W2zc2PPDd Tapering off Vyvanse 50 mg

[W2zc2PPDd]

(edit: sorry, thought the below code would show up as nice organized tables for yall. i'll fix it when i feel less knackered)

 

 

Date	Dose	Time	Medicine	Reason	Prescribing MD
3/2012 - 7/2015	37.5 mg	4am-6am	Effexor XR	Anxiety/Depression	Pdoc 1 (retired spring 2015)
7/2017 - 9/2015	increased to 150 mg	4am-6am	Effexor XR	intrusive thoughts	Pdoc 2 (stopped accepting insurance)
7/2014 - 7/2015	50 mcg	4am-6am	Levothyroxine	Hypothyroidism	Endocrinologist (cleared me to let my GP handle my thyroid disorder)
7/2015 - present	37.5 mcg	4am-6am	Levothyroxine	Hypothyroidism	GP
8/2016 - 5/2017	20 mg to 60 mg	4am-6am	Vyvanse	Fatigue	Pdoc 3
5/2017 - 2/2018	60 mg	4am-6am	Vyvanse	Fatigue	Pdoc 3
2/2018 - 5/2018	decreased 50 mg	4am-6am	Vyvanse	Decreased due to heart palpitations	Pdoc 3
5/2018 -present	250 mg	morning 125 mg afternoon 125 mg	Armodafinil	Fatigue	Sleep doc

Other notes:

• I've had my Vitamin D, Iron, B12, and thyroid levels checked at least once a year since 2014. 
• - Most recent sleep study in February 2018.
• - Sleeping with an APAP since March 2018. Getting a CPAP titration in a couple of weeks because it keeps waking me up every night despite my getting over a dozen adjustments with the sleep tech. 
• - I don't plan on stopping the other drugs. I'm only interested in support for tapering off Vyvanse.
• - In the past, I tapered from 60 mg of Vyvanse to 50 mg. I took 55 mg for three days (it was the last of my 60 mg prescription, so I couldn't taper longer than that) without noticeable withdrawal. I started 50 mg on day 4. Then on day 5, I had a bunch of work stress and family stress and felt super buzzy/tired for the next week. Considering tapering more slowly, maybe in 2.5 mg intervals.
• - I honestly feel pretty crappy today. buzzy, tired. been focusing on eating lots of protein (grilled chicken), vegetables, drinking lots of water.
• Super stressed at work but honestly I don't know when I *won't* be stressed about work.

 

Diary:

5/30/2018
Time	Dose and med	Symptoms
5 am am	150 mg Effexor XR 125 mg Armodafinil 37.5 mcg Levothyroxine 45 mg Vyvanse	None
8 am	n/a	Tired
11:30 am	125 mg Armodafinil	tired/low motivation/buzzy/mildly nauseaus/mild hot flashes/forgetfulness

[Altostrata]

Welcome, W2z.

 

You'd have to post HTML in the Source window. If this doesn't appear top left in a post window, you don't have access to it. You have an hour to edit anything you post. Please do us a favor and post text.

 

Why did you decide to go off Vyvanse? What problems are you having tapering Vyvanse? What do you mean by "buzzy"?

 

Could you put the drug goings-on from 8/16 to present in a narrative form? Just tell us what happened? Did you start Vyvanse because of fatigue from not sleeping well? When did these sleep problems start? What is the nature of your sleep disorder?

 

Did you have any symptoms of hypothyroidism before you started Effexor in 2012?

 

Do you have any side effects of Armodafinil?

 

What drugs are you taking now, at what times of day, in what dosages? To help us out, follow these instructions Please put your drug and withdrawal history in your signature

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results in this topic.

[W2zc2PPDd]

7 minutes ago, Altostrata said:

You'd have to post HTML in the Source window. If this doesn't appear top left in a post window, you don't have access to it. You have an hour to edit anything you post. Please do us a favor and post text.

 

Why did you decide to go off Vyvanse? What problems are you having tapering Vyvanse? What do you mean by "buzzy"?

 

Could you put the drug goings-on from 8/16 to present in a narrative form? Just tell us what happened? Did you start Vyvanse because of fatigue from not sleeping well? When did these sleep problems start? What is the nature of your sleep disorder?

 

Did you have any symptoms of hypothyroidism before you started Effexor in 2012?

 

Do you have any side effects of Armodafinil?

 

What drugs are you taking now, at what times of day, in what dosages? To help us out, follow these instructions Please put your drug and withdrawal history in your signature

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results in this topic.

