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Ritalin Tolerance


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#1 Sam^I^Am

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Posted 07 May 2013 - 09:49 AM

Hi all,

 

I was diagnosed with Nnrcolepsy not quite 2 weeks ago and was diagnosed with sleep apnea years ago.  The doctor this time around prescribed Ritalin (though under some generic meth-something-or-other name) 10mg pills once in the morning and then once again 6 hours later (if the 1 pill in the morning isn't cutting it, I can take 2 and then another 6hrs later).

I noticed a huge difference from the first day: I wasn't yawning and feeling dog-tired less than an hour after waking up and wasn't falling asleep part way through the day.  However, here I am 12 days later and I've noticed that I'm back to feeling almost the same as I did before starting the meds.  A couple of hours after taking my pill, I'm yawning up a storm and ready to head back to bed, regardless of how much sleep I had the night before.

 

I'm wondering if I could have built up a tolerance to the drug this quickly.  I realize 10mg is a low dosage, which may very well explain why it doesn't seem to be working as well as it was, but I can't help but think that if I really have built up a tolerance this quickly, I'd eventually be in this same boat regardless of the dosage.

 

Has anyone else experienced this type of thing?



#2 DeathRabbit

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Posted 07 May 2013 - 10:31 AM

That's pretty common. You probably will need a higher dosage, but also try to take days off. If you have a good day or it's the weekend or something, try to take a break. It decreases the tolerance build up. You can also try an extended release version, or, just get a pill cutter and chop it in half. Take half at breakfast and the other half at lunch. It'll help that whole peaking and crashing thing. More likely, though, if you are going to take Ritalin IR, you're prolly going to want to do something like a 15 in the morning and a 10 at lunch.



#3 Sam^I^Am

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Posted 07 May 2013 - 10:43 AM

That's pretty common. You probably will need a higher dosage, but also try to take days off. If you have a good day or it's the weekend or something, try to take a break. It decreases the tolerance build up.

Thanks DeathRabbit.

 

I did a bit of research on Ritalin when I first got the prescription and one of the things I read said something about building a tolerance to it being fairly easy.  I've only taken the 2 in the morning once since it was prescribed, since 1 seemed to be working just fine.  I'm reluctant to skipping days - particularly my days off - because it would only mean falling asleep in front of the television when my wife and I are trying to enjoy some time alone together.

I may need to do that anyway, though, if it means prolonging the usefulness of the drug.  I haven't noticed a single adverse side-effect from it; in fact, other than not feeling tired, I haven't noticed ANY effect at all from Ritalin, which I'm really happy about and is another reason I want to put off upping the dosage as long as possible.

Before being diagnosed, my family doctor prescribed Modafinil (10mg) once per day.  Unfortunately, besides having absolutely no noticeable effect on my EDS, we had to pay for it ourselves since it wasn't covered.  The respirologist who prescribed the Ritalin said Modafinil would be better, but that the dosage my GP prescribed wouldn't have been effective so he wasn't surprised.  If Modafinil is better, though, we may just need to pay for it anyway, though that would depend on how many I'd need to take each day; 1/day cost just under $50/month.

 



#4 doinmdarndest

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Posted 07 May 2013 - 08:07 PM

it is possible to maintain response to traditional 'stimmies' by simply ramping up the dose, regardless of the pre-existing dose, provided you do not have nor do you develop contraindications to stimulants.  this has worked for many years.  i today get 270mg/d adderall rx.  i am 52.

 

maximum amts. are found in guidelines but there is no rule and md's may prescribe any amt. they can justify medically.  yet finding one willing to rx sufficient amts. can be exceedingly difficult.

 

it sure was for me.  shouldn't be for you your rx is yet < the reccommended max., the doctor you have now likely will grant a doseage increase.  don't hesitate to fire him if he won't w/o good reason he explains.  an example of this would be high bp the antihypertensives won't correct after all are tried.  'stimmies' can cause high bp, lisinopril 10 mg/d works for me w/ this.  my md and i began the med @ 5 mg/d, then doubled it later.  2 other meds were tried before this.  am consistently normotensive these days, have my own checking device to track my bp w/. 



