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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Paulbwell on December 15, 2006, at 12:09:27
As some of the older posters here will know i have taken generic Ritalin 10mg IR tabs for a few years. It was topping out at ~100mgs daily. My Doc switched me to brand name Ritalin-SR20mg tabs 3 daily, for longer effect (IR lasts~2 hours-sad) as he said 60mgs is the max, strangly, well, I'v read, and experienced that Rit SR20 tablets turned out to be a bit of a bunk, in that it was found that only 7-8mgs was ACTUALLY released and absorbed by these small waxy pills.
I altered the dosage (bad boy) to find a more satisfactory effect with these pills, and played with the dosage to find comfortable results, and something akin to what the generic IR tabs controlled. I found a dosage that seemed to be satisfactory, but much to my chargrin it turned out i was taking a sheet, 10 tabs=200mgs SR Ritalin, for effective results.
How the heck am i going to explain this to him-that ~10 tablets, not your 3, was satisfactory in making me comfortable, he would most likely write something like DS (drug seeking) or RA (Ritalin abuser) on my file, when ~3, 20SR tabs 3x daily did something similar to 3, 10mg 3x daily IR gen Ritalins did.
If it's true (and i'v read at more than 1 site) that only 7mgs of the 20mgSR ritalin tab is bioavailable, then x 10=70mgs, the dose he has been giving me before.
Tolerance, after 3 years? i have an aquaintaince who's been on Dexamphetamine ~15 years, and their dose is 80mgs, 16, 5mg IR tabs daily,480 monthly. Dex is usually used at half the dose of Ritalin so thats=to 160mgs Ritalin.
What do i tell the good Doc "hi a dose of 10, 20mgSR tabs, 200mgs daily works fine" he will think i'm drug seeking, he works in addiction medicine, and has commented before about some people injecting Ritalin, and i'v caught him checking my arms out.
Any advice would be appreciated.
Cheers
Posted by linkadge on December 15, 2006, at 12:25:05
In reply to Methylphenidate, Ritalin SR20mg, posted by Paulbwell on December 15, 2006, at 12:09:27
I would definately think that If you asked for 10 sr tabs that he would think you are drug seeking.
This is a lot of ritalin. If the IR dose is pooping out at this dose then I'd say you need to start with another plan.
Either get off the stuff and switch to a different stimulant, or reduce the dose, cause more of it is just going to make things worse down the road.
>7mgs of the 20mgSR is released.
There is 20mg in the 20mg tablet, but maybe they mean that it only reaches a concentration equivilant to IR 7mg?
Linkadge
Posted by mixed_state on December 15, 2006, at 12:50:36
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by linkadge on December 15, 2006, at 12:25:05
I agree with linkadge, 10 Ritalin SR 20s is a massive amount of methylphenidate. I've taken these SR 20s before and I do not believe that only 7 mgs is bioavailable. I distinctly remember that 10 mgs hits quickly and lasts about 3-4 hours, followed by a small lull, and then the second 10 mgs hits for the next 3-4 hours. It felt like 2 IR 10mgs only with a slightly smoother transition between the two doses.
I just can't imagine that such a dose (160 mgs) is sustainable. It seems that the effects of Ritalin have attenuated to such an extent that it really is no longer working. I would look for alternative solutions. There are several options that i would look into if I were in your position:
1) I would try to take a break for several weeks or months, be stimulant free and take magnesium, caffeine, and mate to help you through the period
2) or I would switch to another stimulant for a few months. Adderall, Dex, etc., even if they are not as effective for you, could be used for a while. You can then switch back to Ritalin and you will probably require a much lower dose.
3) or I would try Strattera or Provigil with a very small dose (5 mgs) of Ritalin as needed, to try to give your body a rest from Methyl-p
4) or I would try adding caffeine to a smaller dose of Ritalin.These methods have all helped me in this past. Hope this helps.
Posted by Paulbwell on December 15, 2006, at 13:54:48
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by mixed_state on December 15, 2006, at 12:50:36
Thanks ppl for your replies, Perhaps swallowing SR20s is preferred over breaking the SR formula mmmmmm and creating a more IR effect my Brain was used too.