 

re: HTML/explanation: I apologize for the sparse OP. I had no idea I skipped so much stuff.

 

8/16 to present: I've always felt extremely tired since I was a teenager. People always tell me "drink more water/eat more/check your vitamin levels/check your thyroid/get 8 hours of sleep/stop meds/add meds/change your job/change this/change that" but this constant tiredness has been consistently present since I was a teenager, over a decade before I began medication, despite everything I've tried.

 

In August 2016, I felt very frustrated that I still felt constantly tired after trying multiple lifestyle changes:

- different careers in different industries with different schedules

- cutting out stress drains like bad friends, decluttering my house, addressing anxiety triggers in my life 

- losing 50 pounds

- trying different diets (was vegan for a bit, raw/whole foods, keto...)

- tracking my water/calorie intake

- regular cardio

- getting eight hours of sleep a night (although I've always seemed to wake up after 6 hours, even without an alarm)

- septoplasty and tonsillectomy

- treating my hypothyroidism

- caffeine --I don't like coffee and honestly I don't think caffeine wakes me up so I never got in the habit.

- testing my vitamin levels (B12, D, Iron...)
- getting a SAD lamp and putting it on in the morning

- letting myself have short naps at my regular crash times (11am, 2pm), trying to be productive when I'm most alert (early mornings)

- getting my anxiety under control

 

Pdoc 3 listened to this, prescribed 20 mg Vyvanse. I was amazed that I felt alert and I wasn't crashing with headaches by 2pm. I still felt tired. Month after month, he increased the dose by 10 mg. At 60 mg, I felt anxious and had heart palpitations, but I was so relieved to not be tired that I kept taking it.

 

I was worried, so in December 2017 I talked to a cardiologist who agreed that the Vyvanse was causing high blood pressure. My pdoc agreed to prescribe me a lower dose of 50 mg in February 2018, so I tapered down over a week from 60 mg to 50 mg (I only had three 60 mg pills left, so I really couldn't taper at 55mg for more than a couple of days before I ran out and had to start the 50 mg dose).

 

I was feeling exhausted again so I decided to see a sleep doctor after three friends with narcolepsy confided that they'd wondered for years if I was also managing it. They recommended their sleep doctor. I had a sleep study with MSLT in March 2018, and the doctor said I showed symptoms of both sleep apnea and narcolepsy but he wanted to start me on APAP without narcolepsy medicine since severe sleep apnea can sometimes have similar symptoms as narcolepsy (and sometimes people will have both).

 

The APAP helps, but  it wakes me up every few hours and insurance won't cover an in-lab CPAP titration. I've brought my machine back to the office over a dozen times for adjustments, tried wearing a chin strap, tried it with and without the  humidifier, a tongue detaining device, a night guard, combinations of the above... Doctor insists he needs the in-lab CPAP titration to get the information he wants to adjust my machine, and the at-home titration that insurance covers won't give him what he needs (which is a common opinion for both patients and providers in sleep medicine--at-home tests don't track REM, they don't pick up EEG activity...).

 

While we've been fighting with the insurance company to cover an in-lab cpap titration, the sleep doctor prescribed Armodafinil and advised me to take it in the morning and in the afternoon to a) help me make it through the day until we sort out the insurance stuff and b) as an alternative to the Vyvanse that would be a little easier on my heart.

 

And now I'm tapering off the Vyvanse.

 

Hypothyroidism: oh absolutely. Thyroid issues run on both sides of my family. Even as a teenager, I struggled with constant fatigue, difficulty managing my weight despite swimming competitively and strictly managing my nutrition as part of my fitness regiment, brittle nails/hair, always feeling super-cold when no one else around me did, etc. 

 

Armodafinil: I  haven't noticed any side effects. Honestly, it feels MUCH better than the Vyvanse--much more natural, way less jittery. 

 

Current meds

Morning:

150 mg Effexor XR

125 mg Armodafinil
37.5 mcg Levothyroxine
50 mg Vyvanse

 

Afternoon:

125 mg Armodafinil (although I try to skip this on holidays/weekends)

 

I'm tapering the Vyvanse. I took 45 mg this morning.

 

This is what's in my signature--I tried to follow the directions in the description by keeping it short, is there something specific you need me to add?

