether less would work. Although I'll try to give it a few more days at this dose--not getting much done.
> Oh, and Adderall isn't a combination of >amphetamine and Ritalin. It's a combination of >four amphetamine salts ...
Thanks for clearing up my sloppy understanding. I don't know where I got that other impression--except I think my doctor may have actually been the source. I seem to recall he said that he thought the ritalin-like part of the drug was causing the crash. But I may have misunderstood.
Posted by Ame Sans Vie on August 22, 2003, at 17:08:46
In reply to Re: equivalent doses of adderall and dexedrine, posted by brender on August 22, 2003, at 16:55:17
> Thanks!
Not a problem. :-)
> So now my question is--to you or anyone who knows--can I experiment with lesser amounts by dumping some out of the capsule? The bottle says "swallow whole; don't crush..etc." I know there is some mechanism behind the time release part that is different in different drugs. I'm sure that I couldn't do it exactly, but if I dumped out approximately one third, would I have a good chance of getting a similar effect to 10mg, or would the time release part be too much of a variable? (This is the generic dextroamphetamine ER, btw.)
I'd definitely recommend against trying to achieve a lower dose that way, because for all you know, you may end up removing most of the immediate-release beads from the capsule and thus wouldn't feel any effect from it until several hours after taking it.
One thing that may help though is to take a large dose of powdered ascorbic acid (vitamin C) along with your Dexedrine (I suggest the powdered form because the tablets don't absorb as efficiently). Vitamin C (which is acidic) decreases the effectiveness of dextroamphetamine, while sodium bicarbonate (baking soda), which is basic, *increases* it's effectiveness. So I'd suggest trying maybe 4 grams of vitamin C with each dose of dextroamphetamine and then increasing or decreasing the amount as necessary.
By the way, I also take Dexedrine Spansules (the generic, dextroamphetamine sulfate SR) and I find they work WAY better than Adderall and a little better than Desoxyn.
Posted by brender on August 22, 2003, at 17:15:11
In reply to Re: equivalent doses of adderall and dexedrine » brender, posted by Zenclearer on August 22, 2003, at 16:16:11
Just noticed how to add the previous poster's name...hope this works.
>On the whole, I found I could take more adderal
>than dex. But had more physical fatigue with
>dex, although no anxiety or nastiness.Thanks for the info. I definitely feel a lack of energy. I'm not really *more* anxious, but I don't feel the anxiolytic effect that I felt when I first started taking adderall. That was the first time in my life that I felt relieved of the ambient anxiety that I feel all day long.
> Sometimes, not always, my clearest brain was
>when the med wore off. Only problem is that
>the "clear" effects are hard to predict.I know what you mean. I've been trying to keep a "clarity journal," kind of along the lines of a mood journal (I'm bipolar, too) to figure exactly how long after I take the drug my thoughts are the clearest, and for how long it lasts. Problem is, it's very subjective and there is a point in spaciness when you don't really notice how spacey you feel nor remember what it's like to be able to think. What I really wish I had was a battery of neuropsych tests that I could retake (there would have to be multiple versions) at different parts of the day with different meds/doses, because I can tell that my IQ etc. fluctuate wildly. I can also really tell that it's a trade off (e.g. my ability to focus may be enhanced but my ability to direct my own actions might decline; or spacial skills improve but verbal skills deteriorate) and I'd like to know exactly what I'm trading for what benefit. Hmm. I wonder if such a thing exists on the internet somewhere.
Posted by brender on August 22, 2003, at 17:26:19
In reply to Re: equivalent doses of adderall and dexedrine » brender, posted by Ame Sans Vie on August 22, 2003, at 17:08:46
> One thing that may help though is to take a
>large dose of powdered ascorbic acid (vitamin C)
>along with your Dexedrine
Good idea. I'll definitely try that instead. I remember reading that vitamin C decreased the potency. I also remember reading that eating a high-fat breakfast decreased the potency, which I could also try. But I've heard conflicting things about coffee--both that it decreased it and increased it. Do you know which (if either) is correct?> By the way, I also take Dexedrine Spansules
>(the generic, dextroamphetamine sulfate SR) and
>I find they work WAY better than Adderall and a
>little better than Desoxyn.Cool--I'm hopeful that this, when I get the right dose, will be what I need. If not, I may just ask to go on the non-XR adderall and try to figure out the timing myself.
Posted by Ame Sans Vie on August 22, 2003, at 17:32:30
In reply to Re: equivalent doses of adderall and dexedrine » Ame Sans Vie, posted by brender on August 22, 2003, at 17:26:19
Coffee is acidic, so it probably decreases the effects of dextroamphetamine, but it's also a stimulant... so I'd say the two probably cancel each other out, having no effect on the potency of the Dexedrine, but just adding anxiety due to the caffeine.
