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Vyvanse (lisdexamfetamine dimesylate)

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Old 08-08-10, 03:13 PM
quantice quantice is offline

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Unhappy Does this mean I've built a tolerance already?

I've been on Vyvanse for 8 weeks with Dexedrine boosters added as needed in the past 4 of those weeks. I'm on them for narcolepsy, chronic fatigue syndrome, ADD and (sort of by accident) depression. While weight loss is not the reason why I'm on either med, it has been a welcome "side effect" since I've been trying to lose weight for quite some time now with little success. I've been keeping a daily log of my weight and caloric intake since the first of the year and during the first 5 weeks on the Vyvanse I was losing weight consistently at right around 4.5 pounds per week. The rapid weight loss I assume was partially due to eating less and partially due to what I'm assuming was an increased metabolism. At the end of the 5th week, however, the weight loss just stopped all of a sudden -- plateaued. The dosage didn't change and nothing else did either, but the scale just started giving the same numbers day after day after day instead of consistently going down. I'm not skinny, either, so it's not that there's nothing left to lose; I have roughly 25 more pounds to go before achieving a healthy and average BMI at this point. Eating healthy and making a point of exercising more still didn't affect the weight at all. Right now I weigh only 8 ounces less than I did 3 weeks ago, and every weight that I've recorded within the past 3 weeks has been in the same 2 pound range.

Is this a sign that I've built a tolerance to the medication already? I know that the effectiveness of the meds is hardly measured in pounds but still, 5lbs of weight loss a week for 5 weeks followed by 3 weeks of no change in weight at all definitely seems to indicate that something has changed dramatically in terms of effect. My thinking is that the change is due to my body simply adapting to the meds (although it's weird how it happened so suddenly), aka building a tolerance, which in turn makes me think it's going to be all downhill from here. I haven't been taking a large dose, in fact I've taken *less* than my doctor prescribed since larger doses seem to trigger my panic and anxiety, so I don't know why a tolerance would have built so soon and so suddenly. I started out at 30mg for the first few weeks, then 45mg and finally 50mg. I tried other higher doses at my doctor's recommendation in that time as well (60mg and 75mg) but stopped due to the increased anxiety and side effects. Also, in the past month the 50mg Vyvanse in the morning has been coupled with a 10mg Dexedrine spansule later in the day. Due to my conditions the dex booster is very episodic but I usually only need it on one or two days out of the week. I should also note that this is my first time on any sort of stimulant medication. I've been on just about everything else in the book to no effect and was self-medicating my narcolepsy and chronic fatigue with 3 or 4 trips to Starbucks a day prior to this (which I thankfully have stopped completely since starting the Vyvanse) so I have no previous tolerance to any medications like this.

I believe the medication is still treating what it's supposed to, so it's not like it's totally ineffective at this point, but then again it's hard to say. Some examples: I set my alarm for 5:00AM each morning to take the Vyvanse and then again for 7:00AM to wake up for a second time just as it's taking effect. I've noticed that when I sleep through the 5:00AM alarm on accident and miss the dose I will be exhausted beyond belief upon waking at 7, to the point of physically not being able to go into work. I missed doses a month ago and the effect was the same but to a much lesser extent. The fact that I am significantly more fatigued and exhausted without the medication now than I was a month ago also seems to hint that I've built a tolerance--or rather that my body has adapted to it so much that it has become dependent on it to stay awake. As for the ADD, it's very hard to judge. I'll notice some days when it's as bad as ever and some days when it's great, so there's no real pattern that I can make out. The fact that I've written this much so far for just a forum post, all in about 5 minutes, would seem to suggest today is one of the "good" days. And the depression is tricky as well, but I believe it can be gauged in that when I was just starting out I would feel happy and positive during the day but then experience emotional crashes at night about 10 hours after taking the meds. At the same time of night I would get inexplicably depressed and this would last for an hour or two before fading away. At first this would happen about 5 times a week, then about 3 times, then not really at all. Again, I'm wondering how much this has to do with tolerance/adaptation.

I will definitely talk to my doctor about all of this but I'm concerned he'll get the wrong idea about the weight loss, namely that it is the reason why I take the meds, and/or that he'll just say "well, guess it's become ineffective, back to zoloft you go!" and then I'll have to deal with the plethora of non-working brain-and-energy-killing medications all over again.

