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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 jealibeanz on February 8, 2007, at 10:31:36
Does anyone else seem to have major problems with controlled release drugs? I just don't metabolize them in the manner in which the companies claim.
Concerta is supposed to last 12 hours. It worked for about 4.
I'm now taking Ritalin LA, which is supposed to last 8-12 hours. It only lasts about 3-4 hours with me. I'm taking 30mg b.i.d. That's the max dose I think.
Am I completely abnormal? My doctor was surprised when I told him about the Concerta.
Posted by Phillipa on February 8, 2007, at 11:03:11
In reply to Metabolism and Controlled Release Drugs, posted by jealibeanz on February 8, 2007, at 10:31:36
Well I heard extended release xanax needed regular xanax with it as it didn't hold patients maybe the same with the ADD meds? Phillipa
Posted by med_empowered on February 8, 2007, at 11:10:05
In reply to Re: Metabolism and Controlled Release Drugs » jealibeanz, posted by Phillipa on February 8, 2007, at 11:03:11
I think its pretty normal...when I took Ritalin LA, it would come in spurts: on, off, way too on, off again...kind of the same with adderall xr, but to a lesser, more tolerable extent.
Would your doc rx straight up, generic Ritalin (or amphetamine) ? IRs are cheaper and personally, I find it easier to work out the right dosage and right dosage schedule when using them, b/c they're so predictable: take on an empty stomach, avoid fatty foods and fruit juice for about an hour, and see how you feel. Plus, you can divide the dosing up as you need it--usually 2-3 times a day.
There's a ritalin patch out, I think--daytrana, maybe?--but paying $$$ for a patch when a pill would do just as well seems a bit ridiculous to me.
Posted by dbc on February 8, 2007, at 11:51:42
In reply to Re: Metabolism and Controlled Release Drugs, posted by med_empowered on February 8, 2007, at 11:10:05
My doctor is an old hippy man and he has a very poor opinion of any controlled release/xr drugs and assures me they're simply plots to extend companies patents on drugs and he wont take part in their game. I had to beg him effexor XR because the half life of effexor sucks so damn much.
But when it came to stimulants this was actually a good thing. I would much rather take 15mg of IR dexedrine (3x daily) at a time than some crappy 15mg spanule. They last the same amount of time for most people and *gasp* the IR works much better.
Posted by jealibeanz on February 8, 2007, at 11:58:23
In reply to Re: Metabolism and Controlled Release Drugs » jealibeanz, posted by Phillipa on February 8, 2007, at 11:03:11
> Well I heard extended release xanax needed regular xanax with it as it didn't hold patients maybe the same with the ADD meds? Phillipa
There are allll sorts of release mechanisms with medications. So we can't really generalize. But I do know that the effects can be unpredictable, especially in certain patients.
A lot of people criticize the XR,ER,LA,CR versions of meds as patent-extenders. I don't, even though I've been less than pleased with my experiences with such medication. I do believe they are beneficial to those who do well with them. They avoid the "peaks and valleys", plus allow fewer doses per day. So I think they're a great option if they work for you!
I think Xanax XR has an "enteric coating" on the tablet, which allows it to be slowly released.Ambien CR is almost like Xanax XR coated by Xanax IR, in terms of release mechanism. There's an immediate release of Ambien, the a coated portion underneath to be slowly released hours later. I hope that analogy makes sense!
Concerta is odd.I don't think there's any other med like it in term of physical release structure...It's a casule... there's 1 initial burst, then within the capsule, there's two compartments. Each is to be released at about 4 hours intervals. I think they both contain a powder form of the drug, which somehow turns into a gel-like substance. This is done to allow it to be released over a long time period, plus there's little abuse potential (i.e. snorting to get high).
Ritalin LA is a capsule. It contains beads. The beads themselves have the enteric coating, I believe, which is responsible for the long-acting nature of the drug. I know the capsules can be opened, and sprinkled on food for those who can't swallow it whole, but the beads aren't to be crushed, or else they release immediately.(I believe this is similar to Effexor XR. I know people open the capsule and count out beads to wean off of the med sometimes.)
Sooo, anyway, enough with the talk about drug release mechanisms and my personal beliefs and experiences. I just get the feeling that my body has a difficult time metabolizing them properly. Hopefully not all.I've never used a stimulant with an enteric coating. I used Ambien CR for a few days... and yes, I was one of those people sleeping-walking/driving in the middle of the night like I was stoned... so I stopped it.
Does Focalin XR have an enteric coating?
Posted by jealibeanz on February 8, 2007, at 12:12:49
In reply to Re: Metabolism and Controlled Release Drugs, posted by med_empowered on February 8, 2007, at 11:10:05
> I think its pretty normal...when I took Ritalin LA, it would come in spurts: on, off, way too on, off again...kind of the same with adderall xr, but to a lesser, more tolerable extent.
