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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by sometimesblue on November 12, 2007, at 15:57:55
I've been on Methylin for 4 days now, and i've noticed it makes me cold...my hands and feet start freezing and i get clammy hands??
Anyone else ever experience this? Is it normal?
-SB
Posted by d0pamine on November 12, 2007, at 19:28:51
In reply to Anyone ever COLD while on RITALIN?? Freezing?, posted by sometimesblue on November 12, 2007, at 15:57:55
Yup. Also experienced it with adderall and dex.
"Cold hands are a sign of an overactive autonomic nervous system. More specifically, the signs of an overactive sympathetic nervous system. Our emotional and physiological self are controlled by the autonomic nervous system - a system that increases and decreases our heart rate, breathing rate, etc. One group of nerves "speeds" us up and one group of nerves "slows" us down. These groups are known as the sympathetic nerves and parasympathetic nerves. When the sympathetic nerves are fired (stimulated) the heart rate increases and blood is shunted from our hands, feet, and abdomen to our large muscle groups such as thighs and hips. Many muscles tense during this stimulation. This is a primitive reflex response which prepares us to flee from a threatening situation. (remember in high school biology the fight or flight response?) The parasympathetics, when stimulated, slows the heart rate down, causing rest, relaxation, and eventually sleep. During parasympathetic stimulation blood flows throughout the body and into the abdominal organs (to help digestion, etc)."
This over stimulation of the sympathetic nervous system (which more importantly also results in an under active parasympathetic nervous system) has always been my primary health concern with stimulant or stimulating meds. A healthy parasympathetic balance is an absolute prerequisite for longterm health. A reasonable balance really should be possible, but I always struggle with balance.
Posted by seldomseen on November 13, 2007, at 7:39:52
In reply to Anyone ever COLD while on RITALIN?? Freezing?, posted by sometimesblue on November 12, 2007, at 15:57:55
It's a vaso-constrictor and forces blood out the tiny vessel beds in your hands.
The clamminess (sweatiness) is a reaction of the parasympathetic nervous system to sympathetic activation.
Caffeine does the same thing to me
Posted by sometimesblue on November 13, 2007, at 9:07:35
In reply to Re: Anyone ever COLD while on RITALIN?? Freezing?, posted by d0pamine on November 12, 2007, at 19:28:51
So, if it happens does that mean [how can i put this]...that [in my case] the ritalin maybe isn't the drug for me?/ Or, maybe I just have to get used to it/adjust? I just don't want to worry if it IS normal.
Posted by d0pamine on November 13, 2007, at 14:12:25
In reply to Re: Anyone ever COLD while on RITALIN?? Freezing? » d0pamine, posted by sometimesblue on November 13, 2007, at 9:07:35
> So, if it happens does that mean [how can i put this]...that [in my case] the ritalin maybe isn't the drug for me?/ Or, maybe I just have to get used to it/adjust? I just don't want to worry if it IS normal.
This is a "normal" response to stimulant use, but I personally don't find that terribly comforting.... Hmmm Sometimes I wonder if I'm not becoming to much of a pharmaceutical pessimist to continue troubling you folk.... Anyway after a good number of years of switching between ritalin adderall and d-amphetamine I personally decided that the physical toll taken on my mind and body by chronic stimulant use wasn't worth the benefit I derived from it. At the very least I'd advise keeping an occasional eye on your blood pressure when the cold extremities are at their peak. Yeah I know, "gazillions of people use the stuff", but I'd still encourage anyone to diligently research the potential longterm negatives to this course of medication, the entire time they're on it.
Posted by sometimesblue on November 13, 2007, at 14:26:31
In reply to Re: Anyone ever COLD while on RITALIN?? Freezing?, posted by d0pamine on November 13, 2007, at 14:12:25
Posted by kaleidoscope on November 13, 2007, at 15:16:03
In reply to Re: Anyone ever COLD while on RITALIN?? Freezing?, posted by d0pamine on November 13, 2007, at 14:12:25
Long-term use of stimulants may increase the risk of cardiovascular disease. This is a major concern. Stimulants constrict blood vessels and elevate BP. They also increase heart rate and cardiac work. Regular BP monitoring is very important when taking stimulants. High BP causes heart attacks and strokes, even small increases in BP of a few mmHg produce a large increase in risk. In addition, stimulant use has occasionally been associated with strokes and sudden cardiac death in children. Numerous cardiovascular warnings have recently been added to the prescribing information for all stimulants ie. Adderall, Ritalin, Concerta, Dexedrine etc.
