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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by ed_uk on November 19, 2005, at 22:33:31
Traditional stimulants such as methylphenidate (Ritalin, Concerta) and the amphetamines (Adderall, Dexedrine) can constrict blood vessels, increase heart rate and elevate blood pressure. Hypertension is a major risk factor for CVA (stroke), myocardial infarction (heart attack) and kidney failure.
To those of you who take stimulants.......
How regularly does your doctor monitor your blood pressure?
What was your BP before you started stimulant treatment?
What is your BP now?
Do you require anti-hypertensive medication? What do you take?
Thank you for participating!
Ed
Posted by pseudoname on November 20, 2005, at 6:34:54
In reply to Stimulant survey - please participate, posted by ed_uk on November 19, 2005, at 22:33:31
I *was* taking Adderall 20-30 mg 2-3 times a week.
> How regularly does your doctor monitor your blood pressure?
Never. Never even mentioned it.> What was your BP before you started stimulant treatment?
125/80> What is your BP now?
Temporarily off Adderall; if I take one again, I'll test my BP & post it.> Do you require anti-hypertensive medication? What do you take?
No
Posted by linkadge on November 20, 2005, at 8:59:29
In reply to Stimulant survey - please participate, posted by ed_uk on November 19, 2005, at 22:33:31
ritalin took me from 120/80 to 135/80 (or something like that) was a contribiting factor to my discontinuation of it.
Linkadge
Posted by ed_uk on November 20, 2005, at 13:47:02
In reply to 125/80, posted by pseudoname on November 20, 2005, at 6:34:54
Hi PN
>Never. Never even mentioned it.
That's not good. IMHO, docs need to pay more attention to the potential cardiovascular side effects of stimulants, especially since many people take them on a long term basis.
Hypertension is *extremely* common in the general population. For a hypertensive individual, a *small* rise in blood pressure *greatly* increases the risk of having a stroke/CVA.
>125/80
BP < 120 systolic and < 80 diastolic is ideal. Young people frequently have 'ideal' BP, older people usually don't.
BP < 140/90 but > 120/80 is often called 'pre-hypertension' ie. not hypertension, but likely to develop hypertension in the future
BP > 140 systolic *and/or* > 90 diastolic is classed as hypertension
>No
Well, you certainly don't need antihypertensive medication at the moment :-)
If Adderall raised your BP so that it was *consistently* > 140 systolic and/or > 90 diastolic, medication might be necessary ....but only if you were going to be taking the Adderall on a long term daily/regular basis.
>Temporarily off Adderall; if I take one again, I'll test my BP & post it.
Please do :-) If you were only taking it 2-3 times a week, it's difficult to say whether anti-hypertensive medication would be appropriate. It might be, but only if your BP was markedly elevated and/or you have risk factors for cardiovascular disease.
Kind regards
Ed
Posted by ed_uk on November 20, 2005, at 13:50:29
In reply to Re: Stimulant survey - please participate, posted by linkadge on November 20, 2005, at 8:59:29
Hi Link,
It's interesting.....
Hypertension associated with certain stimulants has received a lot of publicity.......
Ephedra/ephedrine
Decongestants, especially phenylpropanolamine (PPA)
Appetite suppressants eg. phentermineHypertension associated with ADHD meds doesn't seem to have received as much publicity. Odd, since people take ADD meds for years... not many people take decongestants for years.
Ed
Posted by linkadge on November 20, 2005, at 14:18:43
In reply to Re: Stimulant survey - please participate » linkadge, posted by ed_uk on November 20, 2005, at 13:50:29
I told the doctor that the ritalin was causing insomnia and high BP, he wanted to add atenolol and mirazapine, which was awefully nice of him, but I was already taking a kazillion other things. So we dropped the ritalin.
