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Vyvanse to Parnate washout period: 5 or 55 hours?

3.5K views 23 replies 7 participants last post by  CopadoMexicano  
#1 ·
Hi,

https://en.m.wikipedia.org/wiki/Lisdexamfetamine#Pharmacokinetics says that the half life is 1 hour. Therefore you'd only need to wait 5 hours before you could take Parnate (5 half lives = drug is effectively gone).

However: "The prodrug lisdexamfetamine ... is converted by red blood cell-associated enzymes to dextroamphetamine via hydrolysis. ... "At normal urine pH, the half-lives of dextroamphetamine and levoamphetamine are 9-11 hours and 11-14 hours, respectively.[135]"

So would that mean I need to wait 5*11=55 hours instead?

Backstory: I couldn't hack the complete washout I was on any longer and so took some Vyvanse. I was feeling so sh1t :/
Thanks.
 
#3 ·
I am afraid you are misinformed here or confused here. 90% of the information on the internet is just plain wrong.

http://www.psychotropical.info/maois-swapping-combining
"Ceasing and half-lives
On ceasing any SRI-type antidepressant to start an MAOI, washout intervals varying between one and five weeks may be required***. No washout is needed for non-SRI-type drugs because it is safe to co-administer them (as above). The rule of thumb is to allow 5 half-lives to elapse*, which is about one week for many of these drugs."
(emphasis added)

Vyvanse is not a serotonin reuptake inhibitor (SRI).

Waiting one or two days isn't a big deal, but I am addressing this because you should not EVER accept ANY information on MAOI diet/drug interactions unless it is written by Dr. Ken Gillman. Read his 45 page summary here: http://psychotropical.info/images/Publications-pdfs/MAOI_diet_drug_interactions_2016.pdf
 
#4 ·
I may be confused but I'm not misinformed since I took this from http://psychotropical.info/maois-cns-stimulants:
In summary, amphetamine definitely has been involved in deaths with MAOIs, and exhibits significant toxicity with venlafaxine (probably serotonin toxicity, as opposed to noradrenergic toxicity). To what degree the toxicity with MAOIs is serotonergic remains uncertain, but most fatalities have been from intra-cerebral bleeding, not serotonin toxicity [2].

Amphetamine may not be safe in combination with MAOIs (see Feinberg's and Markowitz's recent and helpful reviews of MAOIs and CNS stimulants). It seems to produce noradrenergic toxicity; presumably in the same way as tyramine does, by acting as a releaser. None of these cases were reported to exhibit features that would suggest serotonin toxicity. Several of these cases were fatalities (2 of these below are not cited in the Markowitz paper) [38-41-44].
Now I'm no expert but that surely gives room for caution?
 
#5 ·
Yeah lol. That is a great quote! Contradicts what he has written elsewhere, I am going to e-mail him about it.

I am not going to try to "out-gillman" you on this. I could pull together various quotes and :blah:blah:blah BUT I am very happy you are reading Gillman instead of Wikipedia. He boils down his discussion of amphetamines into 2 concise paragraphs on pages 36 and 37 of the 45 (90) page summary.
 
#6 ·
No, I'm not interested in a competition either (I'd also lose anyway), just a prudent answer. I'll give it a couple of days washout if/when I do try Parnate I think to be safe.

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#7 ·
I wouldn't worry about Vyvanse too much, you shouldn't need to wait any longer than 24hrs. Most of it is deactivated by then and even if there is some in the blood it shouldn't cause a hypertensive crises especially if you're starting the Parnate at low doses.
 
#8 ·
Thanks. Yes I'm starting at 5 (1/2 a tablet) since I'm generally ultra sensitive to meds for some reason, including side effects unfortunately.
 
#9 ·
I would recommend Agmatine as a co-medication when you are taking Parnate. There is a thread about it somewhere here but I am too lazy to dig it up. There are a lot of ways you can treat specific side effects but often treating one side effect makes another side effect worse. The key thing about Agmatine is that it has an effect on a number of different areas of the brain, but it is an indirect regulatory / modulatory effect. Just look up the thread if you want more info.

My 2 most frequent recommendations for people trying Parnate are 1)get enough sleep; 2)agmatine.
 
#10 ·
I would recommend Agmatine as a co-medication when you are taking Parnate. There is a thread about it somewhere here but I am too lazy to dig it up. There are a lot of ways you can treat specific side effects but often treating one side effect makes another side effect worse. The key thing about Agmatine is that it has an effect on a number of different areas of the brain, but it is an indirect regulatory / modulatory effect. Just look up the thread if you want more info.

My 2 most frequent recommendations for people trying Parnate are 1)get enough sleep; 2)agmatine.
Thanks for the tip, I'll dig out that thread.

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#12 ·
How does it work for you? I have no idea. I know for me I went to 150 mg Parnate, developed tolerance rapidly. I added Ketamine, many people don't know this but it reduces tolerance. Still developed tolerance. Agmatine was the final piece of the puzzle that gave me a lasting, stable response and it also reduced sexual side effects, maybe some other stuff I can't remember.

I know exactly what properties of Agmatine allowed for me to overcome tolerance, but it may or may not be relevant to you (it relates to the Glutamate system of the brain and NMDA receptors).

If I stop taking Agmatine for a few days I notice right away. I feel like crap.

Just google agmatine and one of the top 3 hits is an extremely detailed article summarizing 300+ different published research trials. It is so complicated that I will not even begin to offer an explanation. I have never been able to offer predictions on how it will effect people. You have to try it for yourself. It is cheap, doesn't require a prescription, works rapidly - you may notice initial benefits on 1st day, takes 3 days for full effect. And quite safe. No guarantees - but the drawbacks are so small it is worth trying.
 
#13 ·
Just an update: I stopped Vyvanse Monday and started Parnate on Tuesday and encountered no BP issues. So this would indicate that for me at least, 24 hours after dosing was OK. I'm not a doctor and YMMV etc.
 
#14 ·
Good luck.

Did your doctor give you any instructions here in the first place? If you searched out the safety information yourself it is a very good sign that you are motivated to take responsibility for your own treatment.
 
#16 ·
Good luck.

Did your doctor give you any instructions here in the first place? If you searched out the safety information yourself it is a very good sign that you are motivated to take responsibility for your own treatment.
Thanks. With my brain I'll need it.

He wanted me off of all meds for 2 full weeks before starting Parnate. He refused to read/heed/respect/acknowledge any of the literature I forwarded which was beyond frustrating.

I've never personally lacked motivation for trying to get better - I've just never succeeded unfortunately.
 
#15 ·
If you have a question about dangerous substances with MAOIs - dont look up Dr Gillman, ask the real idio....sorry expert who has actual practical experience......me.

I am always willing to actually try the combination if you supply the samples ! If you dont hear back from, throw that substance away.

Anyway, @sming - you were the one who had the pdoc change his mind at the last minute ?? Glad it all got sorted in the end for you mate, all the best with it.
 
#17 ·
Hah, fair enough. Be careful with amphetamine-based stuff and MAOI's though, I had an intense BP spike with Adderall & Nardil.

Yes, that was me. Thanks. What an unnecessary, ultra-stressful saga it turned out to be. I've still got to quit my oxycodone (for chronic pain) even though it's fine to take with Parnate :/
 
#24 ·
im hoping to get vyvanse for binge eating disorder but im scared doing a change of providers since ive been accustomed to having a caseworker and psych nurse for the past six years.