Drugs which inhibit the sympathetic nervous system (eg. beta blockers such as Toprol) are used to prevent heart attacks. Stimulants may increase your risk. This important issue has received very little research attention, which is really very poor considering how frequently these drugs are prescribed in the US...... and I say the US because stimulants are used so much less commonly in most countries. The US is without a shadow of a doubt the stimulant capital of the world! I think this has a lot to do with a culture of academic achievement in combination with the widespread medicalisation of normal symptoms which affect most people eg. poor attention, daydreaming, dislike of boring school/college work. Pharmaceutical companies are phenomenally influential in the US and are very very apt at promoting their products.........which are approved based on short-term efficacy studies and lack of long-term safety data. Although stimulants have been used in medicine for decades, their long-term cardiovascular safety has never been properly investigated. In the absense of proper trials, it would be foolish to assume that they are safe, particularly when you consider the effectiveness of drugs which block the effects of the sympathetic nervous system in preventing heart attacks and strokes. In addition, beta blockers and related drugs increase survival in patients with established cardiovascular disease. Given that most cardiovascular disease occurs in adults, and not children, the recent trend toward prescribing stimulants to large numbers of adults with ADHD is a concern.
Posted by d0pamine on November 13, 2007, at 15:48:35
In reply to Cardiovascular toxicity of stimulants, posted by kaleidoscope on November 13, 2007, at 15:16:03
Beta blockers.... More candy that doctors are handing out without explaining (or possibly even understanding) the long term risks. It's so hard to win at this chemical game. I've done (and lost) at the beta blocker game too. If your curious, Google beta blockers and diabetes. Some studies have apparently indicated a greatly increased risk (50%) of developing this condition with continual use of beta blockers. They have other risks too. It honestly sometimes seems to me that none of these solutions patch anything without making an irreparable mess of something else.
Posted by linkadge on November 14, 2007, at 15:53:09
In reply to Re: Cardiovascular toxicity of stimulants, posted by d0pamine on November 13, 2007, at 15:48:35
The above post by kaleidoscope was very good. I have had blood pressure on stimulants that most doctors would consider borderline high. They were reluctant to prescribe heart medications since it was drug induced, and a little less than high.
Anyhow, it has been an issue that bothered be for a while. I heard they stopped useing desipramine in children with ADHD in many European countries due to cardiovascular complications.
I don't really see how staterra is any different, or other stimulants for that matter.
I have stopped many highly effective medications because of this reason. It is a shame that they can't find ways to elevate monoamines in critical regions without affecting the rest of the body.
I think that psychiatry is guilt of not being well integrated with the rest of medicine.
At lot passes the radar on the premise that psychiatric problems justify harsh treatments.
I think its very unfair. Consider a child on high doses or ritalin. As an adult coming off they may not only have to face the prospect that their reward systems may never function normally again without the drug, but now they are at elevated risk for heart disease. Double whammy.
Linkadge
Posted by linkadge on November 14, 2007, at 15:56:38
In reply to Re: Cardiovascular toxicity of stimulants, posted by d0pamine on November 13, 2007, at 15:48:35
I also agree with dOpamine. It always seems like there is an unnaceptable side effect profile for many drugs. You just can't win.
Sure in the short term, certain drug use might be justified, but to be frank, I don't really want to get started on a drug that I will enevitably have to quit for safety reasons. I have a lot of recurring problems, so the long term safety of many drugs is a big issue for me.