I managed to 'aquire' a supply of 5mg IR Dexamphetamine tabs recently, and they sure act differently on the brain, (daily dose~20-30mgs, spread) a noticably lighting up of the whole brain as opposed to the strong frontal lobe activity with Methyl. I found 20mgs made me larthegic and lazy, i could spend the day on my bed, even falling into very deep naps, which were wonderful. Ritalin feels more like "speed" than Dex (without a stimulant i feel like i'm on speed naturally-unmedicated) which took longer to come up and unoticed when dropping off, smoother, however it certainly did not give me the drive, motivation (at a low dose) to do much, just mellowed me out, unlike Ritalin+Nicotine+caffeine, which shoves me to focus on sumthing i'm into-Ritalin is FAR more focusing than Dextro-althought i had opportunity to combine both and found they complimented each others effects.
Ritalin is a bloody wonderfull med for hyperactivity, and allowing you to drum out background static, mild depression, fatigue (MOA counts)and, i found more activating than Dexamphetamine, except when one night i took 50mgs-can you say PANIC/MANIC ATTACK, thats the problem with Amphetamines, theres A VERY STRONG PULL to just take 1-2 more, if you donot have self control, this thought continues-especially when Dexamphetamine tabs downunder are basically sweet flavoured suger cubes-deliberate by Pharma, i'm sure.
Thanks guys-gals xxx
Posted by linkadge on December 15, 2006, at 15:09:35
In reply to Re: Methylphenidate, Ritalin SR20mg » mixed_state, posted by Paulbwell on December 15, 2006, at 13:54:48
You could also look into a TCA antidepressant. They are sometimes used for ADHD, and may augment stimulants. They are not stimulants per se, but TCA's like desipramine can sure get the ticker going.
If you feel that you may be using the stimulants more as antidepressants, then an antidepressant might offer a more sustainable effect on mood.
Methylphenidate did improve my mood, but it only lasted a month then I was back in the gutter needing more.Linkadge
Posted by Paulbwell on December 15, 2006, at 15:44:03
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by linkadge on December 15, 2006, at 15:09:35
> You could also look into a TCA antidepressant. They are sometimes used for ADHD, and may augment stimulants. They are not stimulants per se, but TCA's like desipramine can sure get the ticker going.
>
> If you feel that you may be using the stimulants more as antidepressants, then an antidepressant might offer a more sustainable effect on mood.
> Methylphenidate did improve my mood, but it only lasted a month then I was back in the gutter needing more.
>
> Linkadge
>
>
I hear you Link-you know you stuff dude, i have 300 25mg Imipramines here, that my PCDoc wanted to push on me,2nd line ADD/HD treatment/mood, i fainted and passed out at work on it. I keep them in case things get............cherrs-respect and thanks
>
>
>
Posted by med_empowered on December 15, 2006, at 15:51:10
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by linkadge on December 15, 2006, at 15:09:35
could you break up the tablets your doc RXs? I know that this probably isn't suggested but...if the IR works, it works...maybe some sort of solvent? I imagine you could buy a dropper, crush the tabs, soak them in alcohol+water, and then dose out how much you needed. Or maybe not. Just a thought.
I think an AD might be a good idea but...lots of ADs suck. A lot. I think in your case you might want something that's helpful for ADHD, but also has some anti-obsessional properties...so maybe low-dose anafranil? Or maybe cymbalta, luvox, even buspar? I think that might prove helpful.
I dont know if you have it where you are, but there is Focalin now. I took it when they were just making the IR tabs. NOthing too crazy; I took a good bit of extended release methlyphenidate in the AM (I want to say 40-60mgs...I really don't remember), and then my doc gave me 10mgs Focalin tabs to take as an afternoon pick-me-up. It worked OK, and I hear its supposed to be 2x as strong as standard ritalin, but w/ fewer side effects and what not. Maybe that's an option? Also, sometimes you don't need to pick amphetamines OR ritalin; some people really do benefit from BOTH, although (I hope) docs are very careful about RXing those kind of combos. And..I dont know if you've tried these already, but non-drug interventions, like awareness training and biofeedback, help some people.
