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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2208
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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No Effect on High Dose Adderall

Resolved Question:

I was diagnosed a month and a half ago as ADHD, started on Adderall XR 20mg daily, b/c of no response now at Adderall 40mg XR BID, still no response. How is this possible? Only difference is a decrease in appetite, other than that I can't even tell I've taken a med. I'm not looking for stim effect or euphoria, just to be able to sit and focus. But at this high of a dose how is it possible that I don't even get any effect??? I've never used stimulants or illegal substances before. I know people respond to drugs differently but how is it possible to have no response to a stimulant this high? My doctor couldn't explain. Couldn't find many online with same experience. 

What medication would be recommended next?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Vikas replied 2 years ago.

Hello nike,

It does happens some times that a patient may not respond to a particular medicine at all.

When a treatment is initiated, the sign of positive responses are increased attention span, decreased impulsiveness and improved mood but you are experiencing none of them.

You have already tried dosing up to 40 mg and that too for more than 4 weeks without any response, in such case, the usual strategy when a patient is unresponsive to a particular medicine is to change to another medicine.

You can discuss with your doctor about trying Methylphenidate preparation such as Ritalin, Concerta, Metadate etc. All these medicine belongs to the stimulant medicine category just like Adderall.

I personally prefer Methylphenidate preparations instead of Adderall and hopefully you will notice improvement very soon.

I hope this helps.

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
Customer: replied 2 years ago.
Would the addition of the Trileptal eventually change my response to Adderall XR? Or if the Adderall is not working at the high dose of 40mg XR twice a day will the addition of Trileptal still not help it?
Expert:  Dr. Vikas replied 2 years ago.

Thanks for your reply.

Trileptal is not an established medicine for treating ADHD. Recently some doctors are using Trileptal for treating ADHD but it is an antiseizure medicine and I am not aware of any such studies to the best of my knowledge where Trileptal has been proved to be effective in controlled studies for those with ADHD.

Probably your doctor want to give it a try on the basis of his or her previous experience with this drug.

I hope this helps.

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
Customer: replied 2 years ago.
Ok, thank you. So in regards XXXXX XXXXX suggestion to trying a Methylphenidate medication, would Concerta or Focalin be better?

I would like to try and stay away from the IR ones to avoid any high/lows. I understand Concerta and Focalin are somewhat of the same but I'm not sure if one is more potent or which would be the best to help me focus and control my hyperactivity so that I can actually sit still for a little while.

Are there any pro/cons to either of them? I am unfamiliar with Metadate.
Expert:  Dr. Vikas replied 2 years ago.

You are most welcome.

Although, all Methylphenidate preparations are more or less equally effective but current treatment strategies favor once a day sustained release preparations because of convenience and diminished rebound side effects.

You can discuss with your doctor about trying Concerta. It has a longer duration of action and should suit your requirements.

Focaline is a new preparation of methylphenidate containing only d-enantiomer,dexmethylphenidate and is meant for patients who show partial response when on methylphenidate preparation.

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
Customer: replied 2 years ago.
How does Concerta compare to Metadate?
Expert:  Dr. Vikas replied 2 years ago.
Metadate ER has duration of action of approximately 4-6 hours and is an older sustained release preparation.

Metadate CD and Concerta are newer sustained released preparations.

Metadate CD has up to 8 hour of duration of action.

Concerta has up to 12 hour duration of action.



Vikas


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Customer: replied 2 years ago.
Thank you so much for all of your help. I have just one last question. Since I didn't respond to Adderall, does that mean I won't respond to something like Dexedrine since it's in the same family?
Expert:  Dr. Vikas replied 2 years ago.

Adderall is a mixture of Dextroamphtamine and amphetamine salt preparation while Dexedrine is a simple Dextroamphetamine preparation so in my view, you may try Methylphenidate preparation this time.


Vikas


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Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2208
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
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