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Old 03-21-18, 01:46 PM
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Seeking advice for startup tolerance due to a dosing mistake

I have been diagnosed with adult ADHD (47 year old male) and my Dr started me on Adderall XR 20 mg once a day in the morning. What I (and the Dr) didn't realize was that I was concurrently taking a PPI (Prevacid 30 mg). So, if you do the research you will see that PPIs, especially in larger doses, shorten the amphetamine effect window and raise the top of the effect curve (concentrating the Cmax and reducing the Tmax).

So, I took my dose for two days and it hit me pretty hard being naive to amphetamines (in part due to the contribution from the PPI I was on, I'm sure).

I did some research and discovered that taking two Adderall IR 10 mg doses four hours apart would fix the PPI issue in the sense that the PPI seems to screw up the extended-release mechanism. At the same time, I decided to skip my dose of Prevacid and (quite stupidly in retrospect) take four antacid (Tums) instead. What I did not know was that antacids potentiate the effectiveness of amphetamines and as a result got an even higher peak dose, because I felt very nervous, anxious, and my teeth were almost chattering. At first I didn't realize that this (potentiation) was happening as a side effect of the antacid, so I did this (i.e., took the 2x10 mg IR doses and Tums, concurrently) for two days straight, immediately after the two days of the 20 mg XRs.

So, in a nutshell, the result was four days of 20 mg total dosage, getting more and more potent.

That's where I am at right now. Having made these mistakes, I want to take the minimum effective dose for me to help with ADHD and have decided to just go start with a 2x5 mg IR per day route. The question is how do I go about resetting whatever tolerance I have built up over the last four days?

I am considering going on a two-day complete break from the Adderall and then moving to a starting dose of two days of 2x2.5 mg. I want to do this as a sort of reset for whatever tolerance my body built from the relatively high doses I took over the four days, before going to the 2x5 mg IR as a starting (potentially) effective dose and trying to titrate my correct dose from there.

Is this a good approach for a reset? How much tolerance could I have built up over the four days taking 20 mg - probably 50-100% more due to an unknown amount of potentiation?
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Old 03-21-18, 02:10 PM
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Re: Seeking advice for startup tolerance due to a dosing mistake

Quote:
Originally Posted by mikegold10 View Post
How much tolerance could I have built up over the four days taking 20 mg - probably 50-100% more due to an unknown amount of potentiation?
Given the usual rate of receptor downmodulation in the brain given your dose and length of time taken, virtually zero.


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Old 03-24-18, 02:39 AM
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Re: Seeking advice for startup tolerance due to a dosing mistake

Quote:
Originally Posted by mikegold10 View Post
I have been diagnosed with adult ADHD (47 year old male) and my Dr started me on Adderall XR 20 mg once a day in the morning. What I (and the Dr) didn't realize was that I was concurrently taking a PPI (Prevacid 30 mg). So, if you do the research you will see that PPIs, especially in larger doses, shorten the amphetamine effect window and raise the top of the effect curve (concentrating the Cmax and reducing the Tmax).

So, I took my dose for two days and it hit me pretty hard being naive to amphetamines (in part due to the contribution from the PPI I was on, I'm sure).

I did some research and discovered that taking two Adderall IR 10 mg doses four hours apart would fix the PPI issue in the sense that the PPI seems to screw up the extended-release mechanism. At the same time, I decided to skip my dose of Prevacid and (quite stupidly in retrospect) take four antacid (Tums) instead. What I did not know was that antacids potentiate the effectiveness of amphetamines and as a result got an even higher peak dose, because I felt very nervous, anxious, and my teeth were almost chattering. At first I didn't realize that this (potentiation) was happening as a side effect of the antacid, so I did this (i.e., took the 2x10 mg IR doses and Tums, concurrently) for two days straight, immediately after the two days of the 20 mg XRs.

So, in a nutshell, the result was four days of 20 mg total dosage, getting more and more potent.
I am prescribed a PPI for a few conditions. I take it at night after Ive taken the adderall during the day and have no problems.

Quote:
That's where I am at right now. Having made these mistakes, I want to take the minimum effective dose for me to help with ADHD and have decided to just go start with a 2x5 mg IR per day route. The question is how do I go about resetting whatever tolerance I have built up over the last four days?
I really do not think you need to "reset"anything because I dont think you did anything permanent. I think you felt that things were not right but tolerance is a lot more rare than you think it is and I think just moving when you take your PPI will solve the issue.

Quote:
I am considering going on a two-day complete break from the Adderall and then moving to a starting dose of two days of 2x2.5 mg. I want to do this as a sort of reset for whatever tolerance my body built from the relatively high doses I took over the four days, before going to the 2x5 mg IR as a starting (potentially) effective dose and trying to titrate my correct dose from there.

Is this a good approach for a reset? How much tolerance could I have built up over the four days taking 20 mg - probably 50-100% more due to an unknown amount of potentiation?
Tolerance doesnt happen over a couple of days. When it does happen it tends to be after many months or years of being on a medication. What happened IMO is that you physically had a reaction to the PPI and Adderall and you noticed it, so you need to move when you take the PPI.
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Old 03-24-18, 11:32 AM
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Re: Seeking advice for startup tolerance due to a dosing mistake

This sounds to me like a fairly normal initial response for someone who is new to stimulants. It takes a bit of time for your body to adjust to stim meds, don't let the initial effects scare you away. You will adjust and before long you'll barely notice them.
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Old 03-24-18, 01:29 PM
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Re: Seeking advice for startup tolerance due to a dosing mistake

BTW,

You really do want to work with your doctor in adjusting the medications and not do all the intellectual work at first. Some of your reactions could be valuable information for your doctor.

Bottom line: work with your doc, because right now you're getting all kinds of clues to how you react to medications ... because the doc needs to know all of this.

Avoid doing all the adjusting on your own. And as others have said, some of your reactions are quite typical and don't require interactions ... sometimes we have anxiety etc., when starting a stimulant and doesn't matter if you're on some other medication.

And tolerance is not something one needs to be concerned with in the first days of using a medication ...

But again, that's info your doc would know.

Good luck.

Tone
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