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ADD – ADHD Medication Treatment – 7 Tips on Finding the Challenging Sides of the Therapeutic Window
The sides of the window are confusing and require a few more office questions. The reason for asking the questions is simple: we want to know exactly how the drug is working in the context of the time of day, duration of effectiveness, and predictable expectations of the specific drug in question.
All of these questions stem from the essential philosophical insight into medication delivery systems: if you know the science and have clear goals, you can objectively measure treatment outcome and properly adjust medications based on individuality. biochemical and metabolic of that specific individual. Measure this “window” for predictable results.
The simplified version of this statement: cookie-cutter medicine based on weight, age, and body size is outdated and simply ineffective. – Let’s be precise each time starting from the same place using the same predictable efficiency measurement grid. These 7 tips for the sides of the therapeutic window, together with the measurements from my other articles here on 7 Tips for the Top and Bottom of the Therapeutic Window, will outline specific treatment goals. I’ve used these “window strategies” with thousands of patients for over 12 years, and I can assure you that they run like a properly timed clock. Predictable results should be the standard of care.
The 7 tips for the sides of the therapeutic window for stimulant drugs.
- The sides of the window are based on time: the expected DOE – holdover time of that specific drug for that specific person’s metabolic rate, and should be individualized for each person from the start and throughout treatment. Each person burns drugs at different rates that cannot be predicted by superficial appearances of weight or height. I have an ex-marine [Nuclear] Commander who is about 6ft 6in tall and towers over me, – has to duck as he walks in the door, – only takes Adderall 10mg XR and DOE is at a reasonable 10am. We want to have a specific match between the expected duration and clinically effective duration.
- Know DOE drug expectations from the start: Authorities and studies disagree on some of the following points regarding the specific drugs I will discuss. Pharmaceutical companies have done their homework and are focusing on these same DOE goals. Many studies span thousands of patient hours over years of treatment focusing on this “window” grid. See the article 7 tips for the top of the window for more details on specific medications.
- Start working: accurately measure the time spent at each meeting: Easy questions: “When did you take it and when did it stop working?” If it’s taken at 7 a.m. and lasts until 3 p.m., it’s DOE. The calculation is simple: 5 a.m. %2B 3 PM = 8 a.m. A drug might work for 8 hours, but keep the person out of the top of the window if the IR is pushed too high.
- The first secondary objective – AM Onset: All medications should work within 30-45 minutes after taking the medicine. IR [Immediate Release] The tablets have a quick start, but the window sides are too narrow and the DOE [Duration of Effectiveness] Is just too fast – meaning it only lasts a short part of the day. IR drugs should be given 2-3 times a day because the DOE is much too short. If the start of the morning is more than 45 min, the dose is be too little, it doesn’t work at all or that may be too much – see point 4 of the 7 Tips for the Top.
- Regulate morning onset: breakfast is key, protein breakfast works better more often: With drugs, since we now pay attention to the rate of metabolism, the DOE, we are much more interested in the “rate limiting steps”. Breakfast is an imperative rate-limiting step that is essential for all psychic medications to prevent irritation of the gastric mucosa. [stomach lining]. With breakfast, this early side of the “window” is smoother and less involved with uncomfortable peaks of excess medication.
- The Second Secondary Objective – The PM Version – When They Stop Working: Concerta Extended-Release Capsules in Adderall XR are all mechanically released and have unpredictable release times based on acid-base variables in the stomach and intestine – and transit time of bowel contents . A long transit time often means greater drug sensitivity and relative drug accumulation over time, with a narrowing “window”. Metabolic challenges related to bowel function almost always alter the release time of PM, when drugs stop working. Vyvanse is not as vulnerable to rate changes based on acid/base balance or transit time.
- The mystery lens: the PM version with Vyvanse: Vyvanse deserves its own advice because it is so effective, with such an excellent and predictable DOE of 12-14 hours. Think about this simple point when measuring DOE with Vyvanse – the metabolically released stimulant is so different that many don’t “feel it working” and therefore miss it when it “stops working”. Remember with Vyvanse: look for the original cognitive, “mental” goals, not the somatic, buzzy effects. When Vyvanse leaves PM, the ability to complete tasks is gone.
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