Wednesday, March 10, 2021

Adjusting Your Vyvanse Dose For Yourself

A Quick Story of my ADHD

 I am an adult with ADHD. I was not diagnosed until I was in my 40’s. This is a very long story which I do plan to share in case my experience can help to validate or illuminate the experience of others but thats not what this post is about. Some things to note before continuing. Yes, ADHD is a real thing. Like every other thing related to the human condition it is a spectrum. From very mild, I can just work a little harder and limit my distractions and I can function to rather severe where you simply cannot do the things required of you without help. In the case of those who are on the further side of the scale medication is a fantastic, almost miraculous help. If I had had these medications in high school I would be in a very different place professionally now and would have had many more choices for higher education than I ended up with because I simply wasn’t reliably brilliant. I was all over the place and my grades showed it. 

Properly dosed and used the medications for ADHD are safe and very effective. They won’t actually do the work for you, and they do not provide motivation to do what you don’t want to do, but they do make it easier or even possible to do things that were previously impossible to do within any reasonable amount of time. I’ll write more about my experience with this in the future as well but for now the safety and efficacy of the meds are not in question here.

Why taking a break is important

After 4 or 5 years of taking 50mg of Vyvanse every single day and every weekend and rarely taking a day off that wasn’t necessitated by a failure to get a refill in time I did start to have some trouble. As a kid and a younger adult my mom or wife or manager would ask me things like just make a list, don’t you get a thrill from actually finishing something and checking it off your list? The answer was no. I never had any pleasure from finishing something and checking it off the list until the Vyvanse and then suddenly I was very much addicted to that dopamine rush. I was not addicted to the meds themselves physically. Taking a day off or more on vacations and so forth resulted in absolutely no physical symptoms at all but I did very much want to get to the hyper-productive state and bang out some more code to catch up to where I perceived I should be if I had been aware of this problem as a child. That turned out to not be a healthy attitude. You cannot undo a lifetime of ritualized procrastination in a few years of medication use. I was pushing it too hard, I was getting up early and going to bed late to get more work done. Eventually that all caught up with me and I simply had to take some time off the meds and get my head wrapped around being OK with how things were and find my center point again where I was happy with how things were going. I am more or less back there now but it was not easy. I have halved my Vyvanse dose for the moment. Even that much now still helps me function, but doesn’t drive me quite so hard mentally.

I don’t believe that a human brain can be driven to that level continuously for years without a break. Your experience may be different but there may still be reasons why you would want to adjust your dose on some days.

Perhaps you still need some help on weekends, but you don’t want the entirety of your dose. Very well, break some in half. Perhaps some days you just don’t need to be as heavily driven by dopamine as other days in which case you should reduce your dose.

Perhaps your prescription is for 30mg but you can talk your doctor into prescribing 60mg and allowing you to divide them in half and you agree to fill the prescription half as often. Since 60mg is not twice the cost of 30mg but only slightly more expensive you might be able to save some money that way.

Most doctors I’ve talked to seem to be OK with this both for kids (managed by their parents of course, don’t let them divide up their own meds) and adults. But your doctor knows whats best for you and you should not do these things without involving them. Everybody on these meds does have at least a GP on call somewhere or you can’t get a prescription for the meds. This is basically an experiment that I am performing on myself. I find the results helpful and wish to share what I have learned but I could be totally wrong, or the whole idea could be totally wrong for you. Only you and your doc can tell for sure, I am not a doc, this is not medical advice. I am not advising you to do anything. If you do this wrong it might be dangerous, if you do it properly it might be dangerous.

How Vyvanse Works and why you can divide it up

Vyvanse is a time release amphetamine. But it does not rely on the physical makeup of the capsule or tablet to do it’s time release. What they have done is to add a lysine molecule to the amphetamine making it inactive. Your red blood cells slowly hydrolyze the lysine off the end releasing amphetamine in a slow and steady way. This is one of the things that makes Vyvanse such a great med is that you can’t take more of it to get a fantastic rush which makes it less prone to abuse but also makes it much more pleasant to be on as it doesn’t have the sharp highs and lows that other systems can generate. 

DO NOT divide up other extended release meds!

If you are taking some other kind of medication that is an extended or timed release it is probably not possible to break up the dose. Indeed it might be very dangerous as it might cause the meds to be released faster or even all at once. Do not try to do this except with time release medications that do not rely on the physical structure of the pill. Some XR type tablets have amphetamine on the outside for the initial dose and then a layer of slow dissolving material, probably something akin to an enteric coating, that takes 3 or 4 hours to dissolve in your digestive tract and then more amphetamine in the middle. If you break down that capsule you’ll get both doses at once basically doubling your dose for the first 4 hours of the day which would be very very bad and potentially fatal if you have a stroke and die.

The Adderall XR that I have seen is done like the traditional extended cold medicine capsules. The capsules are filled with tiny balls. Some of which are just amphetamine, some of which are coated in a thick coating that takes 3 to 4 hours to dissolve in your stomach. So the uncoated parts get absorbed right away and the coated ones get absorbed later. It MAY be possible to divide up an Adderall XR capsule the same way that we are going to do for Vyvanse, but I could be totally wrong about how they work or yours might work completely differently. I have not experimented with that and do not recommend that you do so without learning enough to be sure of how your specific capsules are made and how they work. Also the little balls are harder to measure as they tend to bounce right out of the measuring boat and go all over the place...

