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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by katekite on April 18, 2002, at 19:31:13
Hi,
I started ritalin about a week ago and love the calming effect and ability to think.
Went camping, hiking, this week and found that my low starter dose of 5 mg every 3-4 hrs gave me chest pain. Now I'm home and went and checked my blood pressure and its way too high, just under the line for normal a person but higher than its ever been for me -- 144/71 and that was 2.5 hours into the dose. And here I'd been hoping to up the dose! No wonder I feel a little sick at the peak of it.
So what are my options?
Something to control the blood pressure/heart rate? Is anyone on something for this, in combo with a stimulant?
Other stimulants? How many mgs of Adderall or dexedrine would I try if I was doing ok with 5 of ritalin?
thanks,
kate
Posted by Ritch on April 19, 2002, at 10:19:10
In reply to switch from ritalin to ? for add, opinions?, posted by katekite on April 18, 2002, at 19:31:13
> Hi,
>
> I started ritalin about a week ago and love the calming effect and ability to think.
>
> Went camping, hiking, this week and found that my low starter dose of 5 mg every 3-4 hrs gave me chest pain. Now I'm home and went and checked my blood pressure and its way too high, just under the line for normal a person but higher than its ever been for me -- 144/71 and that was 2.5 hours into the dose. And here I'd been hoping to up the dose! No wonder I feel a little sick at the peak of it.
>
> So what are my options?
>
> Something to control the blood pressure/heart rate? Is anyone on something for this, in combo with a stimulant?
>
> Other stimulants? How many mgs of Adderall or dexedrine would I try if I was doing ok with 5 of ritalin?
>
> thanks,
> kateKate,
You may need to release the medication more slowly. Ask your doctor about 18mg tabs of Concerta (take 1/day). That might fix it. That BP you gave really isn't that bad. Interestingly, that is similar to mine when I am taking a lot of AD's or stimulants. I don't know if Adderall (regular version) would be helpful or not. I had some nasty headaches from it (and increased BP). The XR version (10mg) might be smooth enough. Dexedrine has less pressor effects than Ritalin or Adderall, but it might not work as well for you. I would give the Concerta a whirl. I am going to be trying Focalin probably next week as an experiment. I will let you know what happens.
Mitch
Posted by fachad on April 19, 2002, at 13:18:27
In reply to switch from ritalin to ? for add, opinions?, posted by katekite on April 18, 2002, at 19:31:13
Kate,
For me Ritalin had the least effect on blood pressure of all the stimulants. Adderall had the most effects by far. It increased my BP, pulse, gave me nervousness and such. Dexedrine was somewhere in the middle. It caused more increase in BP than Ritalin, but not as much as Adderall.
However, with both Ritalin and Dexedrine the increase in BP was transient and it went away after about a month. You may want to wait and see if yours goes away too. The BP you reported is not medically dangerous unless you had it every day for 20 yrs.
Foculin is supposed to have less effect on BP than Ritalin; it is dextro form of Ritalin only.
As far as dosage conversions go, it varies from person to person, but I think the rule of thumb is 30 mg Ritalin = 20 mg Adderall = 15 mg Dexedrine = 15 mg Focalin.
I still think you should wait out the BP as it will likely go away and will most likely be worse with Adderall or Dexedrine. Also, as someone else mentioned, Concerta is an excellent, very smooth slow release form of Ritalin. You would most likely have less side effects from Concerta, plus the convenience of only taking it once per day.
-fachad
> Hi,
>
> I started ritalin about a week ago and love the calming effect and ability to think.
>
> Went camping, hiking, this week and found that my low starter dose of 5 mg every 3-4 hrs gave me chest pain. Now I'm home and went and checked my blood pressure and its way too high, just under the line for normal a person but higher than its ever been for me -- 144/71 and that was 2.5 hours into the dose. And here I'd been hoping to up the dose! No wonder I feel a little sick at the peak of it.
>
> So what are my options?
>
> Something to control the blood pressure/heart rate? Is anyone on something for this, in combo with a stimulant?
>
> Other stimulants? How many mgs of Adderall or dexedrine would I try if I was doing ok with 5 of ritalin?
>
> thanks,
> kate
Posted by katekite on April 19, 2002, at 15:07:01
In reply to Re: switch from ritalin to ? for add, opinions? » katekite, posted by Ritch on April 19, 2002, at 10:19:10
Thanks Mitch. I see the doc next wednesday. Until then I'm cutting the dose in half and trying to get my body used to it. Its very very hard not to take a dose I know helps my brain, even though it gives me uncomfortably (for me) high blood pressure. My regular bp is about 100/65. Anyhow please let me know what happens with you.
