Vyvanse Approved For Adults With ADD/ADHD

My question is -is 4 weeks really long enough to test the full effect of a drug-good or bad?
Is this the usual trial time for a new medication?
brenda

This is a big relief! Now we just need the research done to validate more appropriate dosing guidelines for adults! Currently, there are 11adult clients taking Vyvanse in my practice. (There are about 12 more whose doctors/ wouldn’t prescribe, or insurance wouldn’t approve, Vyvanse until it was approved for adults or wouldn’t titrate past 70mg.) Of those adults in my practice currently taking Vyvanse, 1 is therapeutic at about 60 mg. a 2nd at 70 mg. and all of the rest have found their therapeutic doses to be over the pediatric limit of 70 mg. The dosing range for the 9 remaining clients of mine taking Vyvanse is 100 mg. to 250.mg. Every one of these clients has found symptomatic relief, previously unknown to them, with the least side effects. All have previous experience with several other stimulants. Most were previously satisfied with Adderall but state they experience far greater relief, for a longer period, without the side effects, with Vyvanse. It seems that pediatric dosing for adults, who weigh at least twice as much as most children, will most likely produce pediatric results. Vyvanse has a maximum dose two and a half times greater than the other stimulants. It’s a simple math problem. If an adult is therapeutic on Vyvanse at 70mg. that’s great! However, for those who aren’t, the pediatric guidelines serve as an obstacle to appropriate comprehensive treatment and are a disservice to the adult add community. I have one client who met with significant symptomatic relief for the 1st time in his 62 years on Vyvanse 140mg… He had one great week at that dose. Then the insurance company refused to honor the doctor’s prescription. My client had to go back to his previous dose of Adderall because 70mg. of Vyvanse left him too under treated. One week later, this client was fired. His boss had seen the improvement (not knowing it was medication related) and when the return to Adderall resulted in this client’s chronic lateness returning, he was fired. The boss’s rationale was that this client could be on time, (as proven the week before on Vyvanse), so he should be on time. The rationale of the insurance company was that Vyvanse wasn’t approved for adults. This client will try again with the FDA approval but I fear the insurance company will simply point to Shire’s dosing guidelines and refuse payment for any prescription over 70 mg. This week’s approval of Vyvanse for adults is a step in the right direction, but not everyone can breathe a sigh of relief just yet!

First, Dr. Handelman, thank you for the update.

Regina, that’s a hideous story.

Anyone else willing to take a bet that that trend will get worse directly proportionate to the general worsening of the economy?

(Slightly tangential — in this context, is it “proportionate” or “proportional”?)

So do the prominent doctors and practitioners who read and post here have any specific concrete suggestions for clients/patients who are on the verge of finding help but anticipate hitting this wall - with its labyrinthine bureaucratic mazes leading to roadblocks and prospective massive amounts of paperwork - and falling further through the cracks?

Or will there be more shrugging and exhortations of “That’s life” and “You can’t win them all”, and behaving as though these people/clients/patients don’t exist and don’t need help NOW – and not ten years from now after yet more “sufficient” blind trials have been conducted to make some sort of tentative hypothesis so that MAYBE insurance companies and doctors will be willing to REVIEW what the clients/patients have to say after all 10 proper requests have been submitted, all in quadruplicate?

Notwithstanding that these clients’/patients’ actual lives – like that 62 year old guy above, who is probably, at this point, not in the most robust of leveraged bargaining positions in the current job market – have quietly imploded in the meantime?

I don’t know if this is the right place to put this post so if it isn’t please move it to the right place.

