... spansules 2XPD (Barr Pharmaceuticals). I really can't feel its effects. I recently came off Focalin 10mg 3X PD because it stopped working. What should I do?
Coincidentally, I'm also a 41 y/o male with ADD and take Dextroamphetamine Sulfate (15mg sustained-release spansule - Glaxo Smith-Kline) twice daily. I'm going to take a wild guess that you were on Focalin for quite a while and your problem is amphetamine tolerance. Even though Focalin (Dexmethylphenidate) is classified as a psychostimulant rather than an amphetamine, it's mechanism of action is almost identical and therefore long term use of Focalin causes increased amphetamine tolerance.
Obviously, there is a difference in potency between 30mg Dexmethylphenidate and 30mg Dextroamphetamine SR, but if 30mg Focalin wasn't working for you, chances are, 30mg d-amp won't do much better.
There are 4 different courses of action I'd recommend, 3 of which depend on your psychiatrist's willingness to cooperate. As you probably know, these sort of discussions must be handled very carefully as some psychiatrists view requests for dosage/medication changes, especially those involving Schedule II medications, as "drug-seeking behavior" at which point they will most likely label you as a degenerate dope-fiend and write you out a scrip for Strattera or Wellbutrin and send you on your way. Make sure your Psychiatrist fully understands the reason for the request, or find another Doctor more familiar with ADD/ADHD treatment and tolerance management.
That being said, here are my suggestions:
1. Discuss increasing dextroamphetamine SR dose
2. Discuss switching to instant release version of d-amp.
3. Discuss switching to Desoxyn (Methamphetamine Hydrochloride)... Note: Psychiatrist will probably have a nervous breakdown if you even mention Desoxyn, so be careful with this one. (I'm a Gulf War Vet and my V.A. Psychiatrist plans on switching me to Desoxyn when the Dexedrine SR stops working at its current dose, but V.A. Docs pretty much play by their own set of rules, so this may not work with a civilian doc.).
4. If none of the above suggestions sound feasible, try dissolving a teaspoon of baking soda in a glass of water and drinking it about an hour before taking your meds. The higher the PH level in the stomach (less acidic) = greater the absorption / effectiveness of amphetamine-class drugs. Note: This isn't something you want to do on a consistent basis as your stomach is designed to function best at lower PH levels (more acidic), but it definitely makes a drastic difference. There are posts all over the web claiming that baking soda resets amphetamine tolerance, which is completely untrue, it just let's your body utilize more of the medication than it normally would. The nutritional supplement L-Tyrosine also increases amphetamine effectiveness by increasing production of the neurotransmitter Dopamine, which is often depleted by long-term amphetamine use.
One last thing, and it's none of my business, but if you take any of the following substances (prescribed or otherwise), keep in mind that they all limit dextroamphetamine's ability to function properly: Benzodiazepines, Opiates, Barbiturates, Marijuana, Alcohol, Ambien, Diphenhydramine HCL(Benadryl), and just about any other CNS depressant you can think of.
Sorry for rambling on so horrendously... hope this answers your question. Feel free to contact me if you have any other questions.
Colin M. Zimmermann
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