> Would your doc rx straight up, generic Ritalin (or amphetamine) ? IRs are cheaper and personally, I find it easier to work out the right dosage and right dosage schedule when using them, b/c they're so predictable: take on an empty stomach, avoid fatty foods and fruit juice for about an hour, and see how you feel. Plus, you can divide the dosing up as you need it--usually 2-3 times a day.
> There's a ritalin patch out, I think--daytrana, maybe?--but paying $$$ for a patch when a pill would do just as well seems a bit ridiculous to me.I'm sure my doc would do IR if I asked about it. Since I've been trying to get a methylphenidate drug to reach therapeutic levels for 4 months now, without much luck (Concerta and Ritalin LA).
I hate the idea of constant dosing, but I do it with Xanax and I do it with my coffee and diet coke, so it's not much different. Plus, it would allow me to control the amount needed on a daily basis. He's pretty liberal and trusting of me.
Both meds seem to work like magic... for the first day. Then just sorta poop-out, but not completely. If I don't take them at all I feel fluish.. tired, achy muscles, cranky, sore throat...
I was on Provigil for a few months. This actually has that "magic effect" for months, rather than a day, then eventually gave little benefit. I think Provigil is just an immediate release drug with a long half-life, but I may be wrong. (and it's not this magic drug that allows people to stay awake for days without fatigue or sleep debt, at least not if taken regularly. Haha, I hate when the media makes comments about this drug... as if it's new and mysterious.)
Although, taking breaks helps to jump-start the therapeutic effect, I simply can no longer function without any meds for a day. I'm far too tired and accomplish nothing.
This isn't good since I'm a full-time student, was overloaded x2 as a grad student for the last 6 months, and am currently trying to get into a med school. I need energy and focus and memory and stamina! I a very physically fit person and eat healthily, so I don't have those issues to deal with. Plus I sleep great with the help of Lunesta.
I do take Ritalin or Concerta on an empty stomach, and do eat fatty meals.The only reason my insurance is covering Ritalin right now is because finalllly, after 4 months, we had to jump through enough hoops with the pharmacy, insurance company, and doctor's office to get it approved... for narcolepsy. It was initially turned down for ADHD, since I'm not between ages 5-18. Then it was turned down for narcolepsy until the insurance company told my doc exactly what he had to say, due to other meds I'm on, to get it approved! Whoa! Quite a process.
Anyway, I'm not sure he could get the Daytrana patch approved for narcolepsy. But I'm unsure.
Posted by laima on February 9, 2007, at 6:37:16
In reply to Metabolism and Controlled Release Drugs, posted by jealibeanz on February 8, 2007, at 10:31:36
YES! I found extended xanax to be a mere shadow of the regular version, Ritalin LA barely worked for me and when it did, just for a very short time. Meanwhile, regular ritalin very potent and lasting. Tried Concerta briefly- it didn't seem to do anything for me at all. I didn't metabolize these drugs how the companies claimed, either.
> Does anyone else seem to have major problems with controlled release drugs? I just don't metabolize them in the manner in which the companies claim.
>
> Concerta is supposed to last 12 hours. It worked for about 4.
>
> I'm now taking Ritalin LA, which is supposed to last 8-12 hours. It only lasts about 3-4 hours with me. I'm taking 30mg b.i.d. That's the max dose I think.
>
> Am I completely abnormal? My doctor was surprised when I told him about the Concerta.
Posted by laima on February 9, 2007, at 6:42:56
In reply to Re: Metabolism and Controlled Release Drugs » jealibeanz, posted by laima on February 9, 2007, at 6:37:16
Oh- I tried the ambien CR, too. Not only did I not go to bed easily with it- even when I did go to bed, I woke up quite early, or even in the middle of the night. I never tried the regular version- but my point is, a generous adult dose didn't result in any full night's sleep in my case. Sorry, don't remember what the dose was, but I asked the pharmacist about it, and she said mine was a pretty generous one.Maybe it's those coatings on the medications?
I think the point of the daytrana patch is supposed to be so kids don't have to go to the school nurse for their ritalin during the school day.
Posted by jealibeanz on February 9, 2007, at 6:54:54
In reply to Re: Metabolism and Controlled Release Drugs » jealibeanz, posted by laima on February 9, 2007, at 6:37:16
>
> YES! I found extended xanax to be a mere shadow of the regular version, Ritalin LA barely worked for me and when it did, just for a very short time. Meanwhile, regular ritalin very potent and lasting. Tried Concerta briefly- it didn't seem to do anything for me at all. I didn't metabolize these drugs how the companies claimed, either.
>This makes me feel better. I was beginning to lose hope... that I don't really have ADHD and abnormal fatigue... just really messed up and like to try new meds every month.