Its so so hard to be patient with this. I have stuff I need to do.
kate
Posted by katekite on April 19, 2002, at 15:12:39
In reply to Ritalin vs. Adderall, Dex and Blood Pressure » katekite, posted by fachad on April 19, 2002, at 13:18:27
Thanks, that's comforting about waiting it out. I know I used to drink a ton of caffeine and dumb docs had me cut it out completely and now one cup of coffee gets me sweaty.... so it seems reasonable that I might get used to it. I hope!
Bummer that the others are even more likely to cause this side effect.
So far today I've kept on the half a pill and my bp has been ok.
I have now managed to use this as an excuse for 3 days to do almost nothing, LOL. Lowering the dose plus ADD itself = nothing accomplished.
Thanks again. It really makes me feel better that I may get used to it and that a month is not too long to keep trying.
kate
Posted by Bekka H. on April 19, 2002, at 19:44:23
In reply to Re: switch from ritalin to ? for add, opinions? » katekite, posted by Ritch on April 19, 2002, at 10:19:10
> You may need to release the medication more slowly. Ask your doctor about 18mg tabs of Concerta (take 1/day). That might fix it. That BP you gave really isn't that bad. I am going to be trying Focalin probably next week as an experiment. I will let you know what happens.
> Mitch
***********************************************Hi.
I tried Focalin for a couple of days shortly after it first came out. Let me warn you. . .For me, Focalin is VERY INTENSE!! Be sure you take only half the number of milligrams (or even less than half) of what you'd take if you were on Ritalin. Focalin is much more potent than regular ritalin. It was too intense for me, but I'll probably try it again some day at an even lower dose.
Bekka
Posted by Bekka H. on April 19, 2002, at 19:50:31
In reply to switch from ritalin to ? for add, opinions?, posted by katekite on April 18, 2002, at 19:31:13
Hi Katekite,
Mitch and Fachad suggested Concerta, and I agree. For me, Concerta is the best of the methylphenidate formulations. It is by far the smoothest, most consistent and most sustained form of MPH I've tried.
By the way, not every one has this experience with regular ritalin, but I found that it seemed to wash out of my body so quickly (i.e., it had a really short half life). By the time the blood levels were supposed to be peaking, I had about one-half hour of feeling OK, and then rebound set in. For me, regular ritalin is OK only if I'm using it to augment an antidepressant; otherwise, by itself, it's just not long-lasting enough and the rebound was unbearable. I think Concerta is worth a try.
Bekka
Posted by Ritch on April 19, 2002, at 23:17:39
In reply to switch from ritalin to ?-Ritch/Mitch, posted by Bekka H. on April 19, 2002, at 19:44:23
> > You may need to release the medication more slowly. Ask your doctor about 18mg tabs of Concerta (take 1/day). That might fix it. That BP you gave really isn't that bad. I am going to be trying Focalin probably next week as an experiment. I will let you know what happens.
> > Mitch
> ***********************************************
>
> Hi.
> I tried Focalin for a couple of days shortly after it first came out. Let me warn you. . .For me, Focalin is VERY INTENSE!! Be sure you take only half the number of milligrams (or even less than half) of what you'd take if you were on Ritalin. Focalin is much more potent than regular ritalin. It was too intense for me, but I'll probably try it again some day at an even lower dose.
> Bekka
Bekka,Thanks for replying. This is just an experiment. I was just written for 15 tabs of 5mg. I am between major depressions and now is the time to experiment with different meds that can work for the potentially life-threatening depressions (and to check to see how my mood is affected). We already know that stimulants (Adderall, thus far) has worked better than anything else without triggering hypomania/cycling (and that at just 5mg/day for several weeks), BUT, I got too nervous with the Adderall, and plain Dexedrine actually made me drowsy, groggy, and on average I made more mistakes at work. So, we are trying to find the success with major depression and ADHD(without rapid cycling) that I got with the Adderall but without the *anxiety*. I was told if this works I will probably flip to Concerta (see if I am still responding positively). If it doesn't-then we are going to be looking at selegiline or add back nortriptyline-very cheap and works, but cycling is affected, I get numbness, and Q-T interval is prolonged, and it is more toxic than stimulants in overdose (wonderful).
