Can foods—particularly those containing citric acid—affect how well you absorb stimulants, such as Ritalin, Adderall, and Vyvanse? I get that question a lot. So, let’s delve into answering it.
In a word, yes. Yes, food can interfere! Most specifically, an overly acid or alkaline system (ph) can affect some stimulants’ effectiveness.
For example, citric acid and antacids and high/low ph can mean the difference between a stimulant working—or not. This bears thinking about, because many Americans consume an extremely acid diet (e.g. soda, meat, cheese, chocolate, pasta, beer, wine, most grains, etc.). Antacids in the U.S. alone are a $5 billion (with a b) market.
The last thing I want is to lead you into the weeds of “analysis paralysis.” There can be many reasons why a given stimulant medication is not effective for you. These reasons include:
- Sleep deprivation
- Genetics
- Nutritional deficiencies
- Insufficient protein (or certain types of protein)
- Substance use
In This Post on Acid and Stimulants:
In this post I touch upon these points; click to go directly to that section:
- Cautions Don’t Stop with Acid and Alkaline
- Stimulant Medication Response Depends on Many Factors
- Citric Acid and Stimulant Absorption
- FDA-Mandated Paper Inserts Shed Light (examples of most common stimulants)
- The Literature Tells Us This
- Grapefruit’s Particular Challenges
- Bottom line: Stimulants Don’t Act in a Vacuum
- What’s Your Experience – Your comments welcome
1. Cautions Don’t Stop with Acid and Alkaline
But the cautions don’t stop with Ph—acid or alkaline.
Even calcium or ammonium chloride, a food additive to bread and certain types of licorice can reduce stimulant effectiveness.
Grapefruit juice can also create problematic interactions with stimulants and many other medications. Chemicals in grapefruit can interfere with the enzymes that break down (metabolize) the medication in your digestive system. That means the medication may stay in your body for too short or too long a time. When a medication breaks down too quickly, it has insufficient time to work. A medication that stays in the body too long may build up to potentially dangerous levels.
Unfortunately, many prescribing physicians remain unaware of these interfering factors.
By the way, did you find this page while searching for “hacks” to abuse stimulants? You’ll be disappointed. For example, maybe you read somewhere that downing an orange juice chaser with your Adderall pill will boost the effect? I cannot possibly say.
2. Stimulant Medication Response Depends on Many Factors
Please keep in mind: There are many other explanations to explain why a stimulant medication fails—or ceases to work—for an individual. They include genetic and physiologic.
Right now, though, let’s view this issue primarily through the narrow lens of ph (alkalinity and acidity). Merriam-Webster defines ph this way:
a measure of acidity and alkalinity of a solution that is a number on a scale on which a value of 7 represents neutrality and lower numbers indicate increasing acidity and higher numbers increasing alkalinity and on which each unit of change represents a tenfold change in acidity or alkalinity and that is the negative logarithm of the effective hydrogen-ion concentration or hydrogen-ion activity in gram equivalents per liter of the solution; also: the condition represented by a pH number.
3. Citric Acid and Stimulant Absorption
Many years ago, I learned that citric acid can reduce the stimulant’s absorption—because it changes the ph of the gut. So, if someone complained to me of reduced effect from the medication, I would ask about any new habits around citric acid consumption. This might include:
- Drinking orange juice
- Eating certain fruits
- Taking a vitamin C supplement
- Eating some other food product containing citric acid as a preservative. (Examples of the latter include soft drinks, fruit-flavor candies, and even some cooking stock/bouillon.)
The general rule, I’d heard: Do not consume citric acid an hour before or after taking the stimulant. I’ve heard the same of a high-fat meal—to avoid it around the time you take stimulant medication, as it can reduce absorption. But how true is all this?
This webpage (Citric Acid in Foods) contains a list of foods that contain citric acid naturally or to which it is added. The list is bigger than you might think, including berries, preserves and jams, and mayonnaise that is made with lemon juice. With children, think gummy bears, “fruit” chews, and all the other candy masquerading as fruit items.
Then again, I’d also heard that this acid/absorption issue applies more to the immediate-release medications. It’s less of a risk with the novel delivery systems for extended-release stimulants such as Vyvanse and Concerta.
One rumor is that citric acid actually improves absorption. As it turns out, that’s not the case.
Moreover, many middle-aged folks with late-diagnosis ADHD—their guts suffering from years of scattershot eating habits and stress—are also taking antacids. Can that affect stimulant effectiveness, too? You bet.
Let’s start solving this puzzle by examining medication label inserts, textbooks, and published literature. Read on.
4. FDA-Mandated Paper Inserts Shed Light
I checked the label insert for various stimulants. They offered some information.
Basically, yes, the gut ph (alkalinity/acidity) can reduce absorption. But it seems to vary by delivery method. That is, the way the medication travels from the pill (or other) to the bloodstream. For example, Adderall, Concerta, Vyvanse, and Daytrana (the patch) are all delivered via different mechanisms.
To read the product insert for each medication, click on the hyperlinked name.
Adderall:
- Acidifying agents:
- Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines.
- Urinary acidifying agent (ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion.
- Both groups of agents lower blood levels and efficacy of amphetamines.
- Alkalinizing agents
- Gastrointestinal alkalinizing agents (sodium bicarbonate, etc.) increase the absorption of amphetamines. Coadministration of Adderall and gastrointestinal alkalizing agents, such as antacids, should be avoided.
- Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion.
- Both groups of agents increase blood levels and therefore potentiate the actions of amphetamines.
Summary: A system that is too alkaline or acid will reduce medication effectiveness.
Adderall XR:
- Alkalinizing agents (GI antacids, including sodium bicarbonate, and urinary): These agents increase blood levels of amphetamine. (7.1)
- Acidifying agents (GI and urinary): These agents reduce blood levels of amphetamine. (7.2) One of these acidifying agents is ammonium chloride, also known as sal ammoniac; Wikipedia has this to say about ammonium chloride:
In several countries, ammonium chloride, known as sal ammoniac, is used as a food additive under the E number E510, commonly as a yeast nutrient in breadmaking. It is a feed supplement for cattle and an ingredient in nutritive media for yeasts and many microorganisms.
Ammonium chloride is used to spice up dark sweets called salty licorice (very popular in Nordic countries, especially in Finland), in baking to give cookies a very crisp texture, and in the vodka Salmiakki Koskenkorva for flavouring. In India and Pakistan, it is called “Noshader” and is used to improve the crispness of snacks such as samosas andjalebi
Vyvanse:
- Urinary acidifying agents may reduce blood levels of amphetamine. (7.1)
- Urinary alkalinizing agents may increase blood levels of amphetamine. (7.2)
Dexedrine:
Acidifying agents: Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines.
- Urinary acidifying agents (ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion.
- Both groups of agents lower blood levels and efficacy of amphetamines.
Daytrana:
[No ph interactions listed, perhaps because Daytrana is a methylphenidate patch worn on the skin and is not absorbed through the gut.]
Concerta:
- In patients, there were no differences in either the pharmacokinetics or the pharmacodynamic performance of CONCERTA® when administered after a high fat breakfast. There is no evidence of dose dumping in the presence or absence of food.
[The label makes no mention of ph interactions, perhaps due to Concerta’s novel delivery system.]
Ritalin LA:
- Especially tell your doctor if you or your child takes stomach acid medicines.
Focalin XR:
- Antacids or acid suppressants could alter the release of Focalin XR
- The effects of gastrointestinal pH alterations on the absorption of dexmethylphenidate from Focalin XR have not been
studied. Since the modified release characteristics of Focalin XR are pH dependent, the coadministration of antacids or
acid suppressants could alter the release of dexmethylphenidate.
5. The Literature Tells Us This
Next, I checked the literature (not an exhaustive search at this point) and found this information:
- The Medical Basis of Psychiatry: Both citric acid and calcium can affect stimulant absorption; offers no details on how the various delivery systems might differ.
- One paper (Lisdexamfetamine Dimesylate (Vyvanse), A Prodrug Stimulant for Attention-Deficit/Hyperactivity Disorder) offers information about Vyvanse that, if I’m reading this correctly, seems to contradict the official information:
In an in vitro study, the pH-solubility profile of LDX was determined in buffered aqueous solutions using an assay specific for LDX.
The environmental pH did not affect the solubility profile of LDX within the biological pH range (pH, 1–8), suggesting that gastric pH variation does not affect the absorption of LDX.
Due to the effect pH has on absorption, amphetamine also interacts with gastric acid reducers such as proton pump inhibitors and H2 antihistamines, which increase gastrointestinal pH (i.e., make it less acidic).
6. Grapefruit’s Particular Challenges
Now consider a very particular type of citrus: grapefruit. Beyond any considerations about acid and Ph, grapefruit—both the fruit and the juice—can create adverse outcomes when taken with certain medications, including some stimulants. What’s the culprit here? It seems to be flavonoids called furanocoumarins.
Wikipedia has a very clear entry on this topic, excerpted here:
These active materials inhibit a key enzyme (cytochrome P450 isoform CYP3A4) which is responsible (among other activities) for drug metabolism. The effect happens in two ways.
One is that grapefruit can block the hepatic CYP3A4 thereby affecting the medication metabolism. If the drug is not metabolized, then the level of the drug in the blood can become too high, leading to an adverse effect.
On the other hand, if the medication is provided as a pro-drug [Gina notes: Vyvanse is a pro-drug], compromising its metabolism may prevent the drug from being created, thereby reducing its therapeutic effect.
The other effect is that grapefruit can block the enterocyte CYP3A4 thereby affecting the medication absorption in the intestine. Absorbing the medication to a lesser extent means it may not reach a therapeutic level. Therefore, its effect may be compromised.
In other words, grapefruit juice can be a problem in two big ways:
1. Create a toxic too-high dose of the medication
2. Reduce the medication’s therapeutic effect.
The list of grapefruit’s potential drug interactions is long. Here is a sampling, again from the Wikipedia entry on Grapefruit-drug interactions:
- Benzodiazepines
- All the stimulant medications
- SSRI antidepressants
- Statins
- Anti-Erectile Dysfunction medications
- Acetaminophen
Cytochrome P450
For more information on cytochrome P450, check this post from the series I wrote with my molecular-biologist husband: Part 4: Gene-Testing to Inform ADHD Drug Therapy.
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7. The Bottom Line: Stimulants Don’t Act In a Vacuum
It should be clear, from this brief examination, that ph can be a factor in stimulant efficacy. Grapefruit juice has its own particular effect on the absorption of stimulants and other medications. We also touched briefly upon the role of calcium, fat, and food additives such as ammonium chloride.
This is a reminder that stimulants do not act in a vacuum. They act in a highly individual human body. To be most effective, the stimulants require physiological support, including but not limited to:
- Adequate sleep: Stimulants cannot compensate for sleep deprivation
- Good nutrition: All medication targeting neurochemicals need “helpers”—B vitamins, potassium, magnesium, and other vitamins and minerals that help to fuel neural transmission (“moving messages around”).
- Adequate protein: Not “high protein” but rather adequate—because proteins are composed of amino acids. Amino acids are the building blocks of neurotransmitters such as dopamine, serotonin, and the like.
8. What’s Your Experience?
I’d love to hear your experiences on this topic. For example:
- Have you found that acidic foods affect your stimulant’s effectiveness?
- Have you noticed that taking an antacid creates problems with your stimulant being effective?
- Did your physician ever mention these factors? If so, what information did you receive?
- If you have particular knowledge in this area, please write a comment and I will incorporate it into this post for future readers to benefit. Thanks.