I'll have to explain to my doctor that with both Concerta and Ritalin LA only worked for a short period of time, and ask that might be if they're supposed to be controlled release.
When the medication works, it works, but verrry briefly. I'd be OK with that if I were taking an IR version, but I'm not. It just makes me feel like a freak.
I don't want him to simply ramp up the dosage, although that may help if I do and take it 3-4 times a day ... which is seriously what I would need. He was about to do 20mg t.i.d. because he didn't realize initially that there was a 30mg capsule.
Posted by jealibeanz on February 9, 2007, at 7:27:47
In reply to Metabolism and Controlled Release Drugs, posted by jealibeanz on February 8, 2007, at 10:31:36
I also need to remember to tell him that I self-medicate with lots of caffeine (even with 60 mg of Ritalin LA!). Most people can't stand extra caffeine when on a therapeutic dose. I know I couldn't with Straterra or Provigil. Someone remind me to tell him! :)
Posted by jealibeanz on February 9, 2007, at 22:15:37
In reply to Re: Metabolism and Controlled Release Drugs, posted by jealibeanz on February 9, 2007, at 7:27:47
Maybe I should start opening the capsules and chewing the beads. This would make them all immediate release. At least then I'd be getting the entire drug, since seems that the half that are time released aren't doing anything.
Posted by elanor roosevelt on February 10, 2007, at 11:06:22
In reply to Re: Metabolism and Controlled Release Drugs, posted by dbc on February 8, 2007, at 11:51:42
aren't most CR drugs produced for the profit of the pharma companies?
Posted by Larry Hoover on February 10, 2007, at 20:57:42
In reply to Re: Metabolism and Controlled Release Drugs, posted by elanor roosevelt on February 10, 2007, at 11:06:22
> aren't most CR drugs produced for the profit of the pharma companies?
I can't imagine that's the case. Drugs with short half-lives, or with quick onset withdrawal symptoms, can be difficult to manage. Controlled release, extended release, continual release, all help the patient maintain more stable blood concentrations of the drug. At least, in theory.
The technology behind XR tablets is not owned by one drug company. It is licensed out by a third party company. One of the continual release technologies is also held by a non-pharmaceutical company. Of course, these are more costly than the IR tablets.
I'm sure the pharmaceutical companies expect to have increased market share, if their product is more convenient, or safer to use. But they can't market CR drugs unless the IR drug has some practical shortfall to begin with.
Lar
Posted by jealibeanz on February 10, 2007, at 21:05:19
In reply to Re: Metabolism and Controlled Release Drugs » elanor roosevelt, posted by Larry Hoover on February 10, 2007, at 20:57:42
I *believe* it's initially easier to get drugs FDA approved in its simplest form. That's one reason why the ER/XR/CR/LA versions aren't released first.
Posted by elanor roosevelt on February 10, 2007, at 22:24:41
In reply to Re: Metabolism and Controlled Release Drugs, posted by jealibeanz on February 10, 2007, at 21:05:19
well it seems that CR's often come out after the cost of the primary med has dropped
Posted by jealibeanz on February 11, 2007, at 6:35:29
In reply to Re: Metabolism and Controlled Release Drugs, posted by elanor roosevelt on February 10, 2007, at 22:24:41
OK, I've basically realized without doubt that the controlled release mechanisms of both Concerta and Ritalin LA don't work for me, as stated.
I did try opening the capsules and chewing the beads. This does seem to be more effective and lasts longer than just swallowing the capsule. Obviouisly this isn't a good choice long-term, especially since it's not what my doctor prescribed me to do. I think it lasts longer simply because a higher dose of a stim will last longer than a lower dose... so now I'm pretty much getting 30mg IR, instead of the 15 IR and nothing else.
So, I'm looking for a controlled release stimulant that doesnt use the same formula as Ritalin LA... the coated beads within a capsule.
Methylin ER is a coated tablet. The picture just looks like as Aspirin tablet. This seems like an option.
Metadate ER is also available in coated tablets. I've never seen a picture.
Ritalin SR is also a coated tablet. I've heard poor reviews of this formulation is comparison to the IR and LA version. But who knows... it may work for me.
Are there any others I should know about? What do you think of my idea?
Posted by Sebastian on February 11, 2007, at 14:16:34
In reply to Metabolism and Controlled Release Drugs, posted by jealibeanz on February 8, 2007, at 10:31:36
I had a similar problem with wellbutrin XL, but not SR.
Posted by laima on February 12, 2007, at 7:53:08
In reply to Re: Metabolism and Controlled Release Drugs, posted by elanor roosevelt on February 10, 2007, at 11:06:22
In the case of stimulants, the rationale I heard was to even out the peaks and dips (even crashes for some cases) into a more even experience across the day.> aren't most CR drugs produced for the profit of the pharma companies?