So I guess my questions are:

1. Is what I've described a good indication that I've built a tolerance to the medications?

2. If so, what can I do about it? Is there any way to "undo" a tolerance like this?

--and, sort of a general question out of curiosity--

3. How do people take these medications for years at a time? I've read testimonials from people who have been taking Dexedrine daily for 10 to 20 can they do that and still have it be effective after all that time?

Thanks for reading (and sorry for the length)
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Old 08-08-10, 03:23 PM
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Re: Does this mean I've built a tolerance already?

This isn't a sign that you've built a tolerance to the medication, it's a sign that you've hit the wall for the weight loss side effect. When taking antipsychotics, many people will gain weight until they hit a certain point then stop, for example most people gain about 5lbs on Risperdal and then stop. The exception with antipsychotics is Zyprexa, which touts unlimited weightgain.

You're not taking the medication for weight loss, though, so I certainly wouldn't complain to your doctor that you've stopped losing weight. If he asks you if you've lost weight (he should) tell him you did but you stopped. I wouldn't complain about it or say you wish you could lose more weight or he might think you're malingering for the pills as a diet aid.
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Old 08-09-10, 04:46 AM
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Re: Does this mean I've built a tolerance already?

KMiller said most of it.

You hit a wall with the weight loss. This is not a sign of tolerance to the medication.

I have been through before. I'm in good shape, but my body gains weight easily, so I always go through periods of weight gain and weight loss. I've tried every program out there.

There comes a point, where your body stops losing weight, and it doesn't matter what you do. Nothing will come off. Don't worry though. Over time, you will start losing weight again.

You also have to understand that a significant amount of the weight you lost, was most likely water weight. Everyone's body is different, it is possible for most of your 20 pounds of weight loss to have been water loss.

But don't get discouraged. Water weight is still weight, and it needs to come off. Unless you are terribly dehydrated, then water weight loss is a good thing.

Congratulations on that weight loss. That is a great thing. Don't only credit the medication for this though. It isn't solely responsible. You are doing something right, and you will have to continue doing the right thing in order to keep losing.

This is what I will recommend to you now:

First off, drink lots of water. Staying hydrated is one of the biggest keys to weight loss. There is science behind this, but right now the basic fact is only important. I don't know what your size is so it is hard to recommend a certain amount, but probably 3 liters a day minimum.

You also need consistent protein. With each meal, especially in the morning though.

Eating enough fat is also a key to weight loss. Your body needs fat.

Stay away from carbs. Try to completely eliminate bread, pasta, rice, potatoes, sugar etc. Eat fruits and vegetables, but moderately.

You body can get tolerant to your weight loss program, so you need to change it up. This goes for food and exercise. If you keep the process stable, eventually, your body won't respond to it anymore.

The depression etc is hard to figure out. If it has gone away, then that is great. That doesn't mean tolerance to the medication in a negative way though, it just means your body has adapted to the side effects, which is exactly how you want to be.

As far as the morning fatigue goes, I don't think it is tolerance like you're suggesting it. I mean, you got used to waking up, taking a pill, going back to sleep, and waking up with the pill working. Of course if you don't take the pill you're going to feel tired. You got your body into this habit, so if you change it up, then you'll notice. Plus, it is hard to get up in the morning for most people. Almost everyone is tired.

I think you're over analyzing all of this to be honest. It seems like the Vyvanse has helped with your energy level, and the negative side effects have gone away. You tried higher doses, but felt they were too much, so you settled on your current dose. I think this all sounds good.

I don't think you're becoming tolerant to the effects of the medication, but your body is now used to taking the medication, so all of what you explained is normal.

Don't worry about it.
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Old 08-13-10, 05:25 PM
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Re: Does this mean I've built a tolerance already?

Dang.... I have narcolepsy too so I can relate.

Have you asked about switching your meds around? You might benefit more from one of the methylphenidate-based meds like Ritalin or Focalin. They kick in much faster than amphetamines.
Another possibility might be Provigil or Nuvigil. My neurologist added that to my dosing since my Adderall XR wasn't lasting more than 4 hours. She said that if you are still battling a sleep disorder the Adderall can't pull double-duty for that and ADD. So she added Provigil (now take Nuvigil) to handle the sleepy issues throughout the day and the Adderall for the ADD stuff. Been on this for a couple years and love it. I take my Nuvigil right when I get up in the morning.
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