—Gina Pera
I am so grateful to have found this article/blog. Thank you for sharing your knowledge and, what I can tell, time and energy filled research. I am 36 years old and was officially diagnosed with ADHD about a year ago, but had come to realize the possibility a couple years before that. I decided to try different methods before medication (counseling, anxiety exercises, organizational tools, etc.). A year ago was when I got officially diagnosed and treated medicinally. My Dr had me on Concerta for a couple of weeks, and other than dry mouth and a little bit of increased heart rate for 20 minutes, it really did nothing. He switched me to Adderall XR 20 MG, and I felt a difference, but not for a super long period of time…finally 30mgs did the trick, but came with some additional anxiety. Found a sweet spot at 25mg. Several months later, I’m feeling the effect (or lack there of!) that some other people on here have mentioned. I feel so tired and even paralyzed at times without it, but it’s not always helping me like it used to when I do take it. I’m so discouraged! But then I came across this article and it made me wonder if my diet could be playing a role in this. Since taking Adderall, I have lost weight and can pretty much eat what I want without gaining weight. I don’t go crazy, but I used to eat a lot healthier (Whole 30ish) and now I treat myself to a Coke, or sweets, carbs, etc. and I haven’t been consuming a ton of veggies. I DO however, daily, for breakfast have a protein shake (Arbonne), which I’ve been doing for years. I take it with my medicine now. Wondering if there’s something in that that could be affecting absorption?? In the afternoon, I have big glass of water with an Arbonne Energy Fizz stick added. I also, daily, have apple cider vinegar (I make myself a drink using seltzer water, grape juice and 2tbls acv). I do this for good health and for PH balance. At night, I take 10mg of Lexapro. SO…now that you know a whole bunch about me lol…I’m wondering if you think any of these things could be affecting the absorption of my Adderall? Also, I don’t normally consume any other caffeine…not a coffee drinker. Soda is not the norm, but it happens on occasion/
I appreciate your input! My Dr would never mention this stuff! Can’t wait to check out your books!
Hi Krista,
I have no idea what the “energy” product is doing, but I see that the first ingredient is citric acid.
I’d encourage you to go back to a healthy diet. Just because you have lost weight doesn’t mean that added white sugar is a good idea. In fact, it might be a bad idea. With glucose levels on a roller coaster.
Thank you so much for that information.
Can you please tell me what foods I can eat? I know the acidic foods but I don’t know what to eat every morning.
I have fasted and it has helped but I believe I need more nutrients.
You can email me if it’s easier. I truly appreciate all you help!
Hi Stacey,
I’m not qualified to advise you on your diet. I did respond previously to your question this way:
I’m not an expert on dietary acids, etc. And, while healthy diets include plenty of vegetables (which tend to be alkaline), I am CERTAINLY not promoting the “Alkaline Diet.”
I did find this, which makes sense to me:
There are plenty of choices when it comes to alkaline foods for breakfast. Protein sources such as eggs and tofu can both be scrambled or pan-fried with spinach or kale for a satisfying alkaline dish. Another option is unsweetened yogurt topped with fresh coconut, almonds and flax seeds to make a tasty parfait.
https://www.livestrong.com/article/97578-alkaline-foods-breakfast/
It can’t hurt to try. Might be a useful experiment. PLease keep us posted!
good luck!
g
I started eating apples an hour after taking my Vyvanse and it seems to help.
Would plain yogurt be ok? I read on your article that calcium could effect ADD medication.
I also read that Vyvanse needs a protein n to activate it?
I spoke to my doctor about this and like many others there doctor is clueless.
Thanks!
That’s a sticky situation
Creatine helps all your brain cells be able to keep up with you
Hi Stacey,
Vyvanse is a “pro-drug.” It was Shire’s answer to reducing the abuse potential seen with its Adderall.
The stimulant inside the Vyvanse capsule is essentially old-school Dexedrine combined with L-lycine. But it’s called lisdexamfetamine — a combination of dextroamphetamine (the generic name for Dexedrine) and lysine.
Because the L-lycine is attached, the dexedrine doesn’t become active until it reaches a certain point in the gut. That’s the point where enzymes work their magic and “cleave” off the lycine molecule, thus making the medication active.
Lysine is an amino acid, a building block of protein. It’s one that our bodies don’t produce; we need to consume foods that contain it.
“Nutritional experts” say that lysine deficiency is rare. But for people who consume little protein (or the proteins that don’t contain lysine), it’s possible. Especially for vegans and athletes. Certain meats and plant-based proteins contain lysine.
https://www.healthline.com/health/lysine-foods#lysine-in-vegetables
But I’m not sure if a lysine deficiency would affect the absorption of Vyvanse. Seems like another issue altogether.
g
Is it possible that the contradictory information regarding the effect of pH on Vyvanse has to do with the distinction of gastric pH vs blood pH? (if this was already discussed in the comments, sorry for not seeing it)
Hi Random,
I couldn’t possibly hazard a guess, so I won’t!
Maybe someone with authority in that area can opine.
g
Thanks, I read that. What I’m saying is I can’t imagine someone taking even a regular dose of this without tums. I got prescribed a ppi for reflux this year and when I was on it I still thought this add medicine was useless & my brain damage would never start to heal. It was only when I started taking 3 Tums with it in the morning that “”time actually slowed for me””. I thought it was because the tablets were old and degraded like I posted before.
Anyone trying to abuse this by taking even the Rx dosage might get a headache equivalent to a dog’s who ate half a cigarette.
My dose is not high so that I can still sleep. Otherwise I would take more. I used to have it reduced to 1/4th of the normal dose, now it’s 1/2.
I just don’t understand how, after trying a bunch of different medication, the best one now called Zenzedi doesn’t have any effect until I take Tums with it, and if I can’t, then I slightly prefer not to take it at all even though this is supposed to be addictive.
I was studying to be a scientist before realizing the corruption in the industry, and how all the other runts are studying this and then following commands intentionally made to ruin the world, made me stop, and I can tell you the interesting thing about amphetamine is that it increases s845 glua1 production while methamphetamine which is propagandized as mainly a drug of abuse reduces it. Basically that’s one of the most important molecules in the brain because it’s required to keep you sane & be able to distinguish what your next move is properly, according to what, a moment ago, took place. Without it, you can’t tell where’s a good place to be and what you should be doing and whether you should do what you just did another time in the future-this is also known as memory.
Of course, they didn’t give their test subjects Tums so I can’t make really meaningful speculations but it’s pretty weird that they set the illicit drug market up for failure by spreading the word about meth so much when it’s technically proven to not be good for anything.
It’s a pity that people who blindly do & get away with the most stuff are the best off, and the most ethical of us have the worst financial ability. Honestly -people wrote a book about how they are “the only god’s only family”, but if you say that isn’t true, YOU get called a fascist.
What’s next in society, proving *gravity exists* “for the 1st time” again?
Weighty thoughts, Sean!
In addition to what I mentioned before (how dopamine controls many physiological processes, including many autonomic nervous functions), it could be that the stimulant is pushing you to an anxiety disorder. Perhaps you already had baseline anxiety (not from untreated ADHD, I mean, but neurogenic), and the stimulant exacerbated it, thus causing an increase in stomach acid.
Many people with ADHD have a co-existing condition, and that merits treating as well. Often, it is depression, anxiety, bipolar, etc.
g
You have an article up about antacids and ADHD medicine.
Personally if I take Zenzedi without Tums, I get a headache and feel stressed out and depressed. I would prefer not to take it at all than to take it without Tums because it has no therapeutic benefit at any dose.
A lot of people think that antacids increase amphetamine absorption. But there is no proof of this experimentally. The experiment showing that antacids change the way amphetamine works is below. It’s not even the experiment itself, the only thing available is the patent. All it says is that antacids which can themselves turn into acids (amphoteric ones) reduced completely undesirable digestive side effects of amphetamine.
In my opinion, this must be like the “drink 8 glasses of water” newspaper article that got overpublicised until doctors didn’t know it was just from a nonmedical newspaper article.
https://patents.google.com/patent/US2881113A/en
Hi Sean,
Thanks for your comment.
Yes, I realize that many people who are abusing stimulants fancy themselves “hacking” the potency with acid, alkaline, etc. whatever.
This post isn’t for them.
I will parse that patent when I get a chance. Thanks.
I wonder if another stimulant would work better for you. Or maybe it’s too high a dose?
The thing is, boosting dopamine transmission has all kinds of effects, not just “focus.” Because dopamine controls so many physiological functions.
Perhaps the medication is accelerating acid production for you.
So complex, all these physiological systems.
And yes, on the drinking 8 glasses of water. Yes, we all should pay attention to hydration, but we can wreak physical havoc by drinking too much water.
I love this post in my Book Club, where Taylor’s uncle started becoming mentally unhinged….from too much water.
____
Last weekend, a family member sat at my kitchen table. Her head in her hands, she told me about the latest episode with my uncle.
He’s a bachelor in his sixties, the family’s well-established “eccentric.” He has little patience for social niceties, yet is emotionally hurt very easily. That’s why his siblings didn’t see the warning signs as they trickled in.
For example:
“He started calling me at nine or ten at night, asking me for cookies. I had no idea why he’d had such a sugar craving, but I brought him cookies. I brought them every night he called, for about a week. I couldn’t understand why he didn’t eat any of them!
https://adhdrollercoaster.org/tools-and-strategies/chapter-14-denial-and-neurobiology/
thanks,
g
Hi Gina .
Thanks so much for the information;)
My situation is if I eat the medication seems to not work so well.
Have you heard if that happening before?
I take Vyvanse .
I read a lot of articles on ADD and can not seem to find what to eat hat won’t class with the medication.
I am drinking a green smoothie as I feel the Vyvanse crash come on.
Any help would be much appreciated.;)
Hi Stacey,
So you mean, if you eat anything at all, the Vyvanse doesn’t work?
You might want to experiment with different types of foods (alkaline, fat-free, and containing fat), and see if there is a difference.
Perhaps you might investigate Intermittent Fasting, where you fast during the time the Vyvanse is active? I’m reading some interesting research on IF and stabilizing insulin levels; some suspect it might help ADHD symptoms. Again, this is all speculative but it might be worth considering.
g
Great article.
I understand the acid foods. So what foods are suggested for example like breakfast ? I take Vyvanse.
I feel it wears off the moment I eat any foods.
Thanks 😉
Thanks, Stacey. I’m glad you found it useful.
I’m not an expert on dietary acids, etc. And, while healthy diets include plenty of vegetables (which tend to be alkaline), I am CERTAINLY not promoting the “Alkaline Diet.”
I did find this, which makes sense to me:
There are plenty of choices when it comes to alkaline foods for breakfast. Protein sources such as eggs and tofu can both be scrambled or pan-fried with spinach or kale for a satisfying alkaline dish. Another option is unsweetened yogurt topped with fresh coconut, almonds and flax seeds to make a tasty parfait.
https://www.livestrong.com/article/97578-alkaline-foods-breakfast/
It can’t hurt to try. Might be a useful experiment. PLease keep us posted!
g
I’ve been on so many different products, from Ridalin, vyvanse, adderall , dextroamphetamine ER and now I’m back to adderall XR. I have never been told anything about antacids! This could be a great mystery solver for me! I’ve taken an antacid for years and my DNA anylasis had said I should do great on addersll but after the first week, it was as though I hadn’t ever taken it. Every new med I would try would work the same way. If I take the antacid at a different time than the adderall will that help the adderall to work better? Or should I not take it at all? I needs to not have the acid reflux but I would also like to have my life feel like I’m in control and focused! What should I do?
Hi Freddie,
Thanks for stopping by.
It’s impossible to say if your antacid is the reason you’re not getting the effect you’d like from your stimulant medication.
There can be many reasons why the medication doesn’t seem to be working for you.
1. Genetic tests don’t really provide useful information in that regard. They are most useful in indicating that you are a rapid metabolizer (meaning, the medication might run out more quickly for you than most people) or a slow metabolizer (best to try a much lower dose than average).
2. Lots of other reasons!
But hey, it sure is worth trying, taking the antacid at a different time.
But I imagine it depends on your antacid. Some might stay in the gut a long time.
With questions such as these (as obviously, your MD hasn’t thought of it), I’d ask a good pharmacist about your particular antacid. Perhaps there is one that would interfere less with the stimulants?