Ritalin did help in some ways, but it turned me into a freak. I didn't like what I became, I kind of felt posessed. (my behavior was not freakish, but just the way it made me feel)
Linkadge
Posted by iforgotmypassword on November 20, 2005, at 16:04:39
In reply to Stimulant survey - please participate, posted by ed_uk on November 19, 2005, at 22:33:31
when i would take ritalin with my desipramine, i would go over the top. intense anger and agitation. it made me go to the emergency room one night. they brought me to a bed with what was probably BP/heart rate monitoring equipment, but i really can't remember much cos they kept giving me ativan injections. actually i can't remember much at all until i left the next morning, when the nurse gave me a lil envelope of ativan pills, and asked my dad if i was always agitated and moving funny like i was... during the stay, they just kept remarking on my heart rate (which i actually remember seemed to hover in between 140-170 on the machine behind me. my bp may and probably was high as well, but i don't remember if they were talking about that.)
that said my BP is usually high (usually over 130 systolic and im 21), and stimulants seem to raise it when i use my manual BP monitor at home (ritalin definately more so than dexedrine though)...
normally, my heart rate is usually high-ish as well, ~95-115 usually.
my BP may be going down and getting more normal now since discontinuing the desipramine (starting to get systolic readings in the 110-120 range not that uncommonly now)... so in my case my BP responses to stimulants may be connected to my longer term TCA use, and especially how NE-active desipramine is (definatley minimized oversleeping, overeating!) it may even be somewhat of a stimulant in its own right.
Posted by Phillipa on November 20, 2005, at 20:46:56
In reply to not sure if very relevant (about DMI stimulants), posted by iforgotmypassword on November 20, 2005, at 16:04:39
What about all those little kids? Fondly, Phillipa
Posted by alohashirt on November 20, 2005, at 20:48:48
In reply to Stimulant survey - please participate, posted by ed_uk on November 19, 2005, at 22:33:31
> Traditional stimulants such as methylphenidate (Ritalin, Concerta) and the amphetamines (Adderall, Dexedrine) can constrict blood vessels, increase heart rate and elevate blood pressure. Hypertension is a major risk factor for CVA (stroke), myocardial infarction (heart attack) and kidney failure.
>
> To those of you who take stimulants.......
>
> How regularly does your doctor monitor your blood pressure?
>
> What was your BP before you started stimulant treatment?
>
> What is your BP now?
>
> Do you require anti-hypertensive medication? What do you take?Before meds 125/75
On Adderall 145/92
On dexedrine with 100mg Toprol XR
138/88
On Focalin XR, No Toprol 135/85
Posted by ed_uk on November 21, 2005, at 15:17:42
In reply to not sure if very relevant (about DMI stimulants), posted by iforgotmypassword on November 20, 2005, at 16:04:39
Hi IFMP,
My heart rate was very high on lofepramine. It's still high now, even after stopping lofep.
Ed
Posted by ed_uk on November 21, 2005, at 15:18:25
In reply to Re: not sure if very relevant (about DMI stimulants), posted by Phillipa on November 20, 2005, at 20:46:56
Hi PJ
>What about all those little kids?
It's a concern. I hope their docs are monitoring them well.
ED xxx
Posted by ed_uk on November 21, 2005, at 15:19:21
In reply to Re: Stimulant survey - please participate, posted by alohashirt on November 20, 2005, at 20:48:48
Hi!
How have stimulants affected your heart rate?
Ed
Posted by zeugma on November 21, 2005, at 16:57:45
In reply to not sure if very relevant (about DMI stimulants), posted by iforgotmypassword on November 20, 2005, at 16:04:39
hi Ed,
my BP has been constant for years, no matter what combinations of stimulants and TCA's have been in my body- 100/80.
my HR has been subjectively elevated, but the highest recorded rate was 92.
What really was a problem with the stim/TCA combination was severe orthostatic hypotension.
-z
Posted by alohashirt on November 21, 2005, at 17:15:38
In reply to Re: Stimulant survey - please participate » alohashirt, posted by ed_uk on November 21, 2005, at 15:19:21
> Hi!
>
> How have stimulants affected your heart rate?
>
> EdI measure but don't record this. My sense is that Adderall increases heart rate to 85/90 from 70/75. I grab exercise when I can, run down city blocks, work out at lunchtime and my heart rate is all over the plaec anyway.
