Seeking Absorption Information on ADHD Medication(s)

Does anyone know where I can find documentation on extended release and really extended release ADD/ADHD medications and dosage adjustments for BPD/DS or other malabsorption conditions? There is really very little documentation on this. A few threads in different ADD forums but they are about as scattered and varied as you might imagine given the topic.

Trying to find out the issues between an instant release of something like Adderall (how much faster does it cycle and is a dosage adjustment necessary) vs XR (also cycles faster and crashes, dosage adjustments?) or longer lasting like Vyvanse (allegedly does not have an absorption issue as it's not a GI absorption yet was very ineffective so is a different dosage needed or something else), now a new one called Mydayis which is an 18 hour Adderall type vs other types.

While I'm appreciative of opinions and personal experiences, I'm really looking for professional references and documentation. I am not finding anything useful and am not able to call my surgeon. So if anyone knows of a DS professional (preferably in Michigan but anywhere) I could contact with specific experience in this area, I would be very appreciative.

Thank you

Sorry I have no real help. If you've looked in the DS forums you'll see mostly if not all anecdotal information on a variety of XR drugs. Seems very dependent on the surgeon and the persons reaction to the surgery.

They are currently doing a study regarding Vyvanse and gastric bypass patient absorption, actually, which we almost did where I work. (The private practice I work at does clinical trials - I'm a therapist.)

Having said that, there are almost no studies regarding psychotropic medications and DS absorption, but there is significantly more regarding bypass patients. For instance, about 50% less Cymbalta is absorbed by RNY patients, primarily because the site of action is the duodenum which is completely bypassed. With the DS it's less, but Cymbalta is still typically adjusted as per symptoms (or it should be). We do that clinically, at least. So, it depends?

I work with surgeons all the time, and unfortunately most surgeons know little to nothing of drug absorption. I would actually talk to a pharmacist, as they are more aware and familiar with the pharmacokinetics of medications. So they would know where it is absorbed more precisely. With the DS you do retain part of the duodenum, so what you need to find out is where in the intestine your drugs are absorbed. If it's duodenal, you should not require significant adjustment. Even most psychiatrists won't know this.

Definitely talk to a pharmacist, preferably one associated with your bariatric surgeon.

Clinically, I do not see many DS patients require stimulant medications to be adjusted. I treat several with binge eating disorder who take Vyvanse, and I've not seen any require a dose adjustment thus far. Having said that, here is one of the studies which may help, though it's (unfortunately) an animal model.

With Vyvanse, you can take the contents of the capsule without the capsule which causes it to be absorbed easier, as well. Additionally, we often will prescribe liquid forms of stimulants for individuals with malabsorption, like Celiac or the bypass. They often use these for kids, however adults can take them as well. So there are options. Do not take medications outside of the capsules without consulting your doctor, of course, to see.

If I find more data I am happy to post it. Sadly, it's just not very well-researched. Many psychiatrists know nothing of surgery, and almost all surgeons know nothing of psych drugs.

Thanks for this, Donna. With some diligence, you can find a few very very long threads that discuss absorption issues if you remove WLS from the search. I found information when I looked as part of malabsorption as well as Crohns and colitis.

My surgeon died several years ago and I live in a different state now. I could discuss in broad strokes with any DS or I suppose even a sleeve surgeon but of course you're right, the psychs don't know the first thing which is why I'm doing the footwork. I have found that the nurse practitioners are more open minded though.

I had a terrible time with Vyvanse. Not sure if it just should have been double or tripled in strength but it did the exact opposite of everything it was supposed to do. I actually started binge eating in the middle of the night, something I hadn't done in years. Sleeping all the time. It was awful. Stayed on it for 3 weeks. He doubled it and it got better but it took 4 hours to kick in; I started setting my alarm to take it at 5 and still needed an IR when I got up. It was really not good but perplexing because it was supposed to be the one that would not have any sort of dosage challenges with the DS.

Now, I had no idea that there were liquid doses. That is the best thing I've ever read - thank you thank you! And thank you for the link as well. This is the sort of thing I was looking for - I'm glad to know that my request made sense to someone after all :)

I'm curious about the Mydayis but I have never found an 18 hour that works in the 16 or 17 years since I've had the surgery. I also fear the cost; Vyvanse would have been $100 (that was my co-pay, without insurance it would have been $350) but fortunately I had a coupon for the first month. Since it is brand name, God knows how much it may run. Just not a fan of pills, especially several times a day.

Medications are designed to be released at certain points of your digestion. You need a medical professional who knows exactly where the medication is released in the digestive process so they can compare that with the DS anatomy to determine the effects to expect. Some meds are no different to us at all because of where they absorb. Others need adjustment.

I would suggest the drug companies themselves to provide the absorption information and then the DS surgeon would be able to connect those dots to provide the expectation.

Thank you for that primer, Val. I didn't know how medications worked or that medical professionals might be useful. I've also not thoroughly reviewed the information provided by the pharmaceutical companies with several clinicians. That too never crossed my mind.

I think I need to pursue a different career as my writing skills are obviously diminishing. I thought my inquiry was rather clear but I guess not because it's telling me what I really need instead of what I was asking.

Thank you for reminding me why I don't actively participate in these online forums anymore. I needed the bi-annual reminder.

It never hurts to throw something out here, for many have paved the way already.

You might strike something lucky like someone who is actively taking any of those meds. I was inspired to reply to you because of a thread on another group yesterday where someone shared a diagram of where in the digestive system certain vitamins were absorbed (which explains why we struggle absorbing certain ones) and other medications and their design came into the shared thinking.

I just hated to see you without any other useful information. I could at least inspire you in a direction. One other thing is that many surgeons adjust the intestines according to the patient needs, so a blanket answer may not be appropriate either. If you've had the DS already, you may want to bring it to him, for he may have patients already that are on those meds. If you're exploring still, this is something to bring with you in the consultation. Between the surgeon and your prescribing doc, a course of action and a Plan B is a great thing to think about ahead of time.