Good luck!
g
Do you think generic adderol works as well as “real” adderol?
How do I check if my system is acidic or alkaline?
Hi Helane,
Most generic stimulants do not work as well as the brand.
BUT that doesn’t mean the generics won’t work well for some individuals.
In fact, some people prefer the generics to the brand. The differences work in their favor. In other words, these people also tend to do less well on the brand. If that makes sense.
re: “How do I check if my system is acidic or alkaline?”
That’s a complex question — and it’s really not the issue here in this post.
The issue is the effect that some acidic foods can have on the effectiveness of stimulant medication.
For example, you might be just fine consuming orange juice or other citric acid foods in the evening, after your stimulant has worn off. But it might not be a good idea to take the orange juice with the stimulant.
I hope that clarifies.
Gina
The information being sought and the research methods are at odds with one another. These prescriptions are supposed to go inside of brains, but the sole evidence has to do with concentrations in the blood. Could it be possible that after leaving the brain, antacids cause kidney tissue to hoard the amphetamine?
This would only be detrimental to organs such as the spleen and kidney which are not the intended targets of the drug, and especially are affected by changes in bloodflow (with levoamphetamine causing the most bloodflow impairment of mainstream ADHD drug constituents).
Also I would like to take this chance to let you know that the freshness of these drugs (consider the immediate release forms) is more important than the manufacturing factory in predicting side effects. As amphetamine degrades over time, it gives off a smell because of a compound containing acetone in its chemical structure, perhaps along with other compounds. If you are to compare one batch with another, I’m under the impression that effectiveness is correlated with freshness only. Your next political endeavor should be to make expiration dates printed on Rx bottles relevant to the time the drug was created rather than when it was sold to a patient. Amphetamine is considered chemically stable, which makes me concerned that old batches of other drugs have resulted in the deaths of numerous people without fingers even being pointed.
I take dexamphetamine sulphate 5mg which is not mentioned specifically here so I’ve been reading with the assumption that what applies to Adderall applies to me, and that they are the same meds. Is this a correct and safe assumption to make ?
Hi Rick,
I didn’t include Dexedrine as it’s so rarely used in the U.S., but I’ll add it.
According to the product insert:
Acidifying agents: Gastrointestinal acidifying agents (guanethidine, reserpine,
glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines. Urinary acidifying agents
(ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the
amphetamine molecule, thereby increasing urinary excretion. Both groups of agents lower blood levels and
efficacy of amphetamines.
You can read the full insert here: https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/017078s042lbl.pdf
Cheers,
g
I have had ADD since I was a child. And I have struggled with hating myself for not being normal, or as smart as everyone else. As an adult I sought help and was given Adderall XR 15 mg. At first this was great I felt like I was a new person. Unfortunately only a few days after starting it, it stopped working and all I experienced were the side effects; headaches, mood swings and nausea. I went back to my doctor and she said she did not want to up the dosage, and gave me Concerta 36 MG. This was a game changer I felt even more amazing than I did with the Adderall. However roughly a week and a half after starting, the same thing happened; extreme headaches mood swings, and I just wanted scream because there was nothing I could do to alleviate how it was making me feel. It lasted all day long.
I went back to my doctor and she gave me 54 mg Concerta. The first day I took it I realized it was too much there was no positive to it at all. The side effects were the same yet stronger. Again I went back to the doctor and she game me 50 MG Vyvanse. Vyvanse was awesome for the first day but the crash was rough. The second day my eyes felt like they were going to explode, the pressure was so bad and my vision was blurred and my head and face were throbbing.
I am at a loss. when the meds work life works! and right now nothing is working and life sucks! (I’m in a good place promise just frustrated that I can’t be in a better place)
Diet does not seem to be a fix for my medicine woes. Any suggestions?
–Jason
Hi Jason,
I wish that this was the first time I’d read such an account, of how RECKLESS physicians have made life worse for people with ADHD instead of better.
Instead, I have heard thousands of such stories. And yes, diet probably isn’t your problem. Your doctor is.
I recommend that you read this blog post and follow the link to purchase my book. Then read the chapters on medication.
https://adhdrollercoaster.org/adhd-news-and-research/the-tragic-truth-of-adderal-or-madderall/
After you do that, you will know more than 90% of physicians prescribing for ADHD.
Your doc seems to have a “throw spaghetti at the wall” approach to prescribing. Adderall 15 mg, Concerta 36 mg, Concerta 54 mg, and Vyvanse 50 mg….what the heck. Starting you on 50 mg Vyvanse was grossly irresponsible. So was jumping from 36 mg Concerta to 54 mg Concerta, after you were already experiencing significant side effects. That’s just so wrong.
In a nutshell, the stimulants could be exacerbating co-existing conditions, including anxiety, depression, bipolar disorder, etc.
But primarily, the doc should be starting at a lower dose of the stimulant and increasing gradually, taking note of side effects that might indicate exacerbated anxiety, etc.
Your functioning should also be monitored. That is, start with a list of your ADHD-related challenges that can be addressed with medication, and note each day what has improved and what might be getting worse. How many physicians actually use rating scales? Too dang few.
The goal is to treat ADHD 24-7 and try to avoid those drops and rebounds. And to treat the co-existing conditions. For many, some type of antidepressant and a stimulant will work best. It takes a methodical process to find the ones that work best for your neurochemistry.
Read the book. At least the chapters on medication. It’s a must.
Also, try to get sufficient sleep, minimize online activity, and avoid caffeine. All those things can interfere with medication efficacy.
Good luck!
Gina
I have been dealing with adult ADD my entire adult life. I was originally diagnosed with ADD as an elementary aged child. The ups and downs have been overwhelming at times. Always thinking why I can’t be normal, and hating the fact that medication has been the only thing to help. I have taken adderall and it only “worked” for a few days. Then the head ache and and being agitated became more than I wanted to deal with. These symptoms would occur within an hours time of taking the adderall.
I returned to my doctor and she would not give a higher dose. Rather she had me start taking concerta. WOW way better until a week or two later. The same side effects more mild initially, then around noon I would crash and for the rest of the day into the night the head ache and sheer discomfort became overwhelming.
I again returned to my doctor and she upped the dose to 54mg. This was not a good idea. I felt it was to strong and experienced more side effects than before. She then gave me vyvanse 50mg. The first day was wonderful however, I feel like it is affecting my eyes. There is a pressure and my eyes struggle to focus while reading. And nothing I do stops this. I’m hydrating, I’m eating healthy, I’m at a loss. I need the meds because when they do work I am who I feel I should be. Without them, I’m a mess. I hate feeling like I can’t keep up or that I’m not smart enough.
Thank you for your time.
Hi Jason, you must have had trouble submitting your question because two versions came through. I responded to the first.
But to the additional information here, I want to reassure you….it’s not you who isn’t “smart enough.” It’s your physician.
And yes, you should pay attention to the problems that the Vyvanse seems to be causing with your eyes.
I don’t know what options you have. Can you find another psychiatrist? But I wouldn’t even do that until you read that medication chapter in my book. Photocopy it and bring it to the doctor. Ask, “Will you help me use a methodical process to identify the best ADHD treatment for me?”
If not, find another!
Sometimes, though, the doc options are few, and you have to work with what you have. At least you can self-advocate.
Good luck!
g
Hi, I was diagnosed with ADHD about 7 yrs ago, took Adderall for a few months then stopped, I didn’t see it making any difference. Three and 1/2 years ago I started training to be a pharmacy technician. All of a sudden I needed that medicine to count pills, learn to do this job. But I noticed that in the afternoon, I would have trouble again with counting and focusing. After doing my own research, I found out that citric acid, and fruits interact with Adderall XR, basically stopping it from working. And I was eating fruit every day for lunch.
So I stopped doing that, things went well for a while, then I started having trouble again. I found out that Omeprazole that I was taking for my reflux was interacting with the salts in the Adderall. This was also making it stop working. Any PPI for reflux disease will interact in the same manner. So now I’m taking Zantac, a h2 blocker, have been for 4 years but I need something stronger.
Problem is, I am afraid to mess with my Adderall because I can’t do my job without it. Do you know of any PPI’s that are ok to take with Adderall XR that I haven’t heard of?
Or, is there an ADHD med that works as well as Adderall XR that will work with Omeprazole, or other ppi?
Also, avoiding vitamin C, citric acid, fruit for 1 hour before to 1 hour after taking Adderall didn’t work for me. IE- the lunch interaction. So I avoid those things until after work.
I wonder too why Adderall doesn’t give me energy?
It doesn’t give my 2 girls energy either and my doctor thinks that is just weird. But I have heard of that before, I just don’t understand why. It makes me tired.
Great info, sorry for the long post!
But this is the first time I’ve found somewhere to ask these questions.
Thankyou for your time!
Anne
Hi Anne,
There’s a lot to “unpack” in your comment.
Let me take a stab.
1. The person with ADHD taking medication doesn’t always notice when it is working and when it is not. Don’t rely on subjective judgments. Rely on objective measures, such as you did when realizing you needed the medicine to count pills and learn to do the job.
2. The fact that Adderall stopped working in the afternoon might have more to do with it wearing off or your being a rapid metabolizer than what you were eating.
3. Can you take any other measures to counter the reflux? A better diet, for example? Smaller meals?
If the reflux is caused by muscle spasms, that might be better controlled with a different, long-acting, and continuous release stimulant.
4. I don’t know any more about PPIs than what I wrote in the article. Sorry. Maybe a good pharmacist can help you.
5. Have you tried other stimulants? Adderall is quite problematic for many, it is an old formuulation, and for many there are better alternatives. For example, Concerta, Vyvanse, etc.
6. Adderall is not supposed to give you energy. It is supposed to treat ADHD symptoms. The fact that your doctor thinks this is weird (that it doesn’t) is weird. Perhaps your doctor would like to learn more about ADHD.
7. Adderall might be making your tired for many reasons. Including the rebounds when it wears off. But it might also be that you are relaxed more and feeling the effects of poor/insufficient sleep, for example.
I hope this helps,
Gina
Gina
I am a 50 year old Male with multiple medical issues including liver and kidney transplant and all associated medications. I take 60 mg of mixed amphetamine salts every day. Recently due to state requirements my Dr requested a urine test as to ensure I was taking my meds as prescribed. The test indicated zero amphetamine. She followed up with a blood test, again zero level of amphetamine. What is going on here.
Hi Brian,
I can’t tell you what’s going on with your mixed-amphetamine salts not showing up in your urine test.
But I can tell you that you’re not alone.
This phenomenon has created problems for many people over the years — and continuing.
When do you take the pill? When do you take the test?
It might be clearing your system very quickly. Since these tests are designed to detect substance-abuse and not a gradual release of a therapeutic dose of stimulant, they might require a big bolus of the stuff to register.
Here are some papers you can refer to your MD: https://scholar.google.ca/scholar?hl=en&q=amphetamine+urine+20mg
I hope this helps!
g
P.S. Brian, I am so busy right now but curiosity got the best of me!
So, I dove into those citations and found this — just as I instinctively suspected:
These data demonstrate the present guideline for regulated forensic urine drug testing (FUDT) for amphetamine with a screening cutoff of 1000 ng/ml, is too high to consistently detect the administration of a single 5-mg oral dose of d-amphetamine.
Also: The data demonstrated that amphetamine excretion increases with increasing urine flow and decreasing urine pH.
https://academic.oup.com/jat/article/22/6/481/781872
This is so enlightening. I have an appointment with the doctor to adjust my dose, but I have been drinking grapefruit beer lately, which totally makes sense!
Hi Stephanie,
Wow, I’m glad you found my blog.
That sure sounds like something you can at least try eliminating first before increasing your dose.
Good luck!