Mitch
Posted by Bekka H. on April 19, 2002, at 23:38:14
In reply to Re: switch from ritalin to ?-Ritch/Mitch » Bekka H., posted by Ritch on April 19, 2002, at 23:17:39
> Bekka,
>
> Thanks for replying. This is just an experiment. I was just written for 15 tabs of 5mg. I am between major depressions and now is the time to experiment with different meds that can work for the potentially life-threatening depressions (and to check to see how my mood is affected). We already know that stimulants (Adderall, thus far) has worked better than anything else without triggering hypomania/cycling (and that at just 5mg/day for several weeks), BUT, I got too nervous with the Adderall, and plain Dexedrine actually made me drowsy, groggy, and on average I made more mistakes at work. So, we are trying to find the success with major depression and ADHD(without rapid cycling) that I got with the Adderall but without the *anxiety*. I was told if this works I will probably flip to Concerta (see if I am still responding positively). If it doesn't-then we are going to be looking at selegiline or add back nortriptyline-very cheap and works, but cycling is affected, I get numbness, and Q-T interval is prolonged, and it is more toxic than stimulants in overdose (wonderful).
> Mitch***********************************************
Hi Mitch,
It looks as if you and I have some symptoms and medication responses that are very similar. I have one other word of caution that I think I should mention regarding methylphenidate/mph (you said you might try Concerta). . .Switching from an amphetamine (either Dexedrine or Adderall) to methylphenidate can be a little bit difficult at first. For me, it takes one to two weeks of Dexedrine withdrawal before I can even tell how methylphenidate is affecting me. I'm referring to a withdrawal period that occurs even though I might be on another stimulant (mph, for example). The first time I tried to take Concerta, after I'd been on Dexedrine for a while, I got very sluggish, dull, depressed and tearful. I thought that meant that Concerta was no good for me and made me depressed. I tried this Dex to Concerta/ritalin switch on a number of occasions, but I kept giving up on MPH too soon. Finally, this past fall, I spent many weeks off of Dex, and I was finally able to see what MPH was doing on its own. So, don't give up. Give it at least a few weeks.
As for Focalin, as I said in the previous post, I tried it for only a couple of days, so the only thing I have to say about it is that it's very intense, very potent, and be sure to start with a small dose.
Bekka
Posted by Ritch on April 20, 2002, at 8:39:34
In reply to Re: switch from ritalin to ?-Ritch/Mitch, posted by Bekka H. on April 19, 2002, at 23:38:14
> > Bekka,
> >
> > Thanks for replying. This is just an experiment. I was just written for 15 tabs of 5mg. I am between major depressions and now is the time to experiment with different meds that can work for the potentially life-threatening depressions (and to check to see how my mood is affected). We already know that stimulants (Adderall, thus far) has worked better than anything else without triggering hypomania/cycling (and that at just 5mg/day for several weeks), BUT, I got too nervous with the Adderall, and plain Dexedrine actually made me drowsy, groggy, and on average I made more mistakes at work. So, we are trying to find the success with major depression and ADHD(without rapid cycling) that I got with the Adderall but without the *anxiety*. I was told if this works I will probably flip to Concerta (see if I am still responding positively). If it doesn't-then we are going to be looking at selegiline or add back nortriptyline-very cheap and works, but cycling is affected, I get numbness, and Q-T interval is prolonged, and it is more toxic than stimulants in overdose (wonderful).
> > Mitch
>
> ***********************************************
>
> Hi Mitch,
>
> It looks as if you and I have some symptoms and medication responses that are very similar. I have one other word of caution that I think I should mention regarding methylphenidate/mph (you said you might try Concerta). . .Switching from an amphetamine (either Dexedrine or Adderall) to methylphenidate can be a little bit difficult at first. For me, it takes one to two weeks of Dexedrine withdrawal before I can even tell how methylphenidate is affecting me. I'm referring to a withdrawal period that occurs even though I might be on another stimulant (mph, for example). The first time I tried to take Concerta, after I'd been on Dexedrine for a while, I got very sluggish, dull, depressed and tearful. I thought that meant that Concerta was no good for me and made me depressed. I tried this Dex to Concerta/ritalin switch on a number of occasions, but I kept giving up on MPH too soon. Finally, this past fall, I spent many weeks off of Dex, and I was finally able to see what MPH was doing on its own. So, don't give up. Give it at least a few weeks.