Good luck.
Posted by linkadge on December 15, 2006, at 16:05:01
In reply to Re: Methylphenidate, Ritalin SR20mg » linkadge, posted by Paulbwell on December 15, 2006, at 15:44:03
Do you know what the imipramine induced fainting was due to?
Did it cause sedation, or do you think it was due to hypotention?
It might be worth a second shot. Imipramine will have more side effects than the stimulants, but a low dose might prevent the stimulant escalation.
Linkadge
Posted by linkadge on December 15, 2006, at 16:07:23
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by med_empowered on December 15, 2006, at 15:51:10
Focalin.....sounds too much like focasyn :)
Linkadge
Posted by Paulbwell on December 15, 2006, at 16:29:14
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by linkadge on December 15, 2006, at 16:05:01
> Do you know what the imipramine induced fainting was due to?
>
> Did it cause sedation, or do you think it was due to hypotention?
>
> It might be worth a second shot. Imipramine will have more side effects than the stimulants, but a low dose might prevent the stimulant escalation.
>
> Linkadge
>
>
>
>I was put on 150mgs Imipramine, and took a little to much one morning, became as white as a ghost, then blacked out for 20 seconds-didn't know where i was,ORTHROSTATIC HYPOTENSION was the cause,i have a couple times taken one 25mg at night and feel slower and hungrer the next day (i'm 5'11, 60-65kgs=thin, 30's.
You know stuff, are you saying 25-50mgs Imipramine would buffet and discourage over use of Methylphenidate?-don't they potentiate each other?-problems?
Truth be told yes, i am inclined to take Ritalin at times-hell, often for mood issues, to 'wake up' mentally, to feel alive and 'on'
I'm sensing you thing i tend toward OCD traits-yer i do at times-you picked that up,
so 25mgs Imipramine slows compulsion toward taking Ritalin?
Any comments-Thanks Link,
I ham somewhat sleep deprived, as havn't slept in 3 days-got 10mg IR changed to Rit Sr20-they seem stronger-i havn't slept in 72 hours, but theres always some Risperdal, xanax, Vodka, here if i need to knock myself out, but will probably just 'crash' or start loosing it-at which point i'll knock myself to sleep, with above meds.
Cheers dude-appreciated
Posted by linkadge on December 15, 2006, at 17:42:56
In reply to Re: Methylphenidate, Ritalin SR20mg » linkadge, posted by Paulbwell on December 15, 2006, at 16:29:14
In general, any SSRI may slow the compulsion to increase stimulants.
Imipramine is an SNRI really, but it might be benificial to take the lowest effective dose.
The only reason I say is because it seems you may need another plan. If you've maxed out the ritalin, I don't see too many doctors going higher with you.
Other options might include SSRI's.
I found a zoloft/ritalin combination was good too.
Linkadge
Posted by Maxime on December 15, 2006, at 17:54:15
In reply to Methylphenidate, Ritalin SR20mg, posted by Paulbwell on December 15, 2006, at 12:09:27
Are you always on high dosages of your meds. Maybe your body metabolises them really quickly.
I don't know what you would tell your doctor. That's A LOT of Ritalin.
Maxime
Posted by med_empowered on December 15, 2006, at 18:42:06
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by Maxime on December 15, 2006, at 17:54:15
Imipramine kind of sucks. Maybe you could try something else, like low-dose Surmontil or Pamelor? Even low-dose cymbalta, effexor...pretty much anything that might potentiate the ritalin and keep your ocd urges at bay.
Good luck.
Posted by Maxime on December 15, 2006, at 18:51:16
In reply to Re: Methylphenidate, Ritalin SR20mg » linkadge, posted by Paulbwell on December 15, 2006, at 15:44:03
Have you tried Desipramine or Strattera?