Posted by BekkaH on August 23, 2003, at 1:59:29
In reply to Re: equivalent doses of adderall and dexedrine » Ame Sans Vie, posted by brender on August 22, 2003, at 17:26:19
Brender,
Hi. Substances that acidify the urine will hasten the urinary excretion of amphetamines. I don't think that is necessarily the same thing as "lessening the potency." If you acidify the urine and hasten urinary excretion of amphetamines, you might need another dose sooner than you would have otherwise, and tolerance will develop sooner than it would have otherwise. For further discussion of tolerance to amphetamines, you might want to check out "PSYCHOTROPIC DRUGS" by Norman Keltner, RN and David Folks, MD.
Posted by BekkaH on August 23, 2003, at 2:06:05
In reply to Brender - regarding urinary acidification, posted by BekkaH on August 23, 2003, at 1:59:29
A long time ago, I read on some message board (I can't remember which one) that 10mg of Dexedrine is roughly equivalent to 15mg of Adderall and to 20mg of methylphenidate. Unfortunately, that formula never worked for me. I think the best way to find out equivalent dosages is by trial and error. You have to find what's best for YOU.
Posted by BekkaH on August 23, 2003, at 2:08:21
In reply to Brender - regarding urinary acidification, posted by BekkaH on August 23, 2003, at 1:59:29
> For further discussion of tolerance to amphetamines, you might want to check out "PSYCHOTROPIC DRUGS" by Norman Keltner, RN and David Folks, MD.
************************************************
Sorry, that Amazon link doesn't seem to be working properly.
Posted by brender on August 23, 2003, at 3:24:52
In reply to Brender - regarding urinary acidification, posted by BekkaH on August 23, 2003, at 1:59:29
> Brender,
>
> Hi. Substances that acidify the urine will
>hasten the urinary excretion of amphetamines. I
>don't think that is necessarily the same thing
>as "lessening the potency." If you acidify the
>urine and hasten urinary excretion of
>amphetamines, you might need another dose
>sooner than you would have otherwise, and
>tolerance will develop sooner than it would have
>otherwise.Thanks for the info. I'll bear that in mind. I don't think I would try to go a whole month drinking massive amounts of vitamin C, but maybe as an experiment it would give me insight into how well/whether this drug would work in lower doses. I'm pretty sure I'm not just going to get used to it at this high a dose--I pretty much just stared at the wall all day.
Posted by Dr. Bob on August 23, 2003, at 9:46:12
In reply to That link doesn't seem to be working. . ., posted by BekkaH on August 23, 2003, at 2:08:21
> > For further discussion of tolerance to amphetamines, you might want to check out "PSYCHOTROPIC DRUGS by Norman Keltner, RN and David Folks, MD".
>
> Sorry, that Amazon link doesn't seem to be working properly.When that happens, try including the authors inside the (double double) quotes...
Bob
Posted by Viridis on August 23, 2003, at 17:05:43
In reply to Re: equivalent doses of adderall and dexedrine, posted by brender on August 22, 2003, at 16:55:17
I don't understand why so many doctors want to start patients at high-end doses of psychiatric meds -- it just increases the chances of side effects, and the probability that a patient will discontinue a drug that might have been helpful if the dose had been carefully titrated up. I find that a gradual increase in dosage works best for me with most meds -- it takes a while to adjust, and you can work into your "comfort zone".
For me, 5-10 mg Adderall is about right; this seems low, but more just makes me irritable.
As for dividing pills etc., I'd recommend that you call the pharmaceutical company and see what they say. They probably won't recommend it, but at least they can explain how the release mechanism works, which may allow you to determine if there's a risk involved or not. Most of these companies have good technical advice people, and are eager to make a favorable impression with their customers. I've gotten some very useful information by doing this, and learned things that my doctors weren't aware of. Ultimately, you should be the one in control of the situation (in consultation with your doctor, of course).
Posted by brender on August 23, 2003, at 18:30:08
In reply to Brender - regarding urinary acidification, posted by BekkaH on August 23, 2003, at 1:59:29
> Hi. Substances that acidify the urine will
>hasten the urinary excretion of amphetamines. I
>don't think that is necessarily the same thing
>as "lessening the potency." If you acidify the
>urine and hasten urinary excretion of
>amphetamines, you might need another dose
>sooner than you would have otherwise, and
>tolerance will develop sooner than it would have
>otherwise....Hi,
I just read this on GlaxoSmithKine's website in the product info for dexedrine (of course I'm taking generic, but I'm sure it applies):
"Drug Interactions
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 molecule, thereby increasing urinary excretion. Both groups
of agents lower blood levels and efficacy of amphetamines."
(http://us.gsk.com/products/assets/us_dexedrine.pdf)So, I'm assuming this means that if I take a bunch of ascorbic acid (I'm thinking emergen-C) with my meds, it will be somewhat similar to taking a smaller dosage and not run the risks you described...I hope...do you think that's a good assumption?
Posted by brender on August 23, 2003, at 18:41:42
In reply to Doses etc. » brender, posted by Viridis on August 23, 2003, at 17:05:43
> As for dividing pills etc., I'd recommend that
>you call the pharmaceutical company and see what
>they say.Maybe I'll do that. I called the pharmacist and, predictably I suppose, they wouldn't give me any information on the release mechanism; they just told me if I thought the dose was too high I should contact my doctor.