Gina
Hi Gina,
I’ve been searching for this kind of information for a few years. I’m so grateful for your research and this blog. My son was on VyVance 30mg for three years and I absolutely loved what it did for him, on the days it worked. We noticed some days it just completely didn’t effect him. So I started paying attention to what he ate for breakfast. On days that he had cold cereal and cows milk it didn’t work. So we try to focus more on more protein like eggs and whole grains. It did seem to help. For insurance reasons we have changed medications and he is now on amphetamine salts ER 15 mg. We are now vegan and don’t eat very many animal products. I usually make him a green smoothie with spinach bananas almond milk and peanut butter. It usually works great but for some reason yesterday didn’t work at all. Not sure what was missing. Do you have any suggestions for vegan breakfast foods for him?
Hi Susan,
Thanks for the kind words. I’m glad you find my blog helpful.
That’s interesting that the Vyvanse didn’t seem to work when your son breakfasted on cow’s milk and cold cereal. I’ve often wondered if that is a big problem for children in the U.S., for whom such a breakfast is almost ubiquitous.
I’ve wondered because that breakfast consists of two of the foods to which MANY people are sensitive, wheat and cow’s milk. There are 8 grams of protein in a glass of milk. But …and I’m no expert on this…from what I’ve read, lactose is metabolized as a sugar. That is, very fast. So, with the sugars from the cereal and the milk, that might create a spike and then a drop.
I understand the philosophical reasons for veganism. But I’m thinking it might be very tricky for a child with ADHD and who is taking medication to get all the nutrients he needs from a vegan diet. Especially in regards to essential fatty acids, B vitamins, proteins, and other vitamins/minerals. That is the stuff neurotransmitters are made of — and that fuel neurotransmission. Vitamins and minerals are also used to metabolize medications. So, taking medication can present an extra “draw” on these nutrients.
Again, I am no expert on veganism. But I’ve observed how some my vegan friends eat, and it’s not a well-rounded diet in terms of these nutrients.
As far as suggestions for vegan breakfasts, I would think old-fashioned slow-cooked oatmeal with toasted walnuts and a little maple syrup and butter would be one good option.
I wouldn’t over-rely on smoothies. Even if they have healthy ingredients, the fruit sugars are absorbed quickly due to the fibers being reduced by blending.
Breakfast might be making the difference. But perhaps there are other factors, such as poor or insufficient sleep, insufficient water consumption, and even the varying generic of the medication.
I hope this helps.
Gina
Just found your blog site, had to get this out there for RA sufferers. Went to Dr ago 61 because losing focus to easily, while driving, etc! Had mentioned this problem to a daughter who gave me some of her son’s 40 mg Vyvanse (he’d moved to a different dosage). Tried it during my visit and immediately saw huge difference in focusing ability, able to finish projects, etc. So time this to Dr, filled out questionnaire about ADD/ADHD, determined yes I definitely fit into category, so prescribed. I’m a severe RA sufferer, and in the year previous was under pretty severe pain on daily basis, which personally I think was the reason for list of focus, as I could not wrap my brain around much with the pain stress. So, after taking it I began to notice that they daily RA pain was so minimal I didn’t notice it. But on days I would’nt take the Vyvanse the pain was right back where it was before and knocking meet on my butt. I’ve mentioned this to my RA doc as well as my GP when he asks me if the Vyvanse is still helping me. So for me this medicine has been a saving grace, though to be more thorough it should be noted that I changed RA doc and the new one says my RA meds were not strong enough nor the right ones as there had been significant permanent joint damage. Anyway, wanted to get this out there if you know if someone else this might help.
Hi Anna,
Thanks for generously sharing your story. You never know what will cause a “light bulb” to turn on for ADHD roller coaster readers.
I’ve heard from many women with fibromyalgia, too, who have found the ADHD diagnosis and treatment definitely diminished their pain and lethargy. (Of course, they could be misdiagnosed…fibro has gotten to be a “bucket diagnosis”).
Perhaps the stimulant is helping to better process the signals. For example, some people with ADHD (especially children) cannot stand the feel of a clothing tag against their skin or a sock seam; the sensory signals are overwhelming. With treatment, this often becomes less noticeable.
I know very little about RA; perhaps your new rheumatologist is correct. But just because you have RA doesn’t mean you don’t also have ADHD.
Best of luck in these medical adventures,
g
Thanks for this blog and everyone who is contributing their experiences it’s truly comforting to know I’m not the only one struggling to find a Balence between my belly and my brain.
I have had acid reflux as long as I can remember… I think I was 5 the first time I told someone I felt like I had battery acid in my throat. I also starting showing signs of endometriosis when I was 14 with involuntary vomiting being one of the symptoms causing me to be hospitalized a few times. I went on and off birth control to combat these symptoms. I was also diagnosed with depression and ADD when I was 16 but had to choose which one to treat. I chose depression meds as doctors wouldn’t mix with ADD meds 20 years ago. SSRI landed me in a mental hospital so I never had a desire to go back on them and was never treated for ADD when I was younger. I had an unsuccessful surgery for endometriosis when I was 22yrs and have been on the nuva ring ever since. 4 years ago I started taking medication for ADD and I found that it helped my depression as well. 3 years ago I had my gallbladder removed and I have been struggling with depression again and finding the right ADD medication that my stomach can tolerate. I realize that the birth control could be propelling my depression and be the reason I developed gallstones but I’m terrified to get off of it as it’s the best relief I have found for my endometriosis symptoms.
I love how I feel when I take Ritalin but the first dose usually gives me diarrhea, wears off after 4hrs, gives me the shakes and I often forget to take my 2nd or 3rd dose. I went on and off Wellbutrin for the last 3yrs which was mostly good but it was making my anxiety worse so I finally desided to give Lexapro a try which seems to be going well for the last 3 months. Now I’m trying concerta and 6 weeks into this I’m noticing my poop is green and supper stinky! My arm pits smell even fresh out of the shower, I’m also peeing and sweating excessively! I’m also experiencing a lot of brain fog, indigestion, bloating, exhaustion and weight gain which is making me more depressed. (Not sure if this is the lexapro, concerta, nuva ring, diet or all of the above) I know diet and exercise will help but the idea of grocery shopping and cooking is daunting! Exercising with abdominal pain and diarrhea is nearly impossible! Yesterday I took the concerta at 9am, ate breakfast a hour later and sat around tired all day but concerta kept me from sleeping… after eating something greasy around 2pm I got diarrhea all green of course then 4 hours later I got a burst of energy and was up until 2am cleaning. I would have been up longer if my roommate didn’t tell me to turn the light out! I know it’s the meds but does this mean my body isn’t absorbing it properly? Can taking Zantac help the concerta work better for my over acidic body?
Im sick and tired of being sick and tired… I was a professional dancer who clocked in 30hrs a week and was a borderline socialite now I’m a total introvert who cringes when the phone rings! I feel like I don’t know my head from my tail right now. I want my life back, I want to finish school and have a career but trying to find a healthy balance where my belly and my brain are harmoniously working together seems like a fairy tail right now.
Dear Rhiannon,
Wow, so much obvious medical treatment you’ve endured. I am sorry to read of your plight.
You shouldn’t have been made to choose between treating ADHD or depression, which often are co-existing. Wellbutrin is NOT a first-line Rx for ADHD, and it often causes anxiety for people with ADHD.
Birth control can be a very backward and imprecise way of treating hormonal imbalances. Can you find a physician who knows how to test for hormonal levels and uses bio-identical hormones?
Perhaps it wasn’t endometriosis at all (which is too often the wrong diagnosis). Perhaps it was a hormonal imbalance (that often causes endometriosis, which is really a “bucket diagnosis” most of the time and is NOT improved by surgery).
Another possibility: Polycystic Ovary Syndrome has been associated with ADHD, and it can create mental-health symptoms.
https://www.cosmopolitan.com/uk/body/health/a19752273/pcos-side-effects-mental-health-issues-depression-anxiety/
excerpt:
It’s long been understood that some of the repercussions of polycystic ovary syndrome (PCOS) include infertility, irregular periods and excess hair growth. But a recent study conducted by researchers at Cardiff University’s Neuroscience and Mental Health Research Institute has revealed another potential side effect of PCOS: an increased likelihood of developing mental health issues.
PCOS is an extremely common condition, with anywhere between 7 and 10 per cent of women of childbearing age being affected by it. Thought to be caused by abnormal levels of hormones, the condition causes a number of harmless cyst-like follicles to grow on the ovaries which can ultimately prevent ovulation (hence the difficulty in getting pregnant for some women).
____
You don’t mention your dose of Ritalin and whether it is brand or generic. You don’t mention your dose of Lexapro, either. These medications must be methodically “dialed in” — that is, started at a low dose and increased slowly. There is no “average dose” and many people are on far too high a dose of SSRIs such as Lexapro.
Since you can control diet, maybe try to start with that. Little by little. Progress, not perfection.
I hope you can find a physician who knows how to treat complex issues.
best,
Gina
Awesome info!!! I’m glad I came across your website. I take adderall every morning and I do my best to avoid acidic items like flavored waters ans colas etc. I don’t abuse my prescription, but I do want to ensure it is able to absorb /perform as best as possible.
I cringe when I see where someone on a forum or elsewhere is telling the absolute opposite . It’s so annoying. Instead of random advice online, this article is put together well and will continue to help so many people.
I am infuriated about that Netflix pseudo doc.
I sincerely appreciate the work you do to help give us a voice. Medication is not evil. Some people benefit from taking these medications legally and properly. Yet we are viewed otherwise . And I agree medication is not a magical fix all. But I’m sick, so sick of people demonizing this .. sorry for going off topic. I had read the comments regarding the Netflix film and i totally agree with you both.
Thanks so much .
Chelsea
Dear Chelsea,
You are not off-topic. You are smack on top of the topic!
Thanks so much for your support and validation.
I’m glad my work is helpful to you.
g
Wow, Gina. Way to judge my lifestyle and life’s habits. This is why I am not coming back to your site and others because people like you sit on here and act like you know it all about how other “you think” medicines affect me personally. Just because you gave some talks and wrote some books on ADHD doesn’t make you capable of judging me and my use of anything I put in my body. You don’t know me personally at all, nor do I find it acceptable for you to say such demeaning things to me and judge my use of psychoactive drugs for my personal mental health needs that you know of only by what I’ve typed on this site, and nothing further about. Thanks.
Hi Jake,
I am not “judging your lifestyle.” I am going simply on the facts you provide.
I am simply concurring that your currently reported mental/physical state is unsurprising, given 40 mg Dexedrine, caffeine, and Wellbutrin, not to mention Testosterone.
This doesn’t come close to recommended ADHD treatment. And that might still be available to you, if you adopt a more prudent approach with more competent prescribing and physicians who know how to help you heal instead of giving you dire predictions.
One minute you say your doctors have failed you. The next, you claim that they know more than random people, such as me, on the Internet.
I know many young people with ADHD who fell for the larger-than-life temptations of Adderall+ It didn’t end well. They learned their lessons and adopted a more reasonable approach to treatment. Life got better.
Good luck,
Gina
Testosterone does not directly influence aggression. Look up “the permissive effect.” It’s a common myth. It takes up to 4x increased testosterone levels to directly influence aggression/dominance.
J – sorry, I don’t have time to debate this.
I’m speaking only of men with ADHD, which is associated with mood dysregulation and poor inhibition. Different thing.
g
When I was on TRT and Dexedrine 40 mg with caffeine and Wellbutrin, it was indeed hard on adrenal hormones because of pituitary down-regulation as I mentioned prior. It’s a shot to the ego, but look up adrenal fatigue and many places list adhd meds as contributors to adrenal fatigue. Cortisol and ACTH production need to be monitored. Also, If you all know about this already, just ignore me I guess, but I’m taking my med professional advice over the 9500 people who have offered their opinion to me on forums like this and Facebook, peaktestosterone.com, additidemag.com, etc etc.
Jake — I’m not sure you can blame this entirely on the doctors.
You were taking Dexedrine, an amphetamine delivered immediately to the system. Always more problematic.
You added caffeine. Horrible idea.
Then you also took Wellbutrin, which is notorious for amplifying anxiety in people with ADHD.
Whatever testosterone you took complicated this trainwreck but I doubt it is solely responsible.