I wonder if your heart is at risk with all the stims you have been taking?
Maxime
> > You could also look into a TCA antidepressant. They are sometimes used for ADHD, and may augment stimulants. They are not stimulants per se, but TCA's like desipramine can sure get the ticker going.
> >
> > If you feel that you may be using the stimulants more as antidepressants, then an antidepressant might offer a more sustainable effect on mood.
> > Methylphenidate did improve my mood, but it only lasted a month then I was back in the gutter needing more.
> >
> > Linkadge
> >
> >
>
>
> I hear you Link-you know you stuff dude, i have 300 25mg Imipramines here, that my PCDoc wanted to push on me,2nd line ADD/HD treatment/mood, i fainted and passed out at work on it. I keep them in case things get............
>
> cherrs-respect and thanks
> >
> >
> >
>
>
Posted by Maxime on December 15, 2006, at 18:54:22
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by linkadge on December 15, 2006, at 16:05:01
I think it would be safer to use Desipramine (derived from Imipramine). Imipramine can mess up your heart.
Maxime
> Do you know what the imipramine induced fainting was due to?
>
> Did it cause sedation, or do you think it was due to hypotention?
>
> It might be worth a second shot. Imipramine will have more side effects than the stimulants, but a low dose might prevent the stimulant escalation.
>
> Linkadge
>
>
>
>
Posted by linkadge on December 15, 2006, at 19:56:09
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by Maxime on December 15, 2006, at 18:54:22
Desipramine can be hard on the heart too. Use of this drug for ADHD is discouraged in Europe after the death of some kids from cardiac problems.
Linkadge
Posted by Paulbwell on December 15, 2006, at 20:15:28
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by Maxime on December 15, 2006, at 17:54:15
> Are you always on high dosages of your meds. Maybe your body metabolises them really quickly.
>
> I don't know what you would tell your doctor. That's A LOT of Ritalin.
>
> MaximeI was used to the quicker MOA of IR, which came on in 5 minutes, and during the 'honeymoon period' a dose worked very effectively, i felt comfortable to 'be', felt in the zone, where life just darn well fit, and it was great. The SR take 1 hour to start, i chew em to get more prompt results.
Posted by paulbwell on December 15, 2006, at 20:20:05
In reply to Re: Methylphenidate, Ritalin SR20mg, posted by linkadge on December 15, 2006, at 17:42:56
> In general, any SSRI may slow the compulsion to increase stimulants.
>
> Imipramine is an SNRI really, but it might be benificial to take the lowest effective dose.
>
> The only reason I say is because it seems you may need another plan. If you've maxed out the ritalin, I don't see too many doctors going higher with you.
>
> Other options might include SSRI's.
>
> I found a zoloft/ritalin combination was good too.
>
> Linkadge
>
>Prozac+Ritalin made me manic-perhaps 1 25mg imipramine may help
Cheers
Posted by Paulbwell on December 15, 2006, at 20:34:15
In reply to Re: Methylphenidate, Ritalin SR20mg » Paulbwell, posted by Maxime on December 15, 2006, at 18:51:16
Hi
"I wonder if your heart is at risk with all the stims you have been taking?"
Methylphenidate, from what i've read is fairly tame, long term to the Heart as opposed to Meth/Amphetamines.
cheers
Posted by linkadge on December 15, 2006, at 21:10:43
In reply to Re: Methylphenidate, Ritalin SR20mg » Maxime, posted by Paulbwell on December 15, 2006, at 20:34:15
>Methylphenidate, from what i've read is >fairly tame, long term to the Heart as opposed >to Meth/Amphetamines.
I wouldn't bank on that. But, lets not go there.
Linkadge
Posted by linkadge on December 17, 2006, at 11:29:02
In reply to Re: Methylphenidate, Ritalin SR20mg » Paulbwell, posted by linkadge on December 15, 2006, at 21:10:43
Don't worry about that though. You havn't been on it that long. You need to find a safe dose, and then find something that can help your mood.
Linkadge
This is the end of the thread.
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