Posted by jealibeanz on February 12, 2007, at 9:47:38
In reply to Re: Metabolism and Controlled Release Drugs » elanor roosevelt, posted by laima on February 12, 2007, at 7:53:08
>
> In the case of stimulants, the rationale I heard was to even out the peaks and dips (even crashes for some cases) into a more even experience across the day.
Yes, that is true. They are beneficial when they work properly.
Posted by jealibeanz on February 12, 2007, at 12:51:06
In reply to Re: Metabolism and Controlled Release Drugs, posted by jealibeanz on February 12, 2007, at 9:47:38
I'm getting so frustrated now:(
I do see my doc in a few weeks again, so I don't have to struggle too long. He's very good at working with me and helping in any way possible.
I guess I need to ask him straight out if there's another stimulant he thinks might work better, or if there's another formulation of Ritalin that I might be about to metabolize efficiently, since both LA and Concerta were just not working the way they should :(
Posted by elanor roosevelt on February 13, 2007, at 11:29:06
In reply to Re: Metabolism and Controlled Release Drugs » elanor roosevelt, posted by laima on February 12, 2007, at 7:53:08
read the posts
and you will find that in many cases the CR is not an improvement
sometimes it is
but the timing of the new CR release is often when the med goes generic
Posted by jealibeanz on February 13, 2007, at 19:10:10
In reply to Re: Metabolism and Controlled Release Drugs, posted by elanor roosevelt on February 13, 2007, at 11:29:06
> read the posts
> and you will find that in many cases the CR is not an improvement
> sometimes it is
> but the timing of the new CR release is often when the med goes generic
>I thought a lot of people do well with controlled release. Maybe I'm just swayed by the docs and drug reps who brainwash them.
I don't know what to do anymore. By early afternoon I've already crashed hard, after my 2nd dose of LA has worn off... so very quickly.I always take it first thing, at 5AM when I get up... my next few hours are spent working out and getting ready for the day. Maybe I'll try delaying the initial dose for now, so I can be able to study in the afternoon.
I seem to crash harder every day. This is not fun. I definitely need a change.
Posted by laima on February 13, 2007, at 21:22:23
In reply to Re: Metabolism and Controlled Release Drugs, posted by jealibeanz on February 13, 2007, at 19:10:10
Would your Dr. go for adding a dose of regular ritalin in the afternoon, do you imagine? If you get up at 5am, it's really getting on in the day then for you by afternoon. Or if Dr. finds that too complex, do you think he/she would consider letting you simply try 3 doses regular instead of 2 LA? Personally, I always thought that the regular lasted just about as long as the LA- though no one ever believed me. And I found it overall more effective. Possibly you might also?
Posted by jealibeanz on February 14, 2007, at 4:00:13
In reply to Re: Metabolism and Controlled Release Drugs » jealibeanz, posted by laima on February 13, 2007, at 21:22:23
>
> Would your Dr. go for adding a dose of regular ritalin in the afternoon, do you imagine? If you get up at 5am, it's really getting on in the day then for you by afternoon. Or if Dr. finds that too complex, do you think he/she would consider letting you simply try 3 doses regular instead of 2 LA? Personally, I always thought that the regular lasted just about as long as the LA- though no one ever believed me. And I found it overall more effective. Possibly you might also?I think he'd go for immediate release, and probably at least 3 times a day, more if I need it eventually for academics/school. I'm lucky enough to have only a 12 credit load right now... with all but one courses online.... a far cry from the 11 grad courses all on-campus last semester, so I can afford to have these bad days where I sleep a lot.
He added a 4th dose of Xanax when I told him 3 weren't lasting long enough.
I have no trouble believing that IR can last as long as LA. If the long-acting portion is the part you aren't metabolizing well, that makes sense. I can't imagine the med lasting much shorter than the few hours is get from LA.
Which stims are best for concentration/energy without crashing? I'm hearing conflicting views regarding Focalin and Ritalin. I have major GAD too (thus, the Xanax), but find coffee very calming, so I know stims can relax me if it's the "right" one for me.
Adderall made me sick... up/down/hot/cold... muscle clentching... anxiety... until I very quickly went into a horrible horrible depression and onto Effexor XR! I don't know if I had Adderall XR, but for some reason a dose of 12.5mg sticks in my head. I think I may have been taking it twice a day, but I could be wrong. The last time it was prescribed was October 2005.
Posted by laima on February 14, 2007, at 8:20:26
In reply to Re: Metabolism and Controlled Release Drugs » laima, posted by jealibeanz on February 14, 2007, at 4:00:13
I'm currently feeling very impressed with the brand name (Shire) regular release adderall for not losing its effectiveness, and for not crashing. I'm finding it to be so different from the generic "adderall" that I was using, that it's not even like the same drug. Night and day difference. Ritalin and generic adderall wearing off, on the other hand, left me feeling moodily vulnerable by comparison.
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