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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by bunk0 on February 16, 2005, at 22:34:59
Greetings all. =) I have visited this site from time to time, mostly through google searches btw, and it usually has helped me with a question or two that I have been having regarding medication(s). Granted, I realize that any suggestions or advice given out on this site should be taken with a grain of salt, and when in doubt, ask your doctor. =) Anywhoo, with all that aside, here's my question. Basically, like the subject says, does anyone know what a reasonable "maximum" daily dosage as well a "maximum" dosage that she be taken at once? The reason that I am asking is the following. As it stands now, I am currently taking 450mg of Effexor XR a day. (3 150mg pills) From what I understand, this is a pretty high dose of Effexor XR. Which, from some of the medication that I have taken in the past, (Paxil, Zoloft, Elavil, Wellbutrin, Zyprexa, Abilify, Ritalin and it's extended/reformulated version, and some others) to get any real benefit, I seem to require more than the usual Joe. So, when it comes to the Adderall XR, I seem to get a maximum benefit from a single dose of 60mg in the morning. Which, that seems to work just wonderfully for my "problems," but it seems to only last about 6 or so hours tops. Now, I do realize that 60mg in and of itself is a high dose (unless I am mistaken), so I am wondering if taking more than that (daily dose), is really a "bad thing." Granted, I will be asking my doctor at my next scheduled visit (soon), but I thought I'd throw that question or two out and see what I get beforehand. Also, I am well aware of the difference between the "high" feeling that one can get when first starting a stimulant, and when things just seem to feel "right" or "normal" when you are on a good dosage. As it stands now, the Adderall XR seems to work really, really well for me, when it comes to side effects, so I don't really want to change if at all possible. I also do realize that there is something stronger Dexedrine available, but I don't like to mess with what works. =) Anyways, sorry for the length, but I thought a little background info. was necessary. BTW, as it seems that I haven't mentioned it yet, I have been seeking help for my "mental" condition/problems/whatever you want to call it this week, for about 5 years now. Thanks!
Posted by med_empowered on February 17, 2005, at 5:35:36
In reply to Upper Limit of Stimulants? (Adderall XR), posted by bunk0 on February 16, 2005, at 22:34:59
The "upper limits" of stimulant dosage really depends on your doctor. The FDA recommends capping Adderall and Dexedrine at 40mgs for ADHD (except in "rare" cases) and 60mgs for narcolepsy. The 60mg Narcolepsy cap is also used by some docs as the uppermost limit for ADHD (when they do exceed 40mgs). Narcoleptics are often prescribed more than 60mgs, or it is augmented with other agents. Obviously, the 40mg cap for ADD/ADHD gets exceeded all the time; I take 60mgs myself. Some doctors will go beyond 60mgs for "resistant" cases...doses 80mgs or so are not entirely uncommon. More common, at least from the people I know, is using Ritalin later in the day, which seems to work well for some people. Other options would include augmenting with Wellbutrin or Pamelor (in theory, Tricyclics and Amphetamines work together) or using Provigil.
Posted by bunk0 on February 17, 2005, at 5:58:57
In reply to Re: Upper Limit of Stimulants? (Adderall XR), posted by med_empowered on February 17, 2005, at 5:35:36
Thank you. As it stands right now, I really don't want to touch the Effexor XR dose that I am taking right now. It does the job well, and the side-effects are hardly noticeable. =) For the record, I have taken Provigil before (interesting stuff btw), although to be honest, when it comes to relieving my symptoms, a hefty amount of caffeine worked better overall. It looks like I'll bring up the Ritalin idea/suggestion to my doctor at the next appointment. Granted, I don't like to add any "extra" medication to what I am taking right now if I can help it, but hey, if it ends up doing the job, then no complaints from me. =) I'll post a follow-up/reply to this thread after my next appointment. If anything, at least it might give some people with similar problems on this board, lurkers and all, another "solution" to try! =) Thanks again.
Posted by Caslon540 on February 17, 2005, at 6:01:06
In reply to Re: Upper Limit of Stimulants? (Adderall XR), posted by med_empowered on February 17, 2005, at 5:35:36
Someone told me that their mom is prescribed 120mg of Adderall. Do you think that's likely to be true? I find it hard to believe.
> The "upper limits" of stimulant dosage really depends on your doctor. The FDA recommends capping Adderall and Dexedrine at 40mgs for ADHD (except in "rare" cases) and 60mgs for narcolepsy. The 60mg Narcolepsy cap is also used by some docs as the uppermost limit for ADHD (when they do exceed 40mgs). Narcoleptics are often prescribed more than 60mgs, or it is augmented with other agents. Obviously, the 40mg cap for ADD/ADHD gets exceeded all the time; I take 60mgs myself. Some doctors will go beyond 60mgs for "resistant" cases...doses 80mgs or so are not entirely uncommon. More common, at least from the people I know, is using Ritalin later in the day, which seems to work well for some people. Other options would include augmenting with Wellbutrin or Pamelor (in theory, Tricyclics and Amphetamines work together) or using Provigil.
Posted by med_empowered on February 17, 2005, at 7:34:29
In reply to Re: Upper Limit of Stimulants? (Adderall XR), posted by Caslon540 on February 17, 2005, at 6:01:06
hey! 120mgs is a bit much, but it does happen...I've heard of some people getting adderall/dexedrine when they're doing rehab for other stimulants (especially methamphetamine). Its not that common (note that most doctors AVOID giving controlled substances to former drug users), but it does happen. She could be narcoleptic (more likely to get high-doses), or severely ADD/ADHD...still, 120mgs does seem like a whole lot.
Posted by Phillipa on February 17, 2005, at 16:41:59
In reply to Re: Upper Limit of Stimulants? (Adderall XR), posted by med_empowered on February 17, 2005, at 7:34:29
I would think you would be very anxious on this high a dose, but I don't know what is wrong with her. And, my problems are the reverse. Fondly, Phillipa
Posted by bimini on February 17, 2005, at 16:54:10
In reply to Upper Limit of Stimulants? (Adderall XR), posted by bunk0 on February 16, 2005, at 22:34:59
Could the high dose of Effexor limit the effectiveness of stimulants? You say you don't want to touch the Effexor dose, possibly within the calibration lies the effect you seek. I'm not clear on the chemical/behavioral outcome, in my case Effexor put me down for a 16 hour nap.
Timing may be another, Effexor at evening and stimulant combination in the morning and noon perhaps?
bimini
Posted by CareBear04 on February 18, 2005, at 23:46:55
In reply to Re: Upper Limit of Stimulants? (Adderall XR), posted by bimini on February 17, 2005, at 16:54:10
hey, i take 50-60mg of adderall, split between xr and ir.
right now, i'm switched partly to concerta, so that's 27x3mg of concerta, which is, what 81mg of ritalin, something like 40 of adderall, then 20more of adderall. i'm not big, so i dont' think it's size-related... maybe has to do with tolerance?
Posted by bimini on February 19, 2005, at 15:20:07
In reply to Re: Upper Limit of Stimulants? (Adderall XR) » bimini, posted by CareBear04 on February 18, 2005, at 23:46:55
I meant that Effexor put me to sleep, seems to me to counter the effect of stimulants. Like a competitive cancelling thingy, which requires more and more meds to couteract unwanted side efects/domino effects and whatnot.
As I am awake more and do things which I don't do during sleep, reactions trickle down to effect processes which change the need of meds. It isn't my weight, it it a thousand things I have no idea about. All I know is it changes.
bimini
This is the end of the thread.
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