 

Current rx: 150 mg Effexor XR (anxiety), 37.5 mcg levothyroxine (hypothyroidism), 50 mg Vyvanse (ADHD/fatigue), 250 mg Armodafinil (125 mg taken in the morning, 125 mg taken in the afternoon, fatigue)

Taper: reducing Vyvanse to 0 per the advice of my cardiologist, psychiatrist, sleep doctor and GP

 

 

Drug Interactions result

 

Major

venlafaxine  lisdexamfetamine

Applies to: Effexor (venlafaxine), Vyvanse (lisdexamfetamine)

Talk to your doctor before using venlafaxine together with lisdexamfetamine. Venlafaxine may increase the effects of lisdexamfetamine, and side effects such as jitteriness, nervousness, anxiety, restlessness, and racing thoughts have been reported. Combining these medications can also increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms while taking the medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

levothyroxine  lisdexamfetamine

Applies to: levothyroxine, Vyvanse (lisdexamfetamine)

Talk to your doctor before using levothyroxine together with lisdexamfetamine. Combining these medications may increase the risk of cardiovascular side effects such as high blood pressure, palpitation, chest pain, and irregular heart beat. If you have preexisting heart disease, your condition may worsen. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Minor

lisdexamfetamine  armodafinil

Applies to: Vyvanse (lisdexamfetamine), armodafinil

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed. 

For clinical details see professional interaction data.

 

[Altostrata]

28 minutes ago, W2zc2PPDd said:

treating my hypothyroidism

 

How do you know how well this has been treated? You're probably aware that all of your symptoms can be from hypothyroidism.

 

Now you know your potential drug interactions and their most likely symptoms. I am quite sure there's an interaction between Vyvanse and Armodafinil, they just haven't defined it yet.

 

Yes, all the amphetamine analogs, Vyvanse included, will be stimulating.

 

Here's our topic for tapering Vyvanse Tips for tapering off Vyvanse (lisdexamfetamine dimesylate)

 

Lowering it by 10mg is a start. You may wish to try 5mg next time, to keep it to a 10% taper and go off gradually.

[W2zc2PPDd]

54 minutes ago, Altostrata said:

 

How do you know how well this has been treated? You're probably aware that all of your symptoms can be from hypothyroidism.

 

Now you know your potential drug interactions and their most likely symptoms. I am quite sure there's an interaction between Vyvanse and Armodafinil, they just haven't defined it yet.

 

Yes, all the amphetamine analogs, Vyvanse included, will be stimulating.

 

Here's our topic for tapering Vyvanse Tips for tapering off Vyvanse (lisdexamfetamine dimesylate)

 

Lowering it by 10mg is a start. You may wish to try 5mg next time, to keep it to a 10% taper and go off gradually.

 

re: hypothyroidism: I'm assuming it's been treated decently because I've seen huge improvement in the following symptoms:

- my nails no longer chip

- my hair looks much healthier

- my thyroid hormone levels are normal and consistent per my endocrinologist and GP

- my prolactin and testosterone levels returned to normal

- I no longer feel constantly cold

- regular menstruation

 

I'm pursuing the sleep angle because the sleep lab found that I'm literally not breathing consistently at night.

 

re: taper: Just to make sure we're on the same page, I lowered my Vyvanse by 5 mg today (from 50 mg on 5/29 to 45 mg on 5/30). I tapered from 60 mg to 50 mg back in February and I thought that was much too fast. Weirdly though, I'm having an extremely rough time with just a 5mg taper. I'm honestly considering requesting FMLA time off work because I have no idea how I can function for six months in this state.

 

On a side note, I think something's wrong with my mg scale. I measured out the powder inside my 50 mg of Vyvanse and it's saying I have 90 mg of white powder. Tried it with multiple pills, made sure my desk was level and I wasn't breathing on it. I don't remember how I measured out the pill I took today but I'm assuming I probably divided the powder in 45 mg chunks and put them in a capsule. Maybe that's why I'm having such bad withdrawals. Maybe I removed more than I should have.

I really really really wish I could afford a compounding pharmacy or that Vyvanse came in 5 mg capsules. Would make this way way easier.

[Altostrata]

13 hours ago, W2zc2PPDd said:

I'm having an extremely rough time with just a 5mg taper

 

Please explain, what are your symptoms?

 

Good to hear you've done better with thyroid treatment. Please note too much thyroid hormone can disturb sleep.

 

The "50" on your Vyvanse capsule refers to the amount of active ingredient in the capsule. The contents will weigh more because of fillers.