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Ask Dr. Kaushik Your Own Question
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4484
Experience:  MD Psychiatry
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My question is regarding my condition of chronic adult ADD.

Customer Question

Hi my question is regarding my condition of chronic adult ADD . I'm on the maximum dose possible of Vyvanse and can't and don't want to increase it but finding its effectiveness greatly diminishing and it barely covers my symptoms each full day if at all. I can't go off medication all together as I work or study 7 days a week and I've tried every other medication and Vyvanse is usually the most effective. I wanted some advise of what to do as its still 3 weeks till I can see my doctor. Is there a way (by combining with another medication or supplement or anything) that I can improve vyvanses effectiveness? Is there a good combination of another medication with my Vyvanse like with a non stimulant or Ritalin la that might work better if its not going to be too make medication to prescribe? Or is it possible to be prescribed high dose Vyvanse one week and High dose Ritalin or Concerta another week to reduce tolerance to Vyvanse and improve its effectiveness? Any other ideas? I'm finding I'm taking extra medication daily just to get thru and I'm not sure how to stop that when I'm getting symptomatic from current regime?
Submitted: 6 months ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 6 months ago.


Welcome to the site.

Kindly answer a few queries before i provide you a plausible and workable solution to your problem.

1) Have you already tried retain la or concerta or focailin or adderall .

2) Are you amenable to the use of herbal remedies to the primary stimulant drug. ?


Customer: replied 6 months ago.
1) I have tried Ritalin,and Concerta but not adderall or focal in but I think focal in isn't available in Australia. Ritalin works ok but not for long enough and I get side effects. Concerta doesn't work at all even on 144mg unless I bit the tablets in half instead of whole but then the duration is less. What is the difference between adderall and Vyvanse? Is there a Adderall XR and what's its usual duration? I usually find any medication work for a lot less duration then it's meant to.
2) yes. I tried a year off stimulants last year and had special diet and special compounded vitamins and supplements but it was extremely hard and only marginal improvement. I couldn't work and had to get a medical letter to discontinue my study. When I reached 12 months I had to go back on meds which was around Jan/February.
Expert:  Dr. Kaushik replied 6 months ago.

Thanks for the inputs.

Well, although both vyvanse and adderall xr belong to the amphetamine class of psychostimulants but they do have variation in their chemical structure owing to which a slight difference is seen in their onset of action. While adderall xr is slightly quicker in its onset of action but it is almost equal to vyvanse in terms of duration of action which is approximately 12 hours.

So now that your body as it seems to have started to develop increased tolerance aka resistance against vyvanse owing to long term use so it will be a good ploy to replace it with either adderall xr ( which is also extended release preparation , thus requiring once a day morning dosing) or replace it with another atypical stimulant like modafinil or provigil.

If replacing vyvanse with any one of these two options is not possible for you to achieve at the moment then another option would be to add clonidine at modest dose of 0.1 mg once a day initially then twice a day after you start seeking benefits. Addition of this medication may actually potentate the action of vyvanse and give it the much needed edge in terms of its efficacy. In other words this combination would be the just required mix to provide you benefits in terms of your ADD.

I hope this helps.

Wish you all the best.

Please kindly leave a POSITIVE RATING if you are satisfied with the answer.


Customer: replied 6 months ago.
Thank you for that very helpful information. So if I'm currently on 4 x 70mg Vyvanse spread out through the day what would be the equivalent in Adderall XR and would it be a bit stronger consistently than Vyvanse is ? And would I take it over a couple of doses? Could I take it daily without coming across the same issue as Vyvanse ? I also haven't tried taking my Vyvanse all together in the morning as a once only as I find its duration lasts less than its meant to with me like any medication? And then I'm stuck without coverage for the last part of the day ? And thanks for the advise about clonidine . Is that an ADHD medication too and does it have any commonly experienced side effects. Thanks I'll be right to leave 5 star rating after I hear back
Expert:  Dr. Kaushik replied 6 months ago.

Thanks for the inputs.

Well, the equivalent dose for adderall xr to 70 mg X 4 dosing of vyvanse would be 30 mg dose twice a day, that is morning and evening, however, initially you may start taking 30 mg once a day in the morning for 2 weeks so as to allow body to get used to the presence of the drug and thereafter you may start taking 30 mg dose twice a day. Efficacy wise both adderall xr and vyvanse are almost similar but in my personal experience I have found adderall xr to be having an edge over vyvanse and also it is faster in its onset of action relatively though.

Well, as far as clonidine is concerned, yes it is approved for use in adhd in adolescent and children but your doctor may find its use in you as well, since It has shown promise against adhd symptoms, hope you try it at 0.1 mg dose once a day to start with and then after 1 week, taking it twice a day.

I hope this sums it up for you.

Wish you All the best.

Please kindly leave a POSITIVE RATING if you are satisfied with the answer.


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