June 3, 2019 at 8:19 am #117488jtr74Participant
I was just listening to a podcast from this site:
My Dr made many mistakes that Dr. Dodson covers. He started me on Vyvasne 30 mg. I’m 45 and this is my first time on a stimulant since I was 13. Obviously, I’m still in the trial phase and I felt like it was working OK – but it was “running out” very early in the day. The response on my 3 week followup to this complaint was to jump me to 70 mg. I’d like to tone this down a bit and see if I can figure out a good dosage (that will probably be under 70 mg). Dr. Dodson states that Vyvasne is stable for a long time in water. Does anyone know if it requires refrigeration? I have been googling around but I haven’t been able to find anything definitive.
April 30, 2020 at 1:01 pm #170771
Hello, This is Dr. Dodson and I just happened to run across your question while I was looking for something else.
The answer is that Vyvanse is stable in water essentially forever and without refrigeration. The FDA says you can dissolve Vyvanse in water for people who cannot swallow pills but that you should throw away whatever is left. This is because the FDA did not specifically study whether Vyvanse remained stable or not.
But the DEA (Drug Enforcement Administration) did study it because they were worried Vyvanse could be put in water and injected (it is their job to worry about such things.) They put Vyvanse in a Mason jar of tap water and put it on a bookshelf for one year. At the end of that year there was no degradation of the lis-dextroamphetamine prodrug delivery system. It was as good as the day it was put in the water. My patients have consistently reported the same thing to me. For example, a student will usually buy the largest 70 mg size and do the math to make up a pitcher of Vyvanse in water at the first of the semester.
This feature can save a lot of money for people who take relatively low dosages (ex. A person who takes a dose of 20 mg can get 3 1/2 doses out of a single 70 mg capsules (all of the various dosage strengths cost the same).
One minor caveat… there will be a white powder that falls to the bottom of the container. It is not medication. It is titanium dioxide that is put in the capsule to prevent caking. It is totally inert. I am told by my patients that if you stir it up, it makes your teeth feel gritty for a few minutes.
I hope this is helpful,
Bill Dodson, M.D.
May 3, 2020 at 5:36 am #170991Attention DisorderParticipant
What is recommended amount of water per 70 mg Vyvanse?
Does the same apply for generic methyphenidate?
Could I remove the lactose in the generic brand of methyphenidate by separating it in water?
- This reply was modified 1 year, 4 months ago by Attention Disorder.
May 3, 2020 at 2:36 pm #170999
When all is said and done the 29 different stimulant medication products that are on the market in the US are merely delivery systems of just two molecules, amphetamine and methylphenidate. Each formulation has advantages and disadvantages but the goal is always to get a small portion of a huge and ever-growing market for ADHD medications.
Both amphetamine and methylphenidate are unstable in water unless they are protected by some other means. If you just drop a tablet of either one in a glass of water and come back in a couple of days, all of the medication will have decomposed and will be useless. That is why we do not have a water formulation of any ADHD stimulant even though about 1/3 of children cannot swallow pills.
All of the liquid formulations (ex. Quillivant, Dyanavel, etc.) are actually suspensions of ion exchange resins that protect the molecules from the water. Don’t bother with all of this complex chemistry. All you need to know is that this is a long-winded way of answering your questions 3 ,5, and 6. The answer is “no” you can’t dissolve any other formulation (that is not already a liquid suspension and, therefore, really expensive) in any liquid and end up with a useable liquid ADHD stimulant medication.
The one exception is Vyvanse. Its delivery system is that they bond an amino acid called lysine to the amine portion of the amphetamine molecule. When they do, they get a totally inert prodrug. There is only one place on the planet that has an enzyme that cuts off the lysine and leaves the amphetamine molecule ready to do its job. That place is the inside of a human red blood cell.
As a result, the prodrug can sit in water forever and not disintegrate. The prodrug is remarkably soluable. You could take an entire month’s supply of Vyvanse and dissolve it in a teaspoon of water. Therefore, you can use as much water as you like so long as you get your math right. In the US we use ounce measures (a measure of weight) but everywhere else in the world they use milliliters (a measure of volume). I am going to assume that you are in the US for my example since our English measue is so much more complicated than metric measures.
I have a patient who is a college student who is very sensitive to dose. He has found that his optimal dose is 12 mg of Vyvanse with each dose lasting about 8 hours. At the beginning of each semester he whips up a large tupperware beaker of Vyvanse in water by dissolving the powder inside twelve (12) capsules of the 70 mg size capsules of Vyvanse in 70 ounces of water (8 3/4 cups). He shakes it up and lets the white powder fall to the bottom. Each ounce now has 12 mg of Vyvanse. Each morning he pours out a shot glass (1 oz.) of the liquid and goes off to class. 7 1/2 hours later he takes another ounce so that he can study at night. He gets almost 6 dose out of a single Vyvanse capsule. Pretty thrifty. Put a label on the beaker and hide it some place where people won’t get into it. It does not need to be refrigerated.
If you have any more questions or if you would like someone to check your math, let me know.
May 3, 2020 at 2:43 pm #171001
I just realized that I did not answer two of your questions.
You are out of luck with the methylphenidate you take. There is no way to dissolve it and have it be stable for more than a day or so. Since the IR tablets only come in 20 mg sizes, there is no way to save a bit of money.
There is no way that I or the pharmacist I consulted know to remove lactose from a solution without adding toxic solvents or heating it to the point that the methylphenidate is destroyed. Sorry, I can’t help you on the lactose problem.
November 9, 2020 at 6:17 pm #187489PizzaParticipant
Thanks a lot for responding, this will save me and countless others I am sure a lot of money and time.
Appreciate your work!
April 4, 2021 at 11:02 am #198759Joe johnsonParticipant
I know this is an old thread, but does anyone have access to the DEA study of the degradation (well..or the nondegradation) of vyvanse in water? I want to show my psychiatrist. thanks
April 4, 2021 at 2:21 pm #198766
To my knowledge that study was never published because it was not done by the FDA as part of the new drug approval process. It was done by the Drug Enforcement Administration (DEA) with an orientation toward abuse potential rather than possible clinical use. As you may be aware, the DEA does not have a strong history of sharing information even with other governmental agencies. The DEA was worried that the prodrug was going to break apart leaving a water solution of amphetamine that could then be snorted or injected.
My understanding is that at the end of one year at room temperature there had been no degradation of the prodrug… none at all. If there had been some breaking of the lysine bond, the amphetamine base would have decomposed in water within a matter of days. That is why we went 30 years without a liquid formulation of an ADHD stimulant even though 30% of kids can’t swallow pills. The many liquid formulations that we now have on the market are colloidal suspensions and not water solutions. The MPH and AMPH are “hidden” from the water in ion exchange resins so that they will not decompose.
You may also notice in the PDR and package insert that the FDA says that it is OK to dissolve Vyvanse in water but that whatever portion that is not used immediately should be discarded. This last direction to discard the solution is not based on there being some reason not to keep it but rather that the FDA will only approve something that they have studied themselves. Since the FDA did not study stability in water, their answer was that you have to throw it away.
In my own practice I had well over 100 people who dissolved their Vyvanse in water and the solution retained it’s full efficacy for months. I did not have a single problem with it.
Dr. Bill Dodson
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