Posted by paulbwell on November 22, 2005, at 20:03:08
In reply to Re: Stimulant survey - please participate, posted by alohashirt on November 21, 2005, at 17:15:38
> > Hi!
> >
> > How have stimulants affected your heart rate?
> >
> > Ed
>
> I measure but don't record this. My sense is that Adderall increases heart rate to 85/90 from 70/75. I grab exercise when I can, run down city blocks, work out at lunchtime and my heart rate is all over the plaec anyway.
>After haven taken Methylphenidate (Ritalin) for 18 months or there abouths, i feel informed to commment on Ritalin.
It is short and quick acting, lasting perhaps 2-3 hours!!.
The Amphetamines have been proven for 80ys now to be of benefit in ADDD/HD ?Narcolepsy cases.
I may well well be changing to Dextroamphetamine, a med MANY have taken for decades without trouble, and indeed major benefit.
Cheers
Posted by ed_uk on November 23, 2005, at 14:13:15
In reply to Re: not sure if very relevant (about DMI stimulants) » iforgotmypassword, posted by zeugma on November 21, 2005, at 16:57:45
Hi Z
Your BP is nice and low :-)
>my HR has been subjectively elevated, but the highest recorded rate was 92.
Was it uncomfortable? A cardioselective beta blocker might help eg. bisoprolol
>What really was a problem with the stim/TCA combination was severe orthostatic hypotension.
Did the stimulate aggravate this?
Kind regards
Ed
Posted by zeugma on November 23, 2005, at 17:05:29
In reply to Re: not sure if very relevant (about DMI stimulants) » zeugma, posted by ed_uk on November 23, 2005, at 14:13:15
> Hi Z
>
> Your BP is nice and low :-)
>
> >my HR has been subjectively elevated, but the highest recorded rate was 92.
>
> Was it uncomfortable? A cardioselective beta blocker might help eg. bisoprololHi Ed
It was not physically uncomfortable but anxiety-provoking. The elevated HR may well have been anxiety-induced.
>
> >What really was a problem with the stim/TCA combination was severe orthostatic hypotension.
>
> Did the stimulate aggravate this?
>Ritalin aggravated this. This was the physical side effect that was truly bothersome (besides the weight loss). On nortriptyline by itself, and in combination with other meds, I experience OT, but with Ritalin it was truly severe.
best,
z
> Kind regards
>
> Ed
Posted by theo on November 23, 2005, at 21:26:03
In reply to Re: Stimulant survey - please participate, posted by alohashirt on November 20, 2005, at 20:48:48
Is your BP why you quit Adderall? My doc wants me to try it before trying Concerta again. I'm a little nervous.
Posted by ed_uk on November 24, 2005, at 13:36:15
In reply to Re: not sure if very relevant (about DMI stimulants) » ed_uk, posted by zeugma on November 23, 2005, at 17:05:29
Hi Z
Where are you going with your treatment/medication at the moment? Are you trying any new meds?
Best
Ed
Posted by zeugma on November 24, 2005, at 15:58:12
In reply to Re: not sure if very relevant (about DMI stimulants) » zeugma, posted by ed_uk on November 24, 2005, at 13:36:15
> Hi Z
>
> Where are you going with your treatment/medication at the moment? Are you trying any new meds?
>
> Best
>
> EdHi Ed,
Feeling holiday stress (love work, don't get along with people in general- more accurately [sorry, it's Thanksgiving here, major social day, I generally like to avoid people on days off][am not a horrible person in spite of this, just am not a good person 'IRL']) but otherwise fine.
I am sticking tom Provigil on doctor's orders. 300 mg Provigil works better, though differently, from lower Provigil/Ritalin combinations (less sociable, but generally happier [except on holidays]). The split dose 200/100 am and noon works much better than the whole Provigil dose am. I get 'overfocused' when I take all the dose at once. And my focus fades away when, like today, I skipped the noon dose.
How is 1200 mg adrafinil working for you? You did a fast titration! Any results?