And then the ones with no side effects are the ones that don't do anything.Linkadge
Posted by linkadge on November 14, 2007, at 16:00:19
In reply to Re: Cardiovascular toxicity of stimulants, posted by linkadge on November 14, 2007, at 15:56:38
One other unexplored issue about ritalin is this.
I just read a study that showed that a metabolite of ritalin was a potent 5-ht2b agonist.
The study (I will try to find) inferred that this may be of relavance to its calming action, as 5-ht2b agonists tend to supress locomotor activity.
Anyhow, 5-ht2b agonists can directly dammage the heart, ie pergolode type of mechanisms.
So, not only is it raising blood pressure, which is a risk for heart problems, it may also cause subtle dammage to heart valves (dending on the affinity of binding).
Linkadge
Posted by War-Face on November 14, 2007, at 20:53:25
In reply to Re: Cardiovascular toxicity of stimulants, posted by linkadge on November 14, 2007, at 15:53:09
> At lot passes the radar on the premise that psychiatric problems justify harsh treatments.Amen to that.
With regard to Ritalin, it just FEELS bad for the body when using it. I had chest pains for most of the time I took it. You always hear stories about millions of people taking it, some for 30 or 40 years, without any serious health problems. I have to think however that the longterm effects over a large sampling are mostly unknown. At the same time, my ADD is really lousy without Adderall for the past month.
I suppose we all need to weigh our own potential risks and benefits from every medication. But of course, this presumes that potential risks are being fully disclosed to the drug consumers, even if actual risks are not fully understood. I fear that average consumer of psychopharmas doesn't really understand the risks to rationally make the decision for themselves, either because of the lack of disclosure of known risks, or because of lack of research or data collection on a drug's use history.
Posted by linkadge on November 14, 2007, at 21:53:40
In reply to Re: Cardiovascular toxicity of stimulants » linkadge, posted by War-Face on November 14, 2007, at 20:53:25
Sometimes I think too that the more popular the drug, the larger the coverup.
Its easy to say that some obscure drug that nobody takes is linked to cancer, but if its something everbody takes, perhaps they are more likely to want to cover things up.
Linkadge
Posted by Astounder on November 15, 2007, at 22:24:40
In reply to Cardiovascular toxicity of stimulants, posted by kaleidoscope on November 13, 2007, at 15:16:03
> Long-term use of stimulants may increase the risk of cardiovascular disease. This is a major concern. Stimulants constrict blood vessels and elevate BP. They also increase heart rate and cardiac work. Regular BP monitoring is very important when taking stimulants. High BP causes heart attacks and strokes, even small increases in BP of a few mmHg produce a large increase in risk. In addition, stimulant use has occasionally been associated with strokes and sudden cardiac death in children. Numerous cardiovascular warnings have recently been added to the prescribing information for all stimulants ie. Adderall, Ritalin, Concerta, Dexedrine etc.
>
> Drugs which inhibit the sympathetic nervous system (eg. beta blockers such as Toprol) are used to prevent heart attacks. Stimulants may increase your risk. This important issue has received very little research attention, which is really very poor considering how frequently these drugs are prescribed in the US...... and I say the US because stimulants are used so much less commonly in most countries. The US is without a shadow of a doubt the stimulant capital of the world! I think this has a lot to do with a culture of academic achievement in combination with the widespread medicalisation of normal symptoms which affect most people eg. poor attention, daydreaming, dislike of boring school/college work. Pharmaceutical companies are phenomenally influential in the US and are very very apt at promoting their products.........which are approved based on short-term efficacy studies and lack of long-term safety data. Although stimulants have been used in medicine for decades, their long-term cardiovascular safety has never been properly investigated. In the absense of proper trials, it would be foolish to assume that they are safe, particularly when you consider the effectiveness of drugs which block the effects of the sympathetic nervous system in preventing heart attacks and strokes. In addition, beta blockers and related drugs increase survival in patients with established cardiovascular disease. Given that most cardiovascular disease occurs in adults, and not children, the recent trend toward prescribing stimulants to large numbers of adults with ADHD is a concern.
>
>
>
>There's little evidence that beta blockers do any good in healthy persons, indeed they have become disused for treating high blood pressure because of the diabetes risk.