You were, in effect, abusing all these drugs.
Begging your pardon, but I am not a forum or a commercial website peddling quackery. And, you were just complaining about your physicians.
But hey, you go right ahead with those dire predictions. If it were me, I’d want to be pro-active in improving my health and brain function. But you do you! 🙂
g
ADHD meds jack up stress hormones to help focus. In doing so, those hormones act to inhibit a lot of testosterone being made by down-regulating the pituitary/hypothalamic/adrenal axis. Testosterone and things like epinephrine, norepinephrine, and cortisol tends to be inversely related, so that is why I believe the ADHD stimulant regimen appears to leave guys with low T. I’ve been treated for low T for 5 years and have possible permanent damage now to my reproductive organs, because unfortunately, my PCP was not aware of the risks of long-term use. Now I’m 22, and my doctors are already talking about my hindered fertility chances, plus I now have chronic fatigue that can take anywhere from 0.5-2 years to fully “normalize.”
Hi Jake,
Actually, the men with ADHD I know who have low T are/were newly diagnosed and had NOT been taking stimulants.
Neurostimulants don’t “jack up stress hormones” — unless they are being abused, and that’s typically Adderall.
As for your docs’ dire prediction, I would take them with a grain of salt.
As you have discovered, there is much that MDs do not know or understand.
If you go about it in a thoughtful way, I bet you can overcome these wrong turns. Especially CFS.
But you’ll need to find MDs who are more like scientists than “proceduralists.”
I’m guessing that competent ADHD+ treatment will help you recover faster.
Read my book’s chapter on medication as a primer. The basics are there.
good luck!
g
Heya Gina, excuse my first comment there about taking antacids with amphetamine stimulants. I’m honestly having an awful day. I’m upset with both my doctors for several reasons, and just talking/thinking about stimulants makes me upset as well as talking about testosterone. I feel my doctors did not make smart choices for my health with treating me over the past 4-5 years for low Testosterone, and now for 2 years with stimulants for ADHD, and I’m experiencing prolonged adrenal insufficiency as well as pituitary gland insufficiency and it’s going to take a good length of time to let my body recover. I am off the hormone medicines completely, but with ADHD, I am now in an online stats course, so I am trying to get things done without much ADHD medicine because my body desperately needs a break from the stimulants, but with crashing from no testosterone anymore, it’s become a health versus academic crisis for my 22 year old self.
Hi Jake,
Thanks for clarifying. I just wanted to make clear that I’m not offering tips for hacking stimulants. I get enough of those requests on Quora. 🙂
I’m so sorry that you’re struggling with all this. The neuro-endocrine system is mind-bogglingly complex and, I am afraid, beyond the ken of most physicians. (But that won’t stop some from prescribing anyway!).
It does seem that ADHD in men carries a greater risk for low T, and I don’t know why. But if an endocrinologist sees only “low T” without recognizing neurogenetic ADHD (that is, not caused by low T), that’s not going to end well.
I’ve tried to find, for many years, integrated advice on this topic. None.
A male friend with ADHD said he tried just a little bit of testosterone supplement (from MD), and he had scary dreams — including shooting rampages. Yikes.
But to hear some tell it, T supplementation is the answer to all men’s problems with energy, memory, etc.
And yes, amphetamines…in particular Adderall…can be so problematic if not carefully chosen and used. As they hardly ever are.
_____
Wow, I’m so glad you are all discussing this!!
Sorry to be the only hen in the barnyard of roosters….but I observed what seemed to be this phenomenon a long time ago, from talking to the partners of men with ADHD. I often asked if testosterone levels had been checked, and if they had been, they were always low! Then more people started checking, and they were low, too! And it wasn’t just the inattentive subtype.
There’s a good book, “The Male Biological Clock,” that addresses some of these issues. This doc is a fan of testosterone supplementation. I don’t know…hormones are powerful things, and once you start supplementing, you can start losing endogenous (locally made) testosterone. Still, it’s worth exploring.,
As to whether some guys with ADHD could be low testosterone (or does the low testosterone cause ADHD-like symptoms), I’m afraid no one is studying this — because I’ve asked every likely expert. Our medical system is so specialized, with so little cross-disciplinary research.
I even asked endocrinologists, and they didn’t even understand that the brain controls, to a large extent, the production of hormones in the rest of the body. I mean, it was crazy — as if the head wasn’t connected to the body. How do these guys get out of med school? It’s frightening!
I guess a neuroendocrinologist would be the way to go.
Anyway, when I was digging around for answers, I came up with a few theories based on these premises:
1. Males (including male primates) who are in “one-down” positions often have lower testosterone as a result. Testosterone raises when they achieve more dominance. Plenty of people with untreated late-diagnosis ADHD feel “one down” — and have for many years.
2. Back to the brain controlling hormones. Sleep is so important for the productions of hormones. Many pwADHD do not get good sleep!
3. ADHD brain patterns mean that all kinds of messages are slow to travel or get “corrupted in transmission.” So, what about the signals that initiate hormone production, release, etc.? Makes sense that those messages could get corrupted, too, or end up in the dead-letter office.
I’ll have to dig around in my notes….seems at least one researcher felt I was onto something. I do think this is an important topic.
Oh, this is probably something Dr. Charles Parker has addressed in his blog. And if he hasn’t, maybe someone could write and ask him to.
http://www.Corepsychblog.com (Note: I couldn’t find info on this particular point).
best,
Gina
_______
BOTTOM LINE: Before supplementing testosterone, I would try to optimize ADHD medication, sleep, and diet (including eating more zinc-rich foods).
Sorry to be long-winded. I don’t have time to be more concise. 🙂
Good luck, Jake. Hang in there.
g
If you are trying to get the idea across that we should take antacids with amphetamines in order to boost their effectiveness, you’re not the first one to think of that and notice that acidic things reduce the absorption and thus the effectiveness of amphetamines.
More effectiveness= more issues typically with side effects as well, so only if you can handle it.
Hi Jared,
Are you addressing me?
I certainly wasn’t trying to “get across the idea that we should take antacids with amphetamines in order to boost their effectiveness.”
From my perspective, trying to “hack” stimulants is usually associated with substance abuse. Especially if it means attempting to change your body’s ph solely for that reason.
g
Hi I take 54mg of xenidate (concerta) and my doctor just prescribed me 150mg ranitidine twice a day. Some websites say the ranitidine increases the effects of concerta where as others say there is no reaction? I don’t want to start starting the ranitidine until I know what will happen as I have anxiety so don’t want to make any symptoms worse
Hi Sophie,
That’s a good question. I typically consult a pharmacist for such issues. Have you tried that? With a particularly complex question, I try to find a university hospital pharmacist.
It looks like there is no known interaction: https://www.drugs.com/drug-interactions/concerta-with-zantac-300-geldose-1606-976-1991-2627.html
But we aren’t really talking about a direct interaction here; we’re talking about a more indirect effect (e.g. lowering acid that results in reduced Concerta effectiveness).
The basic mechanism of Zantac suggests that the acid-lowering result might affect methylphenidate absorption.
excerpt:
Ranitidine, like other drugs that reduce stomach acid, may interfere with the absorption of drugs that require acid for adequate absorption. Examples include iron salts (for example iron sulphate), itraconazole (Sporanox), and ketoconazole (Nizoral, Extina, Xolegel, Kuric)
https://www.medicinenet.com/proton_pump_inhibitors_vs_zantac/article.htm#what_are_the_side_effects_of_proton_pump_inhibitors_vs_zantac
As for Xenidate, I’m unfamiliar with this Concerta generic. I know that it lacks the technology that makes Concerta Concerta (the OROS laser-drilled osmotic pump). So, I would guess Xenidate is even more vulnerable to the reduced-acid environment.
Finally, did your gut problems start when you began taking the Xenidate? Concerta itself can have that effect on some people.
Also, if you also have anxiety (apart from “ADHD-induced anxiety”), the Xenidate could be exacerbating that, thus potentially increasing acid production.
It might be that treating the anxiety as well as the ADHD would be a more helpful strategy.
In my experience, most people with ADHD symptoms strong enough to require a stimulant also benefit from a second medication for anxiety/depression.
Good luck sorting this out.
g
My main concern was if it will make the effects of xenidate stronger… if it reduces the effects of it then I’m not too concerned about that. I forgot to ask my doctor about this when he prescribed it today and pharmacist don’t seem to be very helpful here.
I’ve been on xenidate for about 3 years now but my stomach has only started in the last few weeks so I don’t believe it’s related.
Also, I’m not currently on any anxiety meds as everyone I’ve tried so I’ve had a severe allergic reaction to them so my doctor is avoiding all anxiety/depression meds at all costs. Also, my stomach issue isn’t so much GERD, my doctor thinks I may have a stomach ulcer starting or something.
If i was to take these and they made the effects of xenidate stronger would it be bad enough to hospitalised me? I really want to just find the courage to just try take one in the morning but I’m scared.
Surely my doctor would’ve said if it would interact with my meds before prescribing it ?
Hi Sophie,
I’m afraid no one can tell you with absolute accuracy what exactly will happen when you take the suggested doses of these two medications. So much depends on your gut environment, your genes, etc.
In general, reduced acid would suggest reduced effect of the Xenidate, not increased effect.
If it were me, I would not rely on the prescribing physician being able to advise. I’d try to find a smart pharmacist.
I might also try to take a lower dose of the Xenidate if I had to take the Zantac. Or maybe start the Zantac at a lower dose. Baby steps.
Now.
I know it’s not your question but why do you suppose your stomach issues have started recently? Has something changed? Stress, diet, the Xenidate generic manufacturer?
Generics are notorious for using colorants, binders, fillers, etc. that contain dyes to which people are sensitive, as I wrote in this piece: https://adhdrollercoaster.org/medication/7977/
Excerpt:
2. Different dyes, fill material, and binding
Moreover, branded drugs and their generics almost always contain different dyes, fillers, and binders. These are all ingredients to which many people are allergic or have other adverse reactions. (I cannot cite research to support it, but abundant anecdotal reports indicate that people with ADHD might be more prone to these sensitivities.)
Imagine when your physician has no clue that the filler is the problem, not the medication—and not some additional condition, such as bi-polar disorder.
If you or your child is sensitive to dyes, please note (Thanks, Holly!):
TriGen 27mg tablets contain: FD&C Yellow #6 Aluminum Lake, FD&C Blue #2 Aluminum Lake, FD&C Red #40 Aluminum Lake.
TriGen 54mg tablets contain: FD&C Yellow #6 Aluminum Lake, FD&C Red #40 Aluminum Lake, FD&C Blue #2 Aluminum Lake.
TriGen 72mg tablets contain: FD&C Blue #1 Aluminum Lake.
Mylan 27mg contains Red #40.
Impax 18 mg contains yellow iron oxide (no mention of dyes; iron oxides are used in brand Concerta, too)
Impax 54 mg contains red iron oxide and yellow iron oxide (no mention of dyes; iron oxides are used in brand Concerta, too).
I could find no evidence of FD&C # dyes in Concerta, though perhaps different names are being used.
_____
I hope this helps.
g
P.S. This is about amphetamine stimulants, not methylphenidate; this might not be true for methylphenidate
https://en.wikipedia.org/wiki/Amphetamine
excerpt:
In general, there is no significant interaction when consuming amphetamine with food, but the pH of gastrointestinal content and urine affects the absorption and excretion of amphetamine, respectively.[144] Acidic substances reduce the absorption of amphetamine and increase urinary excretion, and alkaline substances do the opposite.[144] Due to the effect pH has on absorption, amphetamine also interacts with gastric acid reducers such as proton pump inhibitors and H2 antihistamines, which increase gastrointestinal pH (i.e., make it less acidic).[144]
PS: I used to be on the Board of Directors of the Obsessive Compulsive Foundation of the San Francisco Bay Area and got them incorporated.
I got the 5% figure from two specialists in ADHD and it seems to me that I read it somewhere as well.