#5 Sam^I^Am

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Posted 08 May 2013 - 06:34 PM

it is possible to maintain response to traditional 'stimmies' by simply ramping up the dose, regardless of the pre-existing dose, provided you do not have nor do you develop contraindications to stimulants.  this has worked for many years.  i today get 270mg/d adderall rx.  i am 52.

 

maximum amts. are found in guidelines but there is no rule and md's may prescribe any amt. they can justify medically.  yet finding one willing to rx sufficient amts. can be exceedingly difficult.

 

it sure was for me.  shouldn't be for you your rx is yet < the reccommended max., the doctor you have now likely will grant a doseage increase.  don't hesitate to fire him if he won't w/o good reason he explains.  an example of this would be high bp the antihypertensives won't correct after all are tried.  'stimmies' can cause high bp, lisinopril 10 mg/d works for me w/ this.  my md and i began the med @ 5 mg/d, then doubled it later.  2 other meds were tried before this.  am consistently normotensive these days, have my own checking device to track my bp w/. 

Thanks for the additional information.   I'm not TOO concerned about reaching a max dosage just yet, but like I said, I worry that if I really have built up a tolerance already, it seems feasible to me that I'll build up a tolerance in a short period of time regardless of the dosage.

Of course, this is still new to me, so there are still a lot of options even if it turns out that Ritalin isn't the right one.



#6 ikon0304

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Posted 12 May 2013 - 10:26 AM

my doc put me on prasomething or other..didnt work for me at all.  no effect at all. then put me on ritalin..10 mg  3x's a day..was okay in the morning was just not working in the afternoon.  i am now on 20 mg per day  3x's a day.  this works for me..for now at least. i do get tired early at nite tho and i go to bed early.  somedays, no matter what i do i just cant seem to wake up...other days i am fine.  i have cataplexy also and my emotions play a BIG part of how i do.  after a day of high emotions..wether it be laughing too much or anger or anxiety, the next day i just cant wake up no matter what.  thats the day that i know not to do anything that will push me into a cataplexy attack ( i have seizures with my cataplexy).  i just some days dont get anything done but the dishes. i finally learned..the dirt will be there tomorrow and i can always take care of it then. :)



#7 ravanzee

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Posted 20 May 2013 - 09:27 PM

We don't have a lot of experience either, my son was just diagnosed 1 month ago.  He has been on Ritalin for a month, and the first two weeks we were so excited that he was much more like himself again!  Now, for the past two weeks he has slid back into being exhausted all the time.  I wondered the same thing about Ritalin, I don't want him taking a huge dose if he doesn't have to.  He take 10mg in the morning and 10mg in the afternoon also. 



#8 malachi777

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Posted 24 May 2013 - 08:16 PM

I was prescribed Adderall 20mg twice a day. What actually works best for me is taking 10 mg four times a day. I do want to express that I need to stay active or sleep will find its way. It's funny how even by taking amphetamines, a narcoleptic can still fall asleep. Your body can get used to the medication and you will either need to change drug or change the amount prescribed. It has helped me by taking smaller doses and it drastically reduced the crashes later in the day.



#9 exanimo

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Posted 24 May 2013 - 10:39 PM

 Building up a tolerance is pretty common, I believe. 

 

The best solutions are to change the dosage, take medication holidays (not taking your medication on a day where you may not *need* to be so awake/alert), experimenting with short release and extended release, and of course, trying to maintain otherwise healthy sleep hygiene (going to bed at a decent hour regularly, waking up at the same time each morning, scheduled naps, etc). 

 

I also find that working in some sort of 'physical activity' during the day works well. Because sitting down at the computer for three hours, is obviously going to make me more tired. So getting up to do something else in between or whatever, really does help. At work, when I'm getting really tired, I generally get up and go to the bathroom, walk around some, etc. 



#10 Sam^I^Am

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Posted 28 May 2013 - 06:00 AM

Thanks for all the replies, folks.

