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Dr. Vikas
Dr. Vikas, Doctor (MD)
Category: Health
Satisfied Customers: 2209
Experience:  M.B.B.S ; M.D (Psychiatry and Deaddiction), MS. Health Informatics
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I am pescribed vivance and it has changed my life in so many

Customer Question

I am described vivance and it has changed my life in so many ways. It has even helped me with my mood. However I find that only a much higher dose works for me and no dr understands. I am not an addict, I get my liver and heart checked regularly. My question is are there drs out there who can work with me and understand that vivance doesn't work for me on the typically 70 mg FDA approved dose? I live in NYC area.
Submitted: 2 years ago.
Category: Health
Expert:  DrThomasMd replied 2 years ago.
Hello
Doses higher than 70 have not been studied
that does not mean they can not be used.

I would suggest a doc who uses this type of med all the time, a psychiatrist, as they are more likely to have flexibility.

Other than picking the right type of doc, the doc is in charge, there is no way to find a doc because they are going to prescribe a medication the way you ask.....it should be you tell the doc what works and they make a decision.

If that decision is 70 mg/day and it does not work, then you report to the doc, and it is his/her responsibility to find a better solution
good luck

Let me know if you have further questions, details or need clarification, just use reply.......

Please Click Accept to give answer credit so I am compensated for time and expertise. Come back if needed. Bonuses and positive feedback most helpful. Answers for informational purposes only, not to replace your physician advice or visit.

Customer: replied 2 years ago.
Relist: Answer quality.
Customer: replied 2 years ago.
Relist: Answer quality.
Expert:  DrThomasMd replied 2 years ago.
Hello
What else do you want to know?
Expert:  Dr. Chip replied 2 years ago.
Hi--may I ask exactly what more information beyond what Dr. Thomas gave you that you might need?
Customer: replied 2 years ago.
Resources. Info. Anything. I surprised u r even asking me this
Customer: replied 2 years ago.
Relist: Answer quality.
Customer: replied 2 years ago.
Relist: Answer quality.
Expert:  DrThomasMd replied 2 years ago.
Hello
I would be glad to help with your follow up.
can you be more specific about what you hope to achieve here?
Expert:  Dr. Vikas replied 2 years ago.
Hello,

I guess, the study result given below can be helpful for you in requesting / convincing your doctor about trying higher doses of vivance [Vyvanse] (lisdexamfetamine) above 70 mg in your case. If he is not confident enough to do this he or she can refer you to another psychiatrist.

Dose Response Effects of Lisdexamfetamine Dimesylate Treatment in Adults With ADHD

An Exploratory Study

"Conclusion: For LDX doses between 30 and 70 mg/d, the dose–response efficacy effect for LDX is not affected by prior pharmacotherapy, but patients with a greater severity of illness may benefit more from higher doses, especially for hyperactive–impulsive symptoms."

-----------------------------------------------------------------------
Lisdexamfetamine Dimesylate

Linear Dose-Proportionality, Low Intersubject and Intrasubject Variability, and Safety in an Open-Label Single-Dose Pharmacokinetic Study in Healthy Adult Volunteers

-------------------------------------------------------------------------------

Abuse liability study results of lisdexamfetamine dimesylate (NRP104) presented at CPDD"In this single blind, placebo- and active-controlled, single-dose escalation study, lisdexamfetamine dimesylate tended to be less euphoric than d-amphetamine sulfate 40 mg, and had a later peak effect. The systemic exposure to active d-amphetamine sulfate (AUC and Cmax) was dose proportional following a single administration of lisdexamfetamine dimesylate in doses between 30 mg and 130 mg and was attenuated between 130 mg and 150 mg. Overall, doses of lisdexamfetamine dimesylate from 30 mg to 150 mg were well tolerated in healthy adults with previous history of stimulant abuse."

Best wishes,

Vikas


Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Dr. Vikas, Doctor (MD)
Category: Health
Satisfied Customers: 2209
Experience: M.B.B.S ; M.D (Psychiatry and Deaddiction), MS. Health Informatics
Dr. Vikas and 4 other Health Specialists are ready to help you
Customer: replied 2 years ago.
Thank u so so much for taking time to forward me all of this information. I really appreciate it. Your efforts to help show that u must truly be a great doctor. Would you mind clarifying the articles a little bit by any chance? And is there any way for me to give u positive feedback for others to see. Thanks
Expert:  Dr. Vikas replied 2 years ago.
You are most welcome.

70 mg per day is considered to be the maximum dose because after doing many studies it was concluded that doses above 70 mg may increases the chances of side effects without providing much benefit but this doesn't mean that the dose can't be further increased if a patient is able to tolerate it and there is clear benefit noted after increasing the dose.

You have already tried many medicines and have noted improvement only with Vyvanse so on this basis you can request your doctor to either increase the dose or refer you to a psychiatrist who can do it.

All the articles I forwarded conclude that the dose of [Vyvanse] (lisdexamfetamine) can be increased above 70 mg per day if needed depending on the clinical symptoms and higher dose can be tolerated by patients / health volunteers. For example, according to one article doses higher than 70 mg were tried in healthy volunteers "All 20 subjects received 50 and 100 mg while 18, 12, and 9 subjects received 150, 200, and 250 mg of lisdexamfetamine dimesylate, respectively."

One article concluded that "lisdexamfetamine dimesylate tended to be less euphoric than d-amphetamine sulfate 40 mg, and had a later peak effect. Overall, doses of lisdexamfetamine dimesylate from 30 mg to 150 mg were well tolerated in healthy adults with previous history of stimulant abuse." so it is not that much addictive in comparison to d-amphetamine. "The results of these three human abuse liability studies suggest that the abuse liability and abuse potential of lisdexamfetamine dimesylate is less than d-amphetamine sulfate."



You can take a print out of the article and show your doctor these articles and request him or her to try the higher dose in your case.


Best wishes,

Vikas


Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Dr. Vikas, Doctor (MD)
Category: Health
Satisfied Customers: 2209
Experience: M.B.B.S ; M.D (Psychiatry and Deaddiction), MS. Health Informatics
Dr. Vikas and 4 other Health Specialists are ready to help you
Customer: replied 2 years ago.
Again thank u so much. Sometimes Ive taken 180 mg for the purpose of finishing my thesis (I am back finishing my graduate degree in education) or because i am innundated with work amd providing for my family, and never do i feel any adverse side effects. II check my blood pressure three times a week and on average its 110/70. And my average heart rate is 88bpm. I also recenty had my liver checked and an ekg with a normal reading So I guess my questions are 1)does it seem worrisome to u that I take that dosage at times and am I taking a too high of a dose. 2) are there any doctors or neurologists that u are aware of in the nyc or nj area who understand the nature of Vyvance who can treat me accordingly. Thanks so. Much
Expert:  Dr. Vikas replied 2 years ago.
Please accept my apology for the delay in replying.

It is not possible to predict the possible side effects, idiosyncratic reactions which may occur when the dose of medicine is increased beyond its recommended level. A patient may experience adverse effect any time in future also even after repeated similar attempts in past without any problem.


Although even after increasing the dose to such a high level you still noticed no side effect which is a good thing for you but in my view it is not advisable to increase the dose without the consent of your doctor so please try to avoid it from next time.

Regarding referral to a doctor or neurologist I am really very sorry to disappoint you but I am not from your area so can't help a bit in this. I hope you understand my limitations.

Kind regards

Vikas

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