The sympathetic nervous symptom is important in preventing and reversing obesity and insulin tolerance. Although beta blockers increase exercise tolerance, they abolish the positive effects of chronic exercise on triglyceride & cholesterol levels and insulin sensitivity (by preventing lipid mobilization, lipid uptake, insulin & glucose uptake, and consequent lipolysis & glycolyis). The metabolic syndrome is a far greater early predictor of heart disease than elevated BP & HR, and while the hypertension is easily reversed by stimulant discontinuation and antihypertensive drugs therapy (for which there are far more efficacious drugs now than beta blockers), treating type II diabetes & obesity is much more involved.
That said, I'd definitely advocate the discontinuation of stimulants after infarction and putting the person on beta-blockers. Since there's an overwhelming amount of evidence they decrease mortality post-infarction.
Another issue is that orthostatic hypotension, as the result of sympathetic insensitivity, is the biggest cause of falls in the elderly; treatment is routinely ignored, even when there are highly efficacious OTC drugs like pseudoephedrine. Drugs like pseudoephedrine are now a subject of controversy; we've seen the removal of effective sympathomimetic decongestants & OTC anorectics like phenylpropanylolamine, and restriction on sale of ephedrine & pseudoephedrine, largely replacing them with phenylephrine (a drug which metastudies show is no more than a placebo).
There are deaths attributable to these drugs, however the incidence of death is not much more than fatal liver failure from acetaminophen. I suspect that FDA rulings on these drugs were largely political in nature, to squelch outcry against their regulation by the Combat Meth Epidemic Act.
Posted by kaleidoscope on November 18, 2007, at 16:02:18
In reply to Re: Cardiovascular toxicity of stimulants, posted by linkadge on November 14, 2007, at 21:53:40
>Sometimes I think too that the more popular the drug, the larger the coverup.
This has always been the case, it is very true. The more widely a drug is used, the less willing doctors are to even consider the possibility that it might be dangerous. To consider that would be to consider the possibility that they had harmed many people by prescribing it - a very unattractive prospect. Denial of the problem is easier.
Heart attack and strokes are common among the general population. Stimulant use is common among adults in the US. Many people who don't take stimulants have heart attacks.......and many people who do take them have heart attacks. In the absense of a large, well designed trial, no one can claim that stimulants are safe for the heart. The fact that they have been used for a long time doesn't prove anything at all.
Posted by kaleidoscope on November 18, 2007, at 16:33:36
In reply to Re: Cardiovascular toxicity of stimulants » kaleidoscope, posted by Astounder on November 15, 2007, at 22:24:40
Hi
I was not trying to extol the benefits of beta blockers in my post :) I was considering the potential cardiac risk of stimulants, which may occur due to vasoconstiction, increased blood pressure, increased heart rate, and possible metabolic effects.
>There's little evidence that beta blockers do any good in healthy persons, indeed they have become disused for treating high blood pressure because of the diabetes risk.
Certainly, beta blockers are not a first-line treatment for hypertension, although they do as you say have a major role in other conditions such as angina, post-MI, heart failure etc.
>Although beta blockers increase exercise tolerance, they abolish the positive effects of chronic exercise on triglyceride & cholesterol levels and insulin sensitivity.
There are differences among the class however...... certain beta blockers such as carvedilol do not share these undesirable metabolic effects.
>while the hypertension is easily reversed by stimulant discontinuation and antihypertensive drugs therapy
I would hope that all patients treated with stimulants are receiving regular monitoring of blood pressure. ACE inhibitors and CCBs may be helpful if hypertension is detected but they can cause side effects of their own. I am not aware of any study which specifically examines the efficacy and safety of drug treatment for stimulant-induced hypertension.
>phenylephrine
As you say, oral phenylephrine has no value as a decongestant. It is disappointing that its inclusion in OTC medications has become so widespread. Decongestant nasal sprays are suitable for 'colds' and can be safely used for a few days. Nasal corticosteroids are very useful in the treatment of allergic rhinitis.
K
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