Reply To: Vyvance twice daily.

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bdodson
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Hello, I am Dr. Bill Dodson who was quoted above. I just ran across your posts while II was searching for something else.
The FDA is responsible for a huge number of misunderstandings about the use of ADHD stimulant medications. The ones that are interfering with your care are the notions of “once a day medication” and “maximum daily dosages.” The FDA only approves practices that they themselves actually studied. The FDA has never studied taking more than one dose of an extended release formulation and so they approve them for just one dose a day. As all of you know from personal experience, this is complete nonsense.
You are not alone in this. A recent article from Dr. Tom Brown (one of the clearest thinking people in the ADHD field) on what are the unmet needs of adults with ADHD found that overwhelmingly the most common and most impairing problem was not having enough medication to cover all of the time they needed to be functioning at their best. The Standard of Care from the European Union Adult ADHD Network is to “medicate at all times and situations in which there is impairment.” The reference is Brown TE, Romero B, Sarocco P, et al. (2019) The patient perspective: unmet treatment needs in adults with attention-deficit/hyperactivity disorder. Primary Care Companion CNS Disorders. 21(3):18m02397. If you cannot find it easily, email me at billdodson19@gmail.com and I’ll send it to you.

We are lucky if we can get 10 hours worth of benefits from any extended released product. That leaves the other 14 hours of the day uncovered. The duration of any amphetamine formulation is determined by the acidity of your urine (I’m not kidding here). Amphetamine is not metabolized by human beings but rather excreted in the urine unchanged. If you urine is acidic, even extended released amphetamine is gone in 4-6 hours. If it is alkaline, amphetamine can stick around for 20-24 hours. Each person is unique.

I ask my patients to take a nap on their dose of medication after lunch so that they can see that the stimulant will not keep them awake if they take a 2nd or even a 3rd dose. Once you can nap on your medication you will know that another dose will not keep you awake.

BTW the statistic is that 40% (not 60%) of adolescents and adults will get their optimal level of symptom relief at doses higher than those approved by the FDA. That is a lot of people but the FDA refuses to even consider changing their arbitary misinformation.
I hope this is helpful to you in your work with your clinicians.
Bill Dodson, M.D.