 

I got in to see my family doctor just over a week ago and he prescribed the same 10mg pills I was already taking, plus a 20mg slow-release for first thing in the morning.  So now I'm taking one of each when I get up and then another 10mg later in the day if it's necessary.  It does seem to be working for now.  Fingers crossed. ;)



#11 sometimes

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Posted 08 June 2013 - 12:39 PM

I use to take 5mg tablets.  It's probably about the right dosage for an 8 year old with ADHD, and I'm equivalent to about two 8 year olds.  The effect would wear off about two hours after it started. It was not tolerance, that it just how quickly I metabolize it.  I find it incredible that 10mg ever lasted 6 hours, but people do respond differently.

 

Definitely skipping medication on the weekends led to me being slightly more cranky on Friday than on Monday.  On the other hand when taking it seven days a week, I found I would settle into a stable response after a few days.  My understanding is that most people will develop tolerance doing this, but I haven't actually seen research on the long term effectiveness of Ritalin in people with narcolepsy.

 

This is not advice.



#12 Lindsey0172

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Posted 11 June 2013 - 01:57 AM

I was diagnosed with Narcolepsy in August of 2012. I was prescribed 25mg of extended-release Dexedrine (dextroamphetamine) in the morning, and I found it was awesome in the morning to get me going, but at lunchtime I was so hyper and twitchy I couldn't focus on anything and I felt like my heart was always racing. I lowered my dose to 15mg in the morning, and found that was better for sure, enough to keep me falling asleep after lunch, but not so much that I was twitchy or anxious. However, with the lower dose it did not last as long, and therefore I found myself extremely tired in the early evening 7-9pm usually. I'm talking hardcore sleep attacks. I would be getting home from work at 7 or 7:30pm and wouldn't even make it to the house I would just fall asleep in my car immediately after turning off my engine. Scary. My doc prescribed me a 5mg short-acting version of my same Dexedrine. It worked great to get me over that crash, but didn't keep me up as long as I took it at least 6 hours before I wanted to go to sleep. I still have trouble winding down after the day, and that is most likely due to my delayed sleep phase disorder, however it definitely helped me because I was more tired (crashing) after the 6ish hours and it was easier to sleep since I didn't have an unwanted nap earlier in the evening.  I still, occasionally, end up napping at random times, in undesired places, however it is much more manageable and I have learned not to sit still for too long, especially at certain times. 

 

One thing I will mention about my experience with this medication, is that it is really easy, because you are using the meds to stay awake, to start thinking that you don't need as much sleep. Before medication, I would sleep on average 9-10 hours during the week or working days and more like 12 on weekends or non-work days. Since being on medication, I have been sleeping more like 7-8 hours on week days and usually not more than 9 on weekends. I'm not saying I sleep too little now, or that my body needs more, simply that it is sometimes hard for me to justify sleeping for more than 6 or 7 hours when I know that I will be just as tired in the morning after 10 hours of sleep. My mind starts playing tricks on me. Well if i'm going to be tired tomorrow anyway, why not stay up another hour or two and get some more things accomplished. It's hard to know how much sleep your body actually needs when it always tells you you need more :( That being said, I have started to notice the difference between sleep attacks, and my body being exhausted. It is a different kind of tired. It is almost like one is mental, and one is physical. So ya, it has been quite the learning process. 

 

Also, I take periodic breaks from my medication if I have a day off and plan to just hang out at home all day, or just having a lazy day I won't take any meds and usually end up napping and not being very productive, but I find that it makes the next day that much better because I feel so great having energy at least! It is weird to feel that sluggish, un-motivated, walking-under-water feeling after feeling so good and full of energy while on medication. Helps put things into perspective for me, and makes me grateful for my little pills, while also helping my body resist building up a resistance. lol. 

 

So clearly that was not advice, simply experience. My advice is play with it. I haven't experimented a whole lot lately simply because I feel that my current arrangement works for me at the moment, but It was not my first and I'm sure it won't be my last. Try more or different kinds or whatever your options are, because you may not realize how much better you can feel until you feel it. (that comment was lame and I apologize, but you know what I mean)

 

Best of luck with your journey!