What's wrong with High Dose Stimulant Medication? Does the FDA have a set or flexible limit on stimulant medications for adults with ADHD?

[jdelmonaco19]

I need help!

My ADHD medication isn't effective long enough, which causes significant problems (especially driving) with Executive Functions. I have a new doctor and he just got to 60mg immediate release (20mg x3). We recently switched between extended release (30mg capsules) and immediate release (20mg tablets) for delivery. However, I keep trying to explain it's wearing off to soon (under 3.5-4 hrs). Immediate release is more direct, more predictable and therefore more manageable.

My previous doctor/dosage was at 120mg (30mg x4) and it worked okay. I just couldn't afford anymore office visits and they moved as well. So...I ended up, unintentionally, stopping all medications (mood stabilizer too) for about 8 months because I couldn't find another doctor knowledgeable in Adult ADHD. With that gap in treatment, I ended up being hospitalized more than once.

Does anyone, in the Adult ADHD Community, take High Dose Stimulant medication too? If so, is there any knowledge you can share or suggestions on what I can say or do?

There are at least 2 ADHD Specialists (Dr. Joseph Beiderman & Dr. David Goodman) who have turned in White Papers and prescribe it that such way. Oh, I even completed a gene test which said I had ADHD. However, probably due to liabilty, it's vague on dosaging and/or duration of stimulants.

Any help or direction would be life saving!

Sincerely,

Jim

[juli1357]

Jim,

I just spent about an hour writing you a lengthy post that included information about stimulant tolerance and how to manage that, but for some reason my post did not go through. Rather than spend another hour trying to duplicate that post I am going to give you a much briefer response. If you find the information helpful and would like information about stimulant tolerance and how to manage that, let me know when I will send you some additional information.

My first question is what medication are you on? The reason I ask is because 60 mg of any stimulant milligram is considered to be a high dosage, but 120 mg is astronomical. Most physicians will consider patients who request this high of a dosage to be "medication seeking."

For what it's worth, 3.5 to 4 hours of coverage is pretty typical for an immediate release stimulant. One of the benefits of taking immediate release versus extended release is because you can break the immediate release in half, you can have even more control over your dosage, rather than be locked in to 8 to 12 hours of coverage every single day, where there are likely days that you do not need that amount of coverage, such as on the weekends or when you're on vacation. Consistently taking the same dosage and/or a high dosage of stimulants leads to drug tolerance, which means that your body has acclimated to that dosage and will continue to need an ever increasing dosage to receive the same effect.

Here is a link to some information about the maximum adult dosages for ADHD medications:

cms.gov/Medicare-Medicaid-C...

I intentionally do not take a high dose of stimulant medication because of the issues related to drug tolerance. If you would like more information about that topic and how I have learned to manage my tolerance so that I do not have to keep increasing my dosage, I would be happy to provide you with additional information.

Best,

Juli

[applejack123]

You might try the different delivery systems offered by Vyvanse and the newest is Mydayis. Vyvanse lasts, for me, about 5 hours and Mydayis lasts about 11. These medications are new, brand only and can be expensive. If you can't afford them you can go to their websites and they offer coupons for significantly reduced prices; just have to show proof of income. I think we all struggle with finding the right dosage so don't give up.