Sometimes people with ADHD think their symptom of impulsiveness is worse on meds but it is the medicine that allows them to see their impulsiveness and (hopefully) control it.
The treatment of choice for OCD is a combination or SRIs and either Exposure-Response conditioning or Behavior Modification. Behavior mod is a very effective tool for ADHD as well in many patients.
I LOVE this, Alan:
Sometimes people with ADHD think their symptom of impulsiveness is worse on meds but it is the medicine that allows them to see their impulsiveness and (hopefully) control it.
g
SNRI and NRI don’t help my OCD-like impulsive symptoms at all. So do stimulants or SSRI’s help impulsiveness? What about if you cannot tell between your compulsive symptoms and those of a more impulsive nature? It’s not as easy as you may think.
I appreciate your frustration, Jake. It doesn’t help that words like “impulsive” and “compulsive” are imprecise, at best. They are only descriptors of what the behavior “looks like” or maybe “feels like.”
To cut through the confusion when starting medication trials, I encourage folks to target their five most pressing challenges, and then rate them daily as “better/worse” as a medication is introduced (at a low dose) and then slowly increased.
That gives you “data” that helps to determine the next course. To the astute prescriber.
But to do this effectively, the clinician needs to help the patient identify “treatment targets” that are responsive to medication — and not those that requires medication plus new habits, supportive structures, etc.
Yep, taking Rx for ADHD is not the “easy fix” so many people criticize it as being.
g
Maybe but does seeing it better really help control it for everyone? I’d argue from my perspective it’s paradoxical because I find more impulsive relief from SSRI’s and more compulsive relief from amphetamine salts. I don’t really believe I’m perhaps truly OCD, but I have a lot of suspicion it’s adhd with the overactive amygdala and overactive limbic system. But none of it matters unless treatment can be helpful. Talk therapy does not do me much good and honestly it’s boring to me but I have had a few times where I got some good tips and strategies for coping, but mostly it’s just repetition and preaching the obvious like meditation, diet, sleep, yoga, being social and not isolating, avoiding alcohol and other recreational drugs, etc. I’m never going back to Counseling because I’ve done it for 6 years and tried 5 therapists and not helpful for me. Sorry.
HI Jake,
No need to apologize to me for not wanting to give therapy another try.
I’ve seen for years how non-ADHD-savvy therapy can be a costly waste of time and can even exacerbate challenges.
If someone cannot find ADHD-savvy therapy, I’d rather they put that money toward a gym membership and a trainer, a professional organizer — or something
best
g
What I find fascinating is im way more impulsive WITH stimulants. Without them I feel a better sense of control, yet I cannot seem to get my mind going without stimulants, but equally the stimulants I take make my mind move so fast I can’t really put the brakes on. I can never find the happy medium. Seems like it’s just a constant struggle with side effects for me and I’ve tried about every anxiety/ocd med there is. ADHD is hardest for me because I’m a very unique metabolized that is very fast at metabolizing stimulants. Mix that with comorbidity in OCD (that appears to be OCD or stems from ADHD), and it’s just a mess trying to balance it out. Just SSRI I do awful, just stimulant alone I don’t do well at all with mood and depression. It’s been 6 years and I’ve not given up hope of improvement, but the happy medium I seek is like chasing the Easter Bunny.
Hi Jake,
It can be SO difficult to balance all these extremes.
Mostly, the public has no idea. When I hear someone say, “Meds are an easy fix,” I burst out laughing.
Nothing could be further from the truth.
It takes a very methodical approach to “dial in” the right Rx (or combination of Rx).
How many prescribers know how to do that? Hmmm, I’d say “not many.”
If you are a rapid metabolizer, that should definitely figure into how many doses you take throughout the day.
The estimates for how long the medications last are just that: estimates. And your mileage may vary– lots longer, lots shorter, or in between.
Welbutrin is a rather unique drug for ADHDers. It only works for about 5 % of ADHD people. For those it doesn’t work on, it can have different effects, including the opposite effect of stimulants in a somewhat unique way. Another effect it can have is obsessive-compulsive symptoms, likely because o-c is in the same brain activity spectrum of the brain as ADHD (not the symptom spectrum).
Hi Alan,
I’m curious where you found that 5% figure (Wellbutrin “only works for about 5% of ADHD people”).
Yes, when a medication isn’t “right” for a person, there can be all kinds of side effects.
Because Wellbutrin has a complex mechanism of action (we don’t quite understand it, even today), that means there can be a whole range of complex side effects.
Thanks for your comment.
best,
g
It’s because ocd and adhd often have hyperactive limbic systems and excess norepinephrine right? I take Wellbutrin because I like how it inhibits norepinephrine release after I’ve taken all stimulants and helps me recover from the crash (a bit). It is hard on OCD for me, but then again all SNRI/NRI are hard on my OCD. Amphetamines are kind of bad but I’m comorbidity with adhd and ocd together, but stimulants don’t work long enough for me. 70 my VyVanse was like 6 hours and I was freezing. Mydayis would probably kill me from that much length of a racemic salt mixture that long term and no doubt mess my sleep up. Psychotropics suck and after trying 30 medicines over 6 years I’m firmly and completely convinced I know what works for me and what doesn’t. Meds are more about tolerating to me than they are of benefit because without being able to tolerate them they are not useful. Not to mention hormone disruption up the back entrance.
Hi Jake and Alan,
The truth is, brain chemistry is highly HIGHLY complex. With each medication, there are up- and downstream effects. Co-existing conditions can be exacerbated. So much complexity!
in many ways, though ADHD and OCD are at opposite ends of the spectrum, though they can certainly co-exist. Neurogenetically speaking, I mean, and not “acting OCD” in an attempt to cope with ADHD.
You’ve inspired me to write a blog post about that soon. It’s an important topic!
Thanks,
Gina
Just wanted to mention that when I was on Dexedrine and wellbutrin at the same time – the wellbutrin totally made my Dex way less effective. From my understanding of the articles I subsequently researched to find out the reason for this – it’s because the action of Wellbutrin on dopamine is more similar to the Ritalin class where it blocks the transporter so it can’t reuptake (but also blocks it from being released which defeats the action of the amphetamine class.) I don’t know if this is 100 percent scientifically accurate account of what happens because I’ve read people get prescribed methylphenidate class stims And Amph-based ones at the same time (in which case they should take the amph ones first /methylphenidate ones second to account for the action on dopamine) and I’m sure people will be correcting me after this post – but my personal experience (before knowing about this action on dopamine from wellbutrin/bupropion) is that this is true – my Dex was blunted severely and noticeably the very first time I took wellbutrin so I stopped it. That is the reason I looked up the reason…but even when I told my psychiatrist this and also I mentioned to him about acidic vs alkaline reactions – he knew nothing about any of it! I guess the pharmacist is the one to ask! Oh and Effexor/venfalaxine and amphetamines can be taken together beautifully at least for me been on that combo successfully for years. Thx for this article. And Netflix ‘s Take Your Pills – SUCKS and should not be taken as the truth I had to watch it in secret (not with kids around) as my 8 year old was diagnosed this year and takes concerta and I smelled the documentary’s ignorant agenda from the title – it lumps real adhd patients in with recreational stimulant abusers and college performance enhancer abusers and suggests that ALL just take the pills as unfair advantage and everyone’s overmedicated and adhd is over diagnosed over treated. Simulant abuse and miss use maybe rampant but it’s not by people who have ADHD the majority of adults with ADHD don’t even get treated and I’m ashamed Netflix would put this out in this day and age.. why is adhd still treated with such disrespect why are we not given the same political correctness as autism and aspergers and other differences from neurotypicals. It’s because we appear “normal” except for the symptoms which make us appear selfish and lazy but having an Interest Driven Nervous System is NOT a choice. Thank you Gina!
Hi Jacey,
Thanks for your comment. It’s so hard to get a straight answer on these drug combinations. Especially when it comes to a drug like Wellbutrin, whose mechanism of action is rather poorly understood!
re:”Take Your Pills” pseudo-documentary. Actually, many of those people “abusing” stimulants or saying they take them as “performance drugs” DO have ADHD. That’s the irony.
And I agree about the “sanctity” offered to autism, Asperger’s, depression, etc. No one dare offer anything but kindness and compassion.
But with ADHD? It’s everybody’s favorite punching bag.
I suspect it’s because ADHD symptoms are, in fact, human traits. It’s their number and severity, in the presence of impairment, that makes the diagnosis.
In general, humans don’t like to think…it’s haaaard! So, we tend to latch onto easy answers instead of attempting to understand gray area and nuance.
g
I was diagnosed with ADHD as an adult, I was prescribed adderall xr. I was first put on 10 mg then gradually moved up to 20 mg xr . I got to where it did not really seem to be working. My doctor then agreed to move me up to 20 mg xr twice a day (which I am currently on). I was wondering at times why I was still so distracted and becoming more disorganized, and even some impulsiveness. I just yesterday found out how the absorption can be effected by what we eat or drink along with it. I am excited to try experiment with this. I will look to maintain a more even pH base and see if this will help with these behaviors/ issues. Thank you for the article, and I will follow up to let you know my findings. Interesting that my doctor didn’t really emphasize this.
Hi TK,
I’m glad you found this info nugget.
Sorry to say, the information that most MDs prescribing for ADHD don’t provide (or know) could fill a large crater!
It might, in the end, be that acid is not affecting your Adderall’s efficacy. Adderall tends to do that (peter out after a while).
We don’t quite know why, but one reason might be that there is an extra mechanism of action. Unlike the methylphenidate stimulants (e.g. Concerta, Ritalin, etc.), Adderall actually pushes out neurochemicals from the neurons. Perhaps this leads to depletion.
Another more practical reason: People on Adderall tend to over-rely on it to propel them through the day. They rely on this “booster rocket” instead of setting up and following organizational systems, etc.
But yes, please conduct your experiment and share an update!
Good luck!
g
I was taking ritilin and had urine tests to show I was taking it. Results were consitantly negative. I switched to Vyvanse and hope to show my compliance. After reading your blog I realize that I interfered with absorbtion and it makes sense. However, the tests were negative for the drug, but I experienced the effects of the medication. Does that make any sense? Perhaps a placebo effect?
Hi Linda,
I really have no clue. But I suspect that if acids/antacids affected absorption of the Ritalin, you wouldn’t have felt an improvement in symptoms.
It appears that Ritalin/methylphenidate might not reliably show up on the average drug test. Instead, a specific test for methylphenidate might need to be used.
Most blood and urine tests specifically test for ritalin. If they didn’t find it consistently they wouldn’t be used. It is usually the first drug they test for. In the jails they have a liquid that jailers can use to test for Ritalin powder and pills and they test there before they even do a blood test on somebody who may be on it.
Thanks, Alan!
I’ve found methylphenidate works best if I take it immediately after waking,in the morning, two 20 mg tablets. Within minutes, I feel calmer,less irritable,better motivated. It lasts less than two hours. But taking an hour or two later,same dose, there is little or no effect. I understand that the GI tract takes a while to wake up in the morning and may account for this issue. I do take a PPI. Any clue or suggestion’s. 10mg once lasted 12 hours when I began taking it 15 years ago. Thank you.
Hi Rob,
It might be that because the first dose isn’t completely out of your system, the second does doesn’t “register” as much.
But, my money is on the acid-reducing effect of the proton-pump inhibitor.
If possible, I’d encourage you to investigate steps you can take that might reduce/eliminate the need for the PPI. Perhaps a better diet? Less caffeine or soda?
PPIs can also reduce absorption of minerals and vitamins that are very important to brain function AND to metabolizing the stimulant medication.
From the Wikipedia entry on Proton-pump inhibitor:
Nutritional
Gastric acid is important for breakdown of food and release of micronutrients, and some studies have shown possibilities for interference with absorption of iron, calcium, magnesium, and vitamin B12. With regard to iron and vitamin B12, the data are weak and several confounding factors have been identified.