>
> As for Focalin, as I said in the previous post, I tried it for only a couple of days, so the only thing I have to say about it is that it's very intense, very potent, and be sure to start with a small dose.
>
> Bekka
Bekka,I have already been off dexedrine for about a week now. The first day or two off of it was kind of icky, but not that bad. So, by the time I try the Focalin it will probably be nearly two weeks off the dexedrine. I plan on just taking half a tab (2.5mg), which is the same thing I did when I first tried Adderall and then Dexedrine. I plan on just trying it for a two-three day stretch 2-3 doses/day during the week while I am working and see how I react to it. So, I will be looking at several variables: 1) Does it make me irritable? (Adderall did somewhat-but dex didn't), 2) Does it make me anxious around others?, 3) Does it improve my ability to hear and decode speech more readily? 4) Do I make fewer or more mistakes at work-is it making me "overfocus", etc. 5) What is the "crash" like-how is my sleep affected?, etc.etc.
Mitch
Posted by Pogo on April 26, 2002, at 19:20:09
In reply to switch from ritalin to ? for add, opinions?, posted by katekite on April 18, 2002, at 19:31:13
Hi Kate,I'm on a pretty high dose of Ritalin, with no
adverse reaction. The only problem I had was when
I first started on a relatively low dose, I unwittingly drank coffee. My thoughts speeded up and my mind became all the more out of focus. I read medical reports that caffeine can over stimulate when combined with Ritalin- my reactions mirrored the medical literature.regards,
Pogo.
Posted by Phil on April 27, 2002, at 7:10:13
In reply to Re: switch from ritalin to ? for add, opinions? » Ritch, posted by katekite on April 19, 2002, at 15:07:01
Kate, Sorry if someone has already said this, I haven't read all of your replies.
My questions: Your age
Family history of high blood pressure or heart probs
I wouldn't switch to any stim w/o a thorough physical and, if needed, a stress test(treadmill).
What has your doc said?
What, if any, are your other meds?
I took Ritalin for years, great drug. I tried Adderall, great drug. I tried Adderall XR, I like it the most. I took 40-50 mg daily of Ritalin and take 2 30mg time released Adderall a day. One when I get up in the morning and the other around 11-12.
My shrink tells me she's never seen anyone tolerate the amt of drugs I take. With the Adderall, I take 400 mg Wellbutrin SR, 60 mg Celexa, 2-3 mg Clonazepam. When I started AD's 20 years ago, I took 250-275 mg of Amitriptyline.Let us know, okay,
Phil
Posted by katekite on April 27, 2002, at 11:07:24
In reply to switch from ritalin to ? for add, opinions?, posted by katekite on April 18, 2002, at 19:31:13
Posted by karanan on April 28, 2002, at 1:34:38
In reply to switch from ritalin to ? for add, opinions?, posted by katekite on April 18, 2002, at 19:31:13
I read the post and responses, and just want to emphasize one point...Let me explain. We may all search (I'm guilty of this also) to find the perfect "medication." I may be even more guilty of this, since I'm a physician who suffers from ADHD. However, with time and experience, I have seen that people react to medications differently. 5mg of ritalin may cause a 300 lb. male to run 10 miles, while 20mg of ritalin may not have any effect on a 110 lb. female. Also, it may be possible that different dosages may be necessary at different times in our lives. We may develop tolerance to one medication, and thus need to change to another. I've been on 36mg concerta qAM for 6 months, and feel as though it has lost its efficacy. Prior to that, I was on Adderall for 1 year....Same thing...worked at the beginning and then "burned out." Conclusion..."There is no wonder drug."
Posted by IsoM on April 28, 2002, at 1:42:37
In reply to Re: switch from ritalin to ? for add, opinions? » katekite, posted by karanan on April 28, 2002, at 1:34:38
Karan, as someone who has ADHD too, have you ever tried Provigil for your ADHD?
I haven't posted on PB much the last week or two but don't know if you've read the threads on adrafinil or modafinil previously. I know some have benefited wonderfully from it while others can't tolerate it. I've tried Ritalin briefly & used Dexedrine before, but I now use adrafinil (olmifon made by a French pharmaceutical company) & have found it my "wonder" drug, not just for ADHD but for depression & motivation too. The effects are smooth & long-lasting - no peaks & valleys but the same effects throughout the day, day after day.
I'm curious if you, as a physician, have ever tried it?