Today I tried just dumping out approximately a third of each of the two doses and now I feel pretty rotten. I had a period of time when I was thinking pretty clearly (though babbling a lot) but then my face started feeling flushed, in fact my whole body started feeling these weird flushed feelings, I got a painful cramp in my side, and I lost that clarity and am ditzy now. I don't know if the first two are side effects or not.
Also-Last night (after taking the prescribed doses 15mg/bid) and spending the entire day in a motivationless haze, I started to feel tired at around the right time (11-midnight) but then a friend called and asked if I wanted to grab some food and I said yes (since I hadn't eaten all day) and basically missed the crash time and got a HUGE rebound. At 4:00AM I was wide awake, as awake as I feel at the peak of a day, feeling as though I could easily last another 16 hours, no problem, and not feeling motivated to go to sleep at all. But I forced myself to get into bed and fell asleep pretty quickly.
I don't know whether I should keep trying the prescribed dose--maybe I haven't given it a fair trial--try to experiment on my own with ascorbic acid, or ask my doctor on Monday for another prescription (will the pharmacist fill that when I just got one filled?). Usually, I like to give medicines a fair trial and a chance for the side effects to wear off before whining to my doctor. But in this case I'm more afraid of A)toxicity, B) addiction and C) building a tolerance to a higher level than I need.
Posted by BekkaH on August 23, 2003, at 20:47:42
In reply to Re: ascorbic acid lowers absorbtion » BekkaH, posted by brender on August 23, 2003, at 18:30:08
Hi. I think it would be better to work with your doctor on carefully titrating the medicine until you find just the right dose. I think Viridis' idea about starting at the lowest dose and working up slowly is a good one. I really do not see any advantage to hastening the excretion of the medicine. You are simply going to hasten the development of tolerance, which is extremely frustrating and depressing. Tolerance is very common with the stimulants. Tolerance means that you have to keep raising the dose to achieve the desired effects. Urinary acidification is one of the primary means by which tolerance to amphetamine occurs. The other, and more significant, cause of tolerance is depletion of norepinephrine from nerve endings. Regardless of the cause, however, the effect is the same: you have to continue to raise the dose to get the desired effects. By the way, not eating at all also hastens urinary excretion because not eating causes ketosis, which leads to more acidic urine and faster urinary excretion.
Did you know that there are other forms of Adderall and Dexedrine? There are immediate release versions that might make it easier for you to carefully adjust the dosage. Another possibility, if you stay on the Adderall XR, is to lower the dose a tiny bit (the XR capsules do come in 5 mg strengths)and possibly "tweak" the Adderall with another medicine, either a calming antidepressant or a tiny bit of Klonopin.
It sounds as if you are on too high a dose. Perhaps you can talk to your doctor about getting the 5 mg Adderall XR pills. If that does not help, you might try the immediate release version, preferably the proprietary brand. Again, start with the LOWEST possible dose, and work up from there, even if you have to cut the pills into quarters.
Posted by BekkaH on August 23, 2003, at 21:02:59
In reply to Re: ascorbic acid lowers absorbtion - brender, posted by BekkaH on August 23, 2003, at 20:47:42
Sorry, I just re-read your post, and I see that you are now on SR Dextroamphetamine, and I was thinking you were on Adderall XR. The sustained release version of Dexedrine (Dexedrine Spansules, proprietary brand) is also available in 5 mg strengths. Oh, if you stay on the SR version, another possibility is to lower the SR dose, and when that wears off, if it's early enough, you can take a tiny amount of immediate release to last you until you go to bed.
I forgot to ask you whether you are on any other medications? If so, the other medications could be interfering with the metabolism of the stimulant and may cause it to build up in your system.
Posted by brender on August 25, 2003, at 0:05:39
In reply to Correction - brender, posted by BekkaH on August 23, 2003, at 21:02:59
> I forgot to ask you whether you are on any other medications?
>If so, the other medications could be interfering with
>the metabolism of the stimulant and may cause it to build up in your
>system.You're right that I do need to call my doctor and get a different prescription. I really don't want to build a tolerance to a higher dose than I need. I tried just taking one of the 15mg pills today. That seemed almost enough while it lasted but I crashed pretty early and very hard. I hope I can get him to prescribe it in the 5mg version as you suggest, so I can play around with it.
Yes, I am on other medications: neurontin and lithium (although only a tiny amount of the latter). The lithium, I know, interferes with stimulants, and both it and the neurontin worsen the ADD symptoms. I have tried ritalin and the immediate release version of adderall. The only things I haven't tried, I think, are the long acting ritalins and strattera. I'm really reluctant to try strattera. I know someone who got manic on it and, besides, it looks like it has all the side effects of a stimulant plus all the side effects of an antidepressant. I'm also wary of anything that even resembles an antidepressant: I got wildly manic on the last one at the smallest possible dose. For some reason stimulants don't seem to make me manic--I guess because they calm me down.
I did not know that info about not eating, but the only reason I didn't eat that day was because I was so doped up from the dextroamphetamine that I couldn't really get myself to do anything. (Also having no appetite.)
This is the end of the thread.
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