ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Medication

Vyvanse is the new ADHD medication from Shire PLC, the makers of Adderall XR. It marks a significant change in the range of medication available as it uses a different type of stimulant than other medications, it a has long duration and it is especially formulated to prevent substance abuse.

How Vyvanse Works

The active substance in Vyvanse is lisdexamfetamine and is chemically very close to Dexedrine Spansules, a stimulant occasionally prescribed for ADHD. The advantage of lisdexamfetamine over methylphenidate (used in Ritalin and Concerta) is that it has a long lasting effect. Taken in the in the morning, the peak effectiveness last one to four hours but had a notable effect on symptoms for 12 hours.

Traditional ADHD medications have been easy to abuse and this has led to dependency problems. Vyvanse is a prodrug, a substance that is inert until it is digested. This mimics how the body creates useful chemical and vitamins from our food. As Vyvanse only acts as a stimulant once it is broken down by the stomach you cannot get a high from grinding it up and snorting it. Swallowing higher than prescribed doses (150mg compared to the recommend max of 70mg) will still produce a high indistinguishable from that produced by a comparable dose of Ritalin.

Vyvanse: Four Times More Side Effects

Because Vyvanse is new it has only been used by those adults and children who took part in the drug’s trials. In total, less than 1000 people. With such a small sample (compared to the millions who will end up taking the drug) there is very little first hand knowledge of the drugs effects. With each of the other major drugs, Ritalin, Adderall etc, different people can have very different reactions to the drugs. Someone who is fine on one drug may have numerous side effects from a chemically very similar drug. The body and brain are very complex chemical systems and stimulants are a very crude tool.

Currently we only have the Vyvanse prescribing information to go on as a guide to its effects but one things is very noticeable. In trials 10% of users stopped taking the drug due to adverse effects (i.e. side effects). This is much higher than Adderall where only 2.4% of participants were effected. In the Adderall trials more people stopped using the placebo than the real drug but for Vyvanse only 1% of placebo users dropped out. The new drug has a side effect rate 10 times higher than the base line and four times high than Adderall.

Vyvanse And The $1.5 Billion Goal

Shire PLC are introducing this new drug as a replacement for Adderall XR whose patent is running out. They hope to capture 50% of the market share with the drug and as the market is worth $3 billion, a 50% share will generate a lot of money. Expect to see a lot of advertising aimed at parents, not doctors, when Vyvanse is launched in July. In theory Vyvanse is a lot cheaper to make than competing drugs as its chemical formula is its key rather than the complex release mechanisms used by others drugs. However I expect that Vyvanse will retail at about the same as the other ADHD medications at about $130 – $150 for a months dose.

ADD / ADHD Treatment, Dyslexia Treatment, Food and Drink

Omega-3 and Omega-6 fish oils have been promoted not only for dyslexia and ADHD but also heart disease,high blood pressure, rheumatoid arthritis, asthma, bipolar disorder and cancer. In some cases there is good evidence to support fish oils as a treatment and in others the evidence is unclear. But what are the health risks of taking fish oils? Lots of producers of fish-oil capsules promote large dosages of supplements so are there any side effects from fish oils?

The US National Institute of Health classifies low intake of omega-3 fatty acids from fish as “Generally Regarded as Safe”. However they do highlight certain fish oil side effects that may trouble some people. The omega-3 in the fish oil may increase the risk of bleeding when taken in large doses. The bleeding can take the form of strokes, nosebleeds and blood in the urine. As the fish oils seem to decrease platelet aggregation, bleeding times may be longer.

A major worry with fish oils and the fish they are created from is poisoning from heavy metal and other pollutants. Mercury, dioxins and polychlorinated biphenyls (PCBs) are found in some species of fish. However, mostly this fish oil side effect is associated with eating fish directly as the oil, even in contaminated fish, carries little of the pollutants.

Stomach upset are a common side effect of fish oil supplements. Diarrhea may also occur, with potentially severe diarrhea at very high doses. There are also reports of increased burping, acid reflux/heartburn/indigestion, abdominal bloating, and abdominal pain. Fishy aftertaste is a common effect. Gastrointestinal side effects can be minimized if fish oils are taken with meals and if doses are started low and gradually increased.

People with low blood pressure or those taking blood-pressure reducing medicines should take care. One of the reported side effects of fish oil is a reduction of blood pressure. The impact on blood pressure appears to be dose dependent.

Vitamin E plays a part in metabolizing omega acids so large doses of fish oil place high demands on the body’s vitamin E supply. To avoid this fish oil side effect, vitamin E is added to many commercial fish oil products. As a result, regular use of vitamin E-enriched products may lead to elevated levels of this fat-soluble vitamin. Fish liver oil contains the fat-soluble vitamins A and D, and therefore fish liver oil products (such as cod liver oil) may increase the risk of vitamin A or D toxicity.

One side effect of fish oils and their fatty acids is an increase low-density lipoprotein levels (“bad cholesterol”) by 5-10%. This is dependent on the dose used. The oils have also been noted to have an effect on blood glucose levels in people with Type 2 / Adult Onset Diabetes but this is short-term and no long-term effects have been reported.

Overall omega-3 and 6 rich fish oils have few side effects and can be considered safe the vast majority of the population.

Source: Omega-3 fatty acids, fish oil, alpha-linolenic acid from the NIH.
See also: The Omega-3 Diet, ALA to DHA: The Fish Oil Alphabet and The Incredible Brain: A Miner Recovered.