One type of time release Dexmethylphenidate is even more clever. The capsule is completely indigestible and is half filled with the medication as a gel. There is a laser cut very tiny hole in the 2 ends of the capsule. On the side opposite the gel is a compressed sponge. After you swallow it the “fluids” in your digestive tract start seeping into the hole at the sponge end and it starts to soak them up and expand. Over the course of a day it expands to fill the capsule completely slowly pushing the gelled medication out the tiny hole at the other end giving a nicely controlled slow release. Meds that work in ways like this seem to also have a small amount of the medication painted onto the outside of the capsule so that they start to work faster. If you were to try to make any changes to that type of med you would likely get everything at once and if you didn’t die you would at least wish you were dead for some number of hours. It would be very bad.

There are likely many more ways to do this that are equally clever and work great but that would be destroyed or made very dangerous by trying to alter it. If you don’t know for sure what you’ve got don’t do it.

What you need

You’ll need a good properly calibrated scale. I use a “Gemini-20” that is readily available on Amazon and is not very expensive. 

Some capsules to put the other half of the med into. I use size 2 as they are small enough to be easy to swallow but large enough that it’s not too hard to get the measured portion of powder back into them. gelatin and vegan versions are available in bags of 1000 on amazon for very little money and a bag of 1000 lasts a long time! 

Some “Measuring Boats” are not strictly needed but make the process much easier. Use the small or medium ones as you’ll be dealing with very small amounts of very light material. If you want to you can use small squares of paper with a fold down the middle to aid in pouring, but you’ll find that every time you bump the paper the stuff on them goes everywhere and it makes the scale harder to use as it will change the weight with every breath of air movement. I don’t recommend doing without the measure boats. They are sometimes also called “pouring boats” Amazon has many to choose from that are very inexpensive. I have some that are triangular shaped for easy pouring.

Some kind of tiny funnel to help get the meds you poured onto the scale back into a new capsule. If the end of the funnel can fit into the opened capsule then thats great. Mine was close but not perfect and I actually sanded down the end of it to make it fit.

Something to keep the half dose meds in. Don’t mix them back in with the full dose meds or you won’t be able to tell half of them apart. Label!

Measuring

At the beginning of each session you have to re-figure out how much of the powder constitutes how much of the medication. It will be mixed with some kind of filler and flow agents and may be at different concentrations mixed into that. A 40mg capsule of Vyvanse has a lot more than 40mg of powder in it. The weight of it will also change from one dose level to another, from one refilling to another, and even from one week to the next as the moisture content changes. 

This page does not contain instructions for the proper use of your scale! Learn how to tear the weight of the empty measuring boat and how to wait to let the weight stabilize or bad things will happen.

To find the full dose weight you have to empty one capsule entirely onto a measuring boat. In my case this morning 50mg of Vyvanse weighed 123mg. So to divide it in half I want to end up with 2 capsules with 61 or 62 mg of powder in it in order to have a 25mg Vyvanse dose. The 40mg capsules I recently divided actually had 155mg of powder in them, so for a 20mg dose I needed 77 or 78mg of powder in each capsule. Yours will be different, and it will be different every time you do this so don’t record old numbers and expect them to be the same this time.

The powder in the capsules I have seen is compressed into a little plug that is basically free floating inside the capsule. In order to most easily divide this up I open the capsule and then while holding the longer end with the plug of compressed powder in it I gently squeeze it and roll it between my fingers to break up the plug and to start it rolling out onto the measuring boat. The scale does not update very quickly so you have to go slow or you’ll overshoot. Go slower as you approach the amount that you want. Once you’ve pulled out what you want in the other half you can put the cap back on the commercial capsule and put it in your labeled container as it now has half a dose still left in it. 

You will lose a tiny amount of powder in the process but unless you’re really careless it shouldn’t really matter. 

Here’s me pinching and rolling the capsule to pull out half the contents by weight.


Getting the second half into another capsule

Now you have one half of the pill and you need to get the other half into a new capsule. In this picture you can’t see the capsule, but I’m pinching it and holding the funnel into it with one hand. Then dump the powder carefully into the funnel. It won’t just magically flow down into the capsule but if you gently tap the side funnel a few times it will all drop down. I use a stirring stick but a pencil or something similar will work just fine. Seal that up and put it in the properly labeled container.

Is this a good idea?

It has been a good idea for me, so far. I use only as much meds as I actually need for a particular day. And I can refill less often. Vyvanse is going off patent in another year or so but it’s still very expensive right now. If this is a good idea for you is up to you and your doc. Your doc may be happy for you to take less when you don’t need it but might prefer that they write you 2 prescriptions for 2 different doses rather than let you divide them up yourself. Or if you’re not willing to go to all this trouble you can specifically ask for that option. What your insurance will think about paying for 2 prescriptions of different doses of the same meds I have no idea but it will likely lead to questions from them and from the pharmacists every time you refill. 

In almost every other case messing with your meds dosage yourself is a Very Bad Idea. ADHD meds however are meant to adjust your mind in ways you can absolutely feel for yourself. Being able to control it on a more granular level than just on or off seems to have some value. Why would you take two tylenol if you only had minor discomfort that would be made better with just one? That is my non-doctor, not trained, completely self imagined opinion. It is worth what you paid for it! If you feel the same as I do then talk to your doctor before you experiment with any such things. Keep in mind that it IS an experiment. Nobody can tell you exactly what you’ll feel or experience doing any of this. It’s not tested or approved. It has improved my health and sense of well being by using less whenever I can while still letting me be the woodshedding code whirlwind that I sometimes need to be. Or just be able to do some housework on the weekends without the same sense of terrible urgency.