I am 32 years old 22 years ago when I was 10 I had been diagnosed with ADD and started on Ritalin. My parents kept me on Ritalin for a couple of months and decided it was just a phase and I was past it. While in high school I was diagnosed with a learning disability something to the effect of anxiety brought about by exams or some such thing. The school diagnostician came to this conclusion because I had an above average IQ, However I didn’t participate in much class, but I was able to answer any question when called upon, and then would do very poorly on the exam. I have tried several times to go to college since high school and usually get about halfway through a semester and drop out. Well over the last 14 years I have hopped from job to job when ever I got bored, restless, or just didn’t feel like going to work. The exception being my current job I’ve been here almost 6 years; not that I haven’t tried to leave but every time I try I get offered different position which has kept me here. I did the same thing in my personal life stick around in a relationship till I got bored or found someone else more interesting or attractive and moved on with the exception of my now wife we were off and on again for the first couple of years but have been together for going on 6 years straight now and have been married for 3 almost 4 years now (not for lack of trying to leave but because she has a way of making me see how stupid I act at those times). About 6 weeks ago I was talking with a good friend (who is also a psychologist) and he asked me a couple of questions about how I felt, things I had done and why I did them, remarked on some of my behaviors he had noticed and suggested that I talk to my doctor about the possibility that I might have ADD. Well with out much effort I was able to blow that off for a week or two and I researched little online about it and read posts on various blogs and it was like reading a journal of my life. So I got an appointment with my doctor he asked me a few questions about my medical history and a few about what was going on and wrote me a prescription for Adderall. I took it twice a day for a month and it almost instantly changed my life. I had spent the majority of my life wondering why I couldn’t seem to finish anything I started and a lot of times couldn’t even start cause the whole thing seemed overwhelming or “Why start it I won’t finish it anyway at least this way I won’t feel the guilt of not finishing yet another task”. I saw all of my friends out at social gatherings and events having fun and enjoying life while all I was able to do was literally sit in a corner and try to block out everything around me. It was like everything was a blur, too much going on to process and it made me feel like I was going crazy. I couldn’t even carry on a conversation without thinking whats going on behind me what are the people two tables over talking about and never being able to focus on my friends and family and enjoy the moment because of the anxiety I felt from everything going on around me was overwhelming. In my mid 20’s I had been diagnosed with Social Anxiety Disorder, and I fit the mold almost exactly. I was given a prescription for Xanax and Paxil. I took the Paxil for about a month with no positive effect whatsoever but I kept taking the Xanax at the start of any anxious feelings. All it did was make me sleepy and lethargic it didn’t really make me feel better but it was better than nothing. Since I started taking medication to treat my ADD. It’s like the fog has lifted I can go out concerts and party’s with no anxiety, at work I don’t feel the sudden urgent need to get up from my desk and go for a walk or go smoke a cigarette. I used to get up and go outside to smoke just because I was bored not that I had a craving or wanted one. Last week I met with my doctor for a one month check up I told him some of the side affects from the Adderall I was constantly chewing, I had no appetite (I had to force myself to eat so I didn’t get sick), dry mouth, lite headaches and some small bowel trouble. He wanted to try me out on Vyvanse. He said it’s more expensive but people who have switched to it from Adderall have reported fewer side effects and some none at all. Luckily my Health Insurance covers Vyvanse it costs $40 a month as opposed to the $4 a month of Adderall but so far so good it’s only been a week I still have dry mouth but thats not something a little water can’t fix and I still eat even though I don’t feel hungry. With all the changes in the last month I find myself wondering how different my life would have been, How much farther down the road and ahead of the game I would be if I had never been taken off the medication as a child or even at the very least Googled what feelings I was having and the problems I was experiencing and found others that felt the same way,but the past cannot be changed what’s done is done and all we can do is move ahead from the point we are at now. I have a 2 year old son who apart from my wife is the most important person in my life. I look at him and see myself not just the physical resemblance but mannerisms and personality and wonder if he too is a victim of the curse that has plagued me my whole life, However I take great comfort in knowing that if he does, the path his life takes will not mirror my own, because I will make sure he has the tools to be the best he can.

My 10 year old is being placed on this after 5 years of being on Adderall Xr. She took 40mg daily. It is not working effectivley. ( still looses attention, and focus, moody, NO appetite!) Her Dr ask i try this becasue her growth curve has plumeted from day one- straight down in weight. She is in 8%. I wanted to know if this is in fact a better/ safer choice? I hear both extremes and worry for her health. I pray i will find the best choice but am always nervous for her.