Adderall XR Twice Daily Dosing

[Zenman1]

What are your thoughts about this? Rationale for doing so.

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[Shikima]

What are the symptoms you're trying to target? It's not a problem in theory, I've done it with people I'm treating for Narcolepsy or Idiopathic Hypersomnia.

 

[milesed]

I see it done by others, but don't do it myself. Lots of patients say it wears off after 4-6 hours, so I try Vyvanse, regular adderall bid or tid or keep them on XR and add regular adderall later in the day. They will soon release Adderall XXR (or some other name) that should last much longer.

 

[TexasPhysician]

Some are fast metabolizers or have symptoms after school. I often dose in am and between 12-3pm.

 

[WingedOx]

I think I've done it once. I kept the total dose the same. Seemed to work out ok

 

[hamstergang]

The nice thing about the stimulants is that many times the patient and/or family can tell when it wears off. From this, we can tell for that individual patient just how long the medication effects them, more or less. So whether it's the short acting formulations or the XR formulations, an extra dose at a specifically chosen time can be completely reasonable to provide full day coverage without still interfering with sleep.

 

[smalltownpsych]

The nice thing about the stimulants is that many times the patient and/or family can tell when it wears off. From this, we can tell for that individual patient just how long the medication effects them, more or less. So whether it's the short acting formulations or the XR formulations, an extra dose at a specifically chosen time can be completely reasonable to provide full day coverage without still interfering with sleep.

Keep in mind that it can be difficult to administer at that specifically chosen time though. We had an issue with that at a therapeutic boarding school that I ran. Morning meds, lunch meds, dinner meds, and HS meds were all no problem, but to try to remember any other time would be. I imagine that this would be the case in a home situation, as well. I eventually made a policy that medications could only be administered during our regular times. It frustrated a few psychiatrists and families, but the alternative was inconsistency and increased liability on our part when we skipped adminstrations.

 

[Zenman1]

What are the symptoms you're trying to target? It's not a problem in theory, I've done it with people I'm treating for Narcolepsy or Idiopathic Hypersomnia.

I just had 30 seconds of boredom so that I'd just see what others are doing. Most recently I had a guy on Adderall XR 10mg which wore off about noon. He had some loss of appetite on that dose and didn't want to increase it as he wanted to play football and stay buff. Adding afternoon dose worked great

 

[PistolPete]

Is there any point in simply increasing the dose of Adderall if it wears off by noon, rather than adding a second dose during the day? Or does a higher dose still have the same half-life and simply cause more side effects? What is the patient doesn't report any side effects?

 

[Shikima]

I just had 30 seconds of boredom so that I'd just see what others are doing. Most recently I had a guy on Adderall XR 10mg which wore off about noon. He had some loss of appetite on that dose and didn't want to increase it as he wanted to play football and stay buff. Adding afternoon dose worked great

If he had appetite suppression, what about another agent to see if it is equally efficacious, without the appetite suppression and remain around longer? Utilizing compare and contrast....

 

[Therapist4Chnge]

I've seen XR + IR in early afternoon much more than XR in morning and then afternoon. The latter makes sense if the person actually does metabolize it quicker, though I'd still be concerned about quality sleep and abuse potential.

 

[milesed]

If XR only lasts a few hours and has to be dosed frequently, why use it instead of IR?

 

[hamstergang]

If XR only lasts a few hours and has to be dosed frequently, why use it instead of IR?

Wouldn't IR presumably last even less long in this individual, necessitating possibly TID or QID dosing?

 

[Shikima]

I've used XR and IR in a TID dosing, with naps, to maintain wakefulness. Then I forgot that I would have enough information to challenge the VA formulary to start the person on Xyrem. Alas, that was a year ago.

 

[cbrons]

What about Vyvanse in the AM plus low-dose dexedrine spansules in the PM?

I actually worry that many of the young adults though on the twice daily regimen have more significant sleep issues related to this than we think.