Posted by karanan on April 28, 2002, at 2:01:27
In reply to Have you ever used...? » karanan, posted by IsoM on April 28, 2002, at 1:42:37
Hi Isom, I haven't tried Provigil yet....but would be interested in hearing anyones experience. I have only used methylphenidate as (Ritalin and Concerta), and mixed amphetamines salts (Adderall) immediate release. Its my first time posting, although I've visited the site many times.......But I'm here as a fellow patient. Take care, and be well.
Posted by IsoM on April 28, 2002, at 5:05:56
In reply to Re: Have you ever used...?, posted by karanan on April 28, 2002, at 2:01:27
E-mail me, if you wish, & I'll give you a breakdown of how my experiences with it & its benefits. I've honestly had no ill effects whatsoever. It even enabled me to discontinue my last small dose of Paxil I was on without experiencing those "more-than-annoying" (to say the least) discontinuation problems of SSRIs. An absolutely wonderful medication for me. I can't begin to say enough good about it.
Posted by katekite on April 28, 2002, at 14:15:31
In reply to Re: switch from ritalin to ? for add, opinions? » katekite, posted by karanan on April 28, 2002, at 1:34:38
Thanks for your post. I don't really believe there is a wonder drug either. Certainly there must be a least-of-evil drug though. --kate
Posted by Cressida on April 29, 2002, at 11:56:25
In reply to Re: switch from ritalin to ? for add, opinions? » karanan, posted by katekite on April 28, 2002, at 14:15:31
I've been taking 36mg of Concerta for quite a while, but I've tried Adderall and Dexedrine. I liked Adderall until I reached 30mg 2x/day. Unfortunately, it was too stimulating; it magnified my OCD and aggravated my anxiety. Dexedrine didn't seem to affect me that much. Concerta seems to be losing its affect, especially since I started taking 100-125mg of Seroquel at night for insomnia. Does anyone have experience with the 56mg dose of Concerta? I wonder if it would be too much. I used to take regular Ritalin at 20mg 2x/day, but I stopped because of unusual itching. Does anyone think, in their best opinion, that would happend again if I switched to a higher dose of Concerta? Was the itching possibly an allergic reaction? Also, is that a common side-effect of treatment with high doses of methylphenidate?
Posted by Ritch on April 29, 2002, at 12:39:05
In reply to Re: Concerta..., posted by Cressida on April 29, 2002, at 11:56:25
> I've been taking 36mg of Concerta for quite a while, but I've tried Adderall and Dexedrine. I liked Adderall until I reached 30mg 2x/day. Unfortunately, it was too stimulating; it magnified my OCD and aggravated my anxiety. Dexedrine didn't seem to affect me that much. Concerta seems to be losing its affect, especially since I started taking 100-125mg of Seroquel at night for insomnia. Does anyone have experience with the 56mg dose of Concerta? I wonder if it would be too much. I used to take regular Ritalin at 20mg 2x/day, but I stopped because of unusual itching. Does anyone think, in their best opinion, that would happend again if I switched to a higher dose of Concerta? Was the itching possibly an allergic reaction? Also, is that a common side-effect of treatment with high doses of methylphenidate?
I think dermatological things are common with stimulants. Mostly dermatitis-itching-etc. I got itchiness from Adderall (between my fingers-strange!), also got a little bit of itchiness with Dexedrine (on my arms), got some itchiness with Effexor (everywhere), some itchiness with Wellbutrin (on my legs). I think they all belong to the same chemical class ..phenylethylamines. You may have some sensitivity to that. The Concerta may be smooth enough that it doesn't trigger the itching. Oh, BTW, they are going to be marketing a 47mg dose of Concerta soon (if not already). You might ask your doc about jumping to that one first.
hope this helps,
Mitch
Posted by Cressida on April 29, 2002, at 15:31:23
In reply to Re: Concerta... » Cressida, posted by Ritch on April 29, 2002, at 12:39:05
Annotation: There's now a 27mg tablet for Concerta. As far as I am aware there aren't any plans for a 47mg dose.
Posted by Ritch on April 29, 2002, at 23:10:05
In reply to Re: Concerta...Dose Correction » Ritch, posted by Cressida on April 29, 2002, at 15:31:23
> Annotation: There's now a 27mg tablet for Concerta. As far as I am aware there aren't any plans for a 47mg dose.
Oops! Yes, that is correct. I wonder though, if they will come out with a 45mg dose? That would fall evenly between 36mg and 54mg like the 27mg falls between 18mg and 36mg. ??
Thanks for the correction,
Mitch
This is the end of the thread.
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