Low levels of magnesium can be found in people on PPI therapy and these can be reversed when they are switched to H2-receptor antagonist drugs.
I hope this helps.
Gina
Thank you
I am SOOOOO glad I found this article. I was just diagnosed with ADHD a little over a year ago, and the first 2 times I took Adderall it worked amazingly and after that, I felt pretty much nothing at all. I even tried Vyvanse, I went from XR to IR, and still not even close to the first 2 times. My does has been incresed to 2 30MG a day, which I have to wait until the afternoon to take them both at the same time so I can at least stay awake for the rest of the day. Right now the only thing Adderall does for me is keep me awake, otherwise I am extremely tired all the time and can barely function. I have mentioned to my DR. several times that I think the acid in my stomach could be affecting it, but I cannot tell her it’s not working because she may stop prescribing it, and she tells me she cannot go any higher in dosage, which I don’t think would help anyway. She did start prescribing me Buproxin, which she says adds to the effect of adderall, also suppresses appetite, some people lose weight, etc.. I never experienced any of that from either pill, she was very surprised when I told her I was always hungry, you would think that would have been a sign for her. Around that same time I was diagnosed with ADHD i had gotten tested for having occasional burning sensations shoot up to my throat , neck, ear. Come to find out it was the acid in my stomach. I had been on medication for it, but it stopped working so I was put n what I was told was the strongest one, Dexilant.
So I think now I will ask her to try Concerta to see if that will work for me, because as of now, my ADHD is really affecting my job performance and my everyday life. Any updates would be appreciated, especially if anyone knows for sure that high acidity in the stomach wold affect, or wont affect as much Concerta.
Hi Jelan,
I’m sorry to learn that you are experiencing this “Meds Roulette” distress. For some people, it can be so difficult to find the most effective stimulant (and sometimes another medication to treat other co-existing conditions). For others, it’s a snap. It’s just the luck of the genetic draw.
There could be many reasons why Adderall worked “amazingly” the first two times.
For example, the difference was extremely novel for you, an absolute and dramatic change. After several times, though, this change becomes less remarkable. Adderall is tricky because in some people it can provide a feeling of “super human focus” and so these people might not work on implementing other strategies, such as getting sufficient sleep, eating well, using a calendar/planner, etc. They just rely on the “boost” from Adderall to propel them through their day. Those are typically the people who need higher and higher doses to feel an effect.
For example, for whatever reason your nervous system quickly adapts, downregulating neurotransmitters to accommodate this big shift.
The Dexilant could definitely be counteracting the stimulants. But so could the Buproxin (Wellbutrin); that is a very tricky medication and I don’t know many (any?) people with ADHD for whom that works well with a stimulant. Most report getting too anxious.
I would have preferred that your physician work with you on “dialing in” a more useful stimulant for you before adding a second drug. Stimulants might bring side effects, often exacerbating an underlying condition (e.g. depression, anxiety, etc.), but they should still perform their main function: reducing ADHD symtoms. It doesn’t sound like you have that benefit at all, and Buproxin isn’t bringing you any closer.
So YES, I would ask your physician about Concerta. So far you’ve only tried amphetamine-based stimulants (Vyvanse and Adderall). If you haven’t tried methylphenidate-based stimulants (Ritalin, Concerta, Quillivant, etc.), you should have a trial of one or two in that class.
Meanwhile, you should know that sleep deprivation means that stimulants will never work as effectively as they should. So try to get some sleep.
Also, the gastric acid issue could have many causes, including stress from trying to get through the day with ADHD-related challenges. But if you have a poor diet, it might help to reduce acid-producing foods (meat, sugar, coffee and sodas, etc.) and adding more vegetables, etc.
For some guidance in guiding your physician in a logical, practical approach to ADHD medication, you can read the medication chapters in my book:
http://amzn.to/2Er2P72
Good luck!
Gina
Thank you so much for this post. Very enlightening and gives me hope!
I have suffered from ADHD my whole life, and really started to think “I must have ADD” during college when I struggled on exams, getting stuck on re-reading the questions 20 times even though I understood them the first time. Somehow I made it through grad school, and a few years into my career. My current job is so intense that I started having panic attacks because I couldn’t get the work completed by the deadlines and felt like everything was just piling up higher and higher. I finally decided to look into the “add thing”. I got diagnosed with ADHD at the age of 31, and I was prescribed Vyvanse.
For several months, I felt like SUPERMAN!! I conquered my job and personal life. I had stopped drinking energy drinks when I started the Vyvanse, although I really enjoyed the taste of my “go to” energy drink. After slaying at life for several months, I longed for that yummy taste of the energy drink I had cut out of my routine… and that electric feeling it gave me in the mornings. Vyvanse worked great but it was a subtle effect, not the instantly gratifying electricity effect with the refreshing-taste energy drink.
I started back on the energy drink (that I had more or less been drinking daily for 10 years pre-diagnosis). I enjoyed the taste, the electric feeling and the jolt of instant gratification energy it gave me. I figured that it probably wasnt a great idea to couple it with a prescription stimulant, but nothing crazy happened. The energy drink eventually made its way back into my daily routine, and around that time, i started noticing that the Vyvanse seemed to be losing its effect. I upped the dosage 10mg, and that seemed to solve the issue… but over time, that dosage wasn’t giving me the SUPERMAN abilities anymore either. I talked to my psychiatrist about it, and he acknowledged that some patients do experience similar “wearing off” effects after being on the medication for a while. But he also reminded “the higher you climb (in dosage), the farther you fall.” And I agreed with that sentiment. I felt like upping the dosage anymore would not be a long-term solution, and could potentially be a worse outcome.
Over time, I have felt the effects of the Vyvanse gradually reduce more and more over time. The 13-hours of focus and energy dwindled down to 11-hours, 9-hours, 7-hours… not it even feels like the Vyvanse does not work AT ALL anymore, my crash comes in around 2pm after lunch… around the time that the energy drink should be wearing off.
I have always known intellectually, that the energy drink coupled with Vyvanse couldn’t be GOOD for me, and was probably BAD for me nutrition-wise. But I found ways to justify that reasoning because of the taste, electric feeling and instant gratification. Lately, I have been feeling like the energy drink is altering my mood, and more recently, I have started having the panic attacks I had at work pre-diagnosis… and the feeling of work piling up higher and higher, me being unable to succeed at work and in life. Anxiety attacks coming back more often.
It would seem that my reliance on the energy drink and stubbornness to ignore “reason” has now completely cancelled out my daily Vyvanse pill. Completely cancelled it out. I feel like an IDIOT. But I am soooooo grateful for this post. It makes COMPLETE sense to me!! I knew it was the energy drink, but didn’t know how or why. Now I do. No more energy drink, no more sodas… tomorrow I am going to really pay attended to acidic content of drinks and foods I eat. I really hope I can go back to being SUPERMAN again. 🙂
Hi Drew,
Thanks for your comment. I’m sure you’re not alone.
These “energy drinks” are ubiquitous. It sounds like they affect you the way Adderall affects some people — like attaching a booster rocket to one’s behind.
When they stop feeling that “super human” energy, they increase the dose, etc. and it doesn’t end well.
Vyvanse, if it works for you, is more subtle, as you say. It can help you get more organized, focused, etc. But it’s not going to propel you into winning the Superhuman contest.
In general, relying on these boosts, whether from caffeine or stimulants, is a short-term game. And can really mess with your sleep.
Good luck!
g
Are you certain that three screen take over pop ups pushing people to subscribe etc are the right choice for a blog focused on helping people with a problem being interrupted and returning to task? It certainly ruined my ability to focus on what you had to say and focus on how tone deaf the need for forcing people to view your self advertising is to your target audience. Perhaps at least let people read the article before inundating them, there’s no way to know if they want to subscribe before they can see if you have anything useful to say?
HI Jameson
I’m really sorry about that. I have asked my IT person repeatedly to NOT have that pop-up go off immediately.
But unfortunately, every time the WordPress software updates, it throws off the settings. It’s annoying, I agree! I don’t like that, either.
I just tried it with an Incognito window and it took a full 60 seconds to appear. I don’t think the delay can be longer. Did you get it right away? There are so many platforms…
Please understand. I do almost nothing in the way of “self-advertising.” I give more of my time, freely, than any other ADHD expert around.
The only thing I do with my mailing list is notify readers of a new post. And I’ve been blogging since 2008! Lots of free info here. Good info. Original info. Info that took me years to dig up and hours and hours to write.
But thanks, I’ll send your comment to my IT person as proof that it’s not just me being fussy about that darn popup.
Gina
Earlier today I took a rather large dose of Concerta, about 90 mg, followed by a small dose of valerian root a few hours later and 2 rolaids because I began to feel some heartburn and had an upset stomach. A few hours later after driving to the store, I became extremely nauseous and threw up the small amount of substance in my stomach. I was wondering if the anti acids and valerian root caused this effect or if it was because all I had eaten prior was some cereal and toast?? I read on one site that concerta could interact with certain anti-acids but haven’t been able to find this information elsewhere. I am miserable when I am nauseous so I want to make sure this never happens again & if there’s a way I can soothe it now! I am prone to heartburn and upset stomach as well.
Hi Penny,
That is a very large dose of Concerta. If that’s much higher than the dose you normally take, that could very well have resulted in the side effects you report.
Stimulants don’t just affect “attention” — they affect other physiological systems. Breathing. Heart rate. Even gastric motility.
Taking that high a dose could have had dangerous side effects.
It also wasn’t a good idea to risk driving when you didn’t know how it might affect you. Please be careful.
As for Valerian, we don’t know about any interactions. This is also an unregulated product, so you’ll never know how much exactly you’re getting or what else might be in it. I would not risk it. Not when taking a stimulant. If you take it for anxiety, it might be best to look elsewhere. Perhaps a regulated medication.
Yes, it’s possible that having little food in your stomach before taking that high dose of Concerta could have created these side effects, too.
And yes, the antacids could have exacerbated the stimulant effect.
Please be careful!
g
It’s because of red blood cells gina. protein is like vyvanse’s ignition. without it, you will feel anemic and sluggish. Gosh, why don’t doctors tell people this stuff . I had to spend so much time researching crap on my own and figuring it all out and even had to take classes to understand it because the pharmacist and doctor didn’t know what they were doing.
Hey Jake,
I’m not following you….What’s “It” in “It’s because of red blood cells”?
I know that protein in the morning is important for folks with ADHD in particular. This idea of breakfast being milk (largely a sugar) and cereal (metabolized like a sugar — rapidly) — or a bagel and cream cheese — bad ideas!
And yes, it’s ridiculous, isn’t it?
Way back when my husband was finally diagnosed (thanks to my figuring it out), I thought…great…now I can leave the treatment to the MD and my molecular biologist husband — or, as I came to call them later, “Dumb and Dumber!”
My husband knows molecular biology but none of it applied to his treatment. As for the psychiatrist (at a well known clinic), he was mentally out to lunch. In fact, I now suspect he had poorly managed inattentive ADHD.
g
20mg Vyvance seems to last only eight hours for me but im only on Day Three first Day i felt drunkish and as soon as i had lunch i felt better . The second Day i felt ok yet when it Wore off i felt tired and quizy and as soon as i âte i felt better. So i realize that on vyvance i need to eat more often. Ive decided to stay away as Much as possible especially at breakfast from wheat ,Eggs and Milk which seems not to be whats best with meds and also vitamine c. Gonna try to get some healthy snacks un my system to help me feel good, im not sure whats best, but one thing i Do know is i have to snack. I used to always snack during school i guess with summer im kinda out of routine and plus less Hungry because the weather is warm. What snacks are best???? Please email answer , not sure i Will find this post again lolll
Hi Another Gina,
That’s good, that you’re paying attention to how long the medication seems to last.
It’s not unusual for Vyvanse to last only 8 hours.