Best,
z
(fading fast, have to get to parents' house, hence lack of editing)
Posted by alohashirt on November 24, 2005, at 21:30:49
In reply to Re: Stimulant survey - please participate » alohashirt, posted by theo on November 23, 2005, at 21:26:03
> Is your BP why you quit Adderall? My doc wants me to try it before trying Concerta again. I'm a little nervous.
Yes - I wasn't able to safely ramp up to a therapeutic dose. I did a mix of dexedrine and Concerta and a BP med for a while which worked OK. I am now on exclusively Focalin XR which has been sharper than Concerta, no BP effects and for me the best choice so far.
DO you have BP issues? My pdoc suggetsed that less than 2% of his patients have a strong BP effect from Adderall I bought a personal BP monitor from EBay which has helped me monitor BP
Posted by theo on November 25, 2005, at 6:43:09
In reply to Re: Stimulant survey - please participate, posted by alohashirt on November 24, 2005, at 21:30:49
> DO you have BP issues? My pdoc suggetsed that less than 2% of his patients have a strong BP effect from Adderall I bought a personal BP monitor from EBay which has helped me monitor BP
No, my BP is usually 120/80 or below without meds. Would you have continued Adderall had you not had BP problems with it?
Posted by vbAgent on November 27, 2005, at 22:21:55
In reply to Stimulant survey - please participate, posted by ed_uk on November 19, 2005, at 22:33:31
I've taken a number of different stimulants. I recently opted to discontinue Ritalin LA 20mg because it has lost its effectiveness - just doesn't work as well anymore. Rozerem, the new melatonin-agonist drug used to treat insomnia, is the only medication I take right now; it really isn't any better than supplemental melatonin so I won't be taking it much longer. Anyway, the pdoc may switch me to Adderall 10mg 3x/day, but only after she consults my PCP who monitors and treats my (variable) high blood pressure.
1) How regularly does your doctor monitor your blood pressure?
My pdoc doesn't measure bp. That's another doctor's responsibility. I don't see why she doesn't...
2) What was your BP before you started stimulant treatment?
Probably around 140/90.
3) What is your BP now?
Good question. It was last measured a few months ago at approximately 170/110 after I abruptly decided to stop taking antihypertensive drugs (not a good idea by the way).
4) Do you require anti-hypertensive medication? What do you take?
I now take Toprol XL 100mg once per day w/o any stimulant.
The same doc who treats my hbp originally prescribed Ritalin LA 30mg before I starting seeing my current pdoc. So, I expect he'll be okay w/ the switch as long as I continue to take Toprol XL. The task of these two doctors consulting remains on the to-do list. If my PCP denies the med change request then I'm SOL.
I wonder if many people participating in this forum have experience w/ their pdoc needing to consult another doctor?
Posted by ed_uk on November 28, 2005, at 13:23:12
In reply to re: Stimulant survey - please participate » ed_uk, posted by vbAgent on November 27, 2005, at 22:21:55
Hi VBA
>I now take Toprol XL 100mg once per day w/o any stimulant.
If you start Adderall, you might need to add hydrochlorothiazide 12.5mg or amlodipine (Norvasc) 5-10mg to your antihypertensive regimen.
Ed
Posted by alohashirt on November 28, 2005, at 21:45:15
In reply to Re: Stimulant survey - please participate » alohashirt, posted by theo on November 25, 2005, at 6:43:09
> > DO you have BP issues? My pdoc suggetsed that less than 2% of his patients have a strong BP effect from Adderall I bought a personal BP monitor from EBay which has helped me monitor BP
>
> No, my BP is usually 120/80 or below without meds. Would you have continued Adderall had you not had BP problems with it?
>
At the time, yes I would have continued Adderall. It seemed to produce less of the hyperfocus / train track thinking I had noticed with Concerta. The biggest disadvantage of teh amphetamines fo rmeis th t there effectiveness seems to vary widely. Methylphenidate seems much more consistent ibn it's effects.I'd love to see a good comparative study of Adderall, Concerta, Focalin and Provigil, as well as some research on the effects of the "nootropics" like huperzine, picamilon, aniracetam, vipocitaine, acetylcholine, fish oil. Right now doing well with Focalin XR.
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