And yes, it’s good to eat regular meals and snacks. Keep a bag of mixed nuts around, maybe.
g
I am on VyVanse 70 mg as I am the fastest of the fast for metabolizing stimulants CY2PD6. I am ultra rapid at this. I am noticing VyVanse and anything acidic (low pH) make me FREEZE and get extremely tired. I tried Adderall tablets that were faster releasing and I encountered fatigue that was so bad I nearly got in a car accident from the insane onset of tiredness. It felt like the equivalent of taking (3 trazadone pills being on Adderall for me). Now, I tried low dose VyVanse and I had more energy but I was cold all the time. I tried Straterra and would take naps all the time (3 a day or so) and then moved to not sleeping well at night or sleeping too much at night. I tried Ritalin 3 times a day at 10 mg each and then did decently but sure enough I was tired constantly. I tried kicking the energy drinks and then i felt like over time the energy (fatigue issues decreased in the evenings) but it made taking amphetamines in the morning seemingly impossible. I’m so upset and frustrated from this rollercoaster through hell I’m about ready to give up on these pills. I had genesight genetic profile testing done and none of the advise I got from any doctor has helped and I’m tired of being cold and tired like I’m a lifeless zombie. It has been very hard and right not I’m dropping VyVanse from 70 to 60 and want to try 50 now as I continue to have numerous side effects. I hate living life like I cannot have any caffeine and constantly have to live with the concern of balancing my pH on my mind with metabolic absorption and all the works there. I’m really fed up and high dose has been horrible despite my fast metabolism, slow has been only slightly better, and moderate dosing I feel that the medicines wear off too soon. I tried multiple dosings and I was back to too tired to the point of not being able to do anything in my life without falling asleep. To top it all off, I’m home about 300 miles from where my psychiatrist is and every change takes an eternity as he’s overwhelmed from all his patients).
Dear Jacob,
Oh no…. your story surely puts the lie to the idea of stimulants as an “easy fix.” I’m so sorry to read of your challenges with finding a medication regimen that works for you.
One thing I’d question off the bat….Could it be possible the stimulant is making you tired because you are very sleep-deprived? Some people with late-diagnosis ADHD carry an enormous “sleep debt.” And the stimulants, initially, help them to get in touch with how tired they truly are. (The sleepy effect is a little different with Strattera.)
I wouldn’t worry so much about the ph at this point. Just try to eat a varied diet and maybe try to avoid fruit juices entirely.
I wonder if your physician has done thorough thyroid testing.
I wish you much luck. It’s so difficult sorting out these complex issues.
g
I’m not sure really. I sleep pretty well. Thyroid came back as normal. Prolactin has been high with low T but that’s when I took Zoloft and VyVanse. I don’t know really why but there’s a definite issue for me with SSRI Zoloft and VyVanse together. The speed at which I metabolize is so fast that a drug that can give normal metabolizers 10-12 hours of benefit gives me maybe 7-8 at the absolute max, 8. So the idea is raise the dose so it lasts longer but then the speed at which I metabolize is so fast that if I took 90 mg of VyVanse for example, I would get so much fatigue and medicine so quickly with the onset within two hours that I would likely go into a very bad state that I don’t even want to imagine. It appears multiple small doses might be my ticket like a small Adderall capsule dose twice a day but I’m afraid my doc won’t hear me out since everything I’ve suggested has backfired so hard.
Ah! You’re on Zoloft, too. That might be contributing to the problem.
One correction: the way to make a dose last longer is NOT to raise the dose!! The answer is to take another dose later!
Most people with ADHD don’t see the long-lasting effects promised by Vyvanse and Concerta. For many people, it’s several hours shorter. Even for normal metabolizers.
So, it might not be that you are metabolizing it that much faster than normal. Just faster than the claims.
By taking too high of a dose, you are risking the “zombie” state that can come with too-high a dosage of stimulant.
So, as you are concluding…it appears that multiple small doses might be the ticket. Still, Adderall has a very rough start and stop.
If you did well on a “normal” dose of Vyvanse, it might be that you simply need two of those “normal” doses, taken several hours apart (whenever the first dose is wearing off).
If your MD is not coming up with better suggestions, if he’s leaving it all up to you to figure this out, I hope like heck that he “hears you out.” grrr.
good luck!
g
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I think chronic pain syndromes face a very similar balancing act, maybe down to a chemical level. We are faced with a hyperactive nervous system that takes common stimulus and over-reacts by igniting pain pathways (brain tantrum – migraine, or many others). We have to depress the entire system (tricyclic antidepressants, AEDs) which then diminishes overall functionality. Some of us try to boost the functionality back up with a stimulant, but go too far and you’re right back in pain territory! (Though, ironically, stimulants are a Hail Mary line of treatment for refractory migraine.) And also quite a bit of comorbidity with depression/anxiety.
It will be interesting to learn more about the commonalities!
“…we think that this association between ADHD and migraine is mediated by a mutual comorbidity in mood disorders,” explains author Ole Bernt Fasmer, MD, PhD, regarding the study that was published in Psychiatry Weekly. http://migravent.com/blog/migraines-and-addadhd-prepare-for-sensory-overload/
Interesting points, Cristy. Cancer patients also sometimes take stimulants to combat “chemo fog.”
These complex bodies of ours……
g
I think it is very dangerous when we expand our ADD knowledge and try to apply it to other situations. For example, with cancer, primarily in the latter stages, they will give a person anything they can to make them feel better. Most people don’t realize that few patients actually die of cancer. In most cases, they, ultimately, are given a morphine pump that the patient controls and the patient, needing more and more morphine to counteract the pain, ultimately kill themselves with an overdose of morphine. A stimulant might help them at certain points along the line, as you can easily understand, but it is a totally different situation medically. Any given drug can have strange effects on the body. Any time I take anything with zinc in it, I throw up immediately. Logic behind it??? Who knows? Why does Wellbutrin work in 5% of ADD cases and not all?,,,
True, Alan. But I’m talking about non-terminal cases of cancer, wherein the chemotherapy has adversely affected the brain. In such cases, as well as cases of brain trauma, the stimulants can help many people, despite them not having ADHD.
g
I take Vyvanse to combat the sedation and appetite effects of migraine drugs. I do not find its effecitveness in this regard has been impacted by acid reducing medication.
I do find that methylphenidate ER and Vyvanse have been a major cause of my reflux. I could not tolerate the methylphenidate because of it. Vyvanse was not as bad, but over time I had to add more and more acid reducers. So, if they begin to decrease the effectiveness of the drug that will be a real catch 22! Kind of like how I need the Vyvanse to tolerate the headache meds, but too much Vyvanse causes headaches :/
I do not find this as a common adverse effect of these meds, so I guess I’m special!
Hi Cristy,
Wow, that’s a new one to me. What a balancing act.
I have heard of stomach upset, as you describe, from the stimulants. It might be that it is increasing anxiety, which is increasing acid, through whatever mechanism it is that stress does that.
For people with ADHD, it’s often a balancing act between the stimulants and an antidepressant. Too much of one or the other exacerbates ADHD or depression/anxiety.
I guess we are lucky to have these medications, but I’d like to fast-forward to a time when we have more precise strategies.
g
I’m just restarting (Vyvanse) after getting cardiac and gastro clearance. Gastro found a hernia, which makes me more prone to reflux at the best of times. But my reading also indicates that many psych meds and stimulants have an impact on the lower esophageal sphincter.
I’m already on combination therapy but I’m flummoxed on how I can get my team to help me balance if the stimulant means I need to up my H2 blocker which is going to reduce the efficacy of my stimulant…
Hi Lora,
I don’t have evidence or substantiation for this, but I’ve known more than a few people who found that their GERD resolved once they started stimulants. Because the stimulant helped to regulate gastric function.
These things are so dependent on individual physiology.
Perhaps you could simply ask them to take a cautious approach….start at a very low level of the Vyvanse (you can open the capsules into a glass of water, which might mean you can titrate below the lowest starting dose), and go up SLOWLY.
That way, if there is a problem, it’s a minor problem. Also, starting “low and titrating slow” is less of a shock to the system.
I hope this helps. Best of luck to you!
g
Are medications like Provigil and Strattera significantly affected by calcium/acidity/alkalinity, etc.?
Hi Alan,
I don’t see mention of such in the inserts for Provigil:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/020717s020s013s018lbl.pdf
Or Strattera:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2002/21411_strattera_lbl.pdf
cheers,
g
I haven’t seen an issue with any of the drugs in the inserts, but I know grapefruit is a problem with several. Where did you see it on the other acids?
Thanks, Alan. I forgot to add a mention of grapefruit, which has it’s own potential affects beyond the citric acid component.
Grapefruit juice specifically can affect absorption of most of the stimulants as well as many other types of medications.
You can read more about it here. I’ll add a mention to the post.
https://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_interactions
thanks,
Gina
After a bad recurring ear infe tion and strep throat 2 years ago my son started hypermetabolising his biphentin (time released methylphenidate) and it was wearin off in half the time. We started giving him a lower dose twice daily until it seemed to clear up..
Hi Colleen,
Very interesting. It does seem that stimulants can sometime adversely affect the immune system, and I don’t quite understand it.
If that seems to be the case, it does seem wise to lower the dosage and see if that has an effect.
g
If your son had had antibiotics for the ear infection and sore throat there is a possibility that they impacted the gut microbiome which might influence the number of neurotransmitters available in the body for the stimulant to act on. It is also possible that the antibiotic-induced gut dysbiosis could affect the ph of the digestive tract and or urinary tract.
Hi Shelley,
Interesting perspective. Here is an article from the APA (American Psychological Association) for readers wanting to learn more:
http://www.apa.org/monitor/2012/09/gut-feeling.aspx
Thanks for your comment,
g
What about interactions with Intuniv?
I don’t see any ph-related interaction listed on the product insert, Nicole.
http://pi.shirecontent.com/PI/PDFs/Intuniv_USA_ENG.pdf
g
Any info for Focalin XR?
Hi Jeneen,
You can always check the label. I didn’t report on all the ADHD stimulants — there are so many. But I will add info for Focalin XR to the text and here:
Antacids or acid suppressants could alter the release of Focalin XR
The effects of gastrointestinal pH alterations on the absorption of dexmethylphenidate from Focalin XR have not been
studied. Since the modified release characteristics of Focalin XR are pH dependent, the coadministration of antacids or
acid suppressants could alter the release of dexmethylphenidate.
In other words, yes, an overly acidic ph could affect absorption.
Gina
Hi – Thanks for this article! So from your research, would you expect antacids to have a negative impact on Ritalin effectiveness in an adult?
Hi Jess,
It’s hard to say. The Ritalin insert says nothing about acid/alkaline/ph. But it might be worth your experimenting.
https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/ritalin_ritalin-sr.pdf
g
We found that taking amoxicillin had an effect on reducing the efficacy of concerta. I called the pharmacy and there was in interaction in the literature that he was aware of.
Hi Brenda,
That’s interesting. The Concerta insert doesn’t mention it, but the truth is that most drug interactions are not studied.
Here’s the limit of Drug Interactions on the insert:
Drug Interactions
CONCERTA® should not be used in patients being treated (currently or within the
proceeding 2 weeks) with MAO inhibitors (see CONTRAINDICATIONS,
Monoamine Oxidase Inhibitors).
Because of possible increases in blood pressure, CONCERTA® should be used
cautiously with vasopressor agents.
Human pharmacologic studies have shown that methylphenidate may inhibit the
metabolism of coumarin anticoagulants, anticonvulsants (eg, phenobarbital,
phenytoin, primidone), and some antidepressants (tricyclics and selective serotonin
reuptake inhibitors). Downward dose adjustment of these drugs may be required
when given concomitantly with methylphenidate. It may be necessary to adjust the
dosage and monitor plasma drug concentrations (or, in the case of coumarin,
coagulation times), when initiating or discontinuing concomitant methylphenidate.
Serious adverse events have been reported in concomitant use with clonidine,
although no causality for the combination has been established. The safety of using
methylphenidate in combination with clonidine or other centrally acting
alpha-2 agonists has not been systematically evaluated.
g