Amphetamine (Adderall), bike riding, and heart issues

[fmradio516]

So about 3 months ago, I was evaluated, and was started on a prescription of Adderall. Things are going okay with it, but I was wondering if anyone could chime in about any irreversible health risks there are, in particular to the heart.

Depending on what brand(generic) my pharmacy is stocking, there are some that make my heartbeat really fast and make me jittery. Then, other brands(same dose) which should be EXACTLY the same, dont give me any kind of sensation at all. For instance, one brand 20mg extended release made me jittery all morning after taking it. Then a different brand 30mg INSTANT release does nothing to me. Both taken on empty stomachs first thing in the morning. But FWIW, only one of my scripts had the jittery brand. Not sure whats going on there, but thats a whole other story. My current refill doesnt do that.

The jittery ones had me thinking... I've been doing a lot of mtn biking this year and the New England trails definitely require some high intensity riding. Much higher, and more frequent than going on a road bike ride.

I know for a few years, people were all about high intensity training, but more recently, I have seen articles about this type of training causing long-term heart issues. Im not doing any HIIT purposely, but I do run up my heart rate frequently on the trails.

Could this be a bad combination? There is definitely risk of heart disease in my family, so id like to avoid anything that will put me at even more risk..

[rzthomas]

Talk to a doctor, not strangers on the internet.

[Steve in SLO]

The most important question to ask your physician is does Adderall or generic cause vasoconstriction of the coronary arteries? Amphetamines can cause this, and an increase in heart rate combined with constriction of your coronary arteries and resultant tissue hypoxia under load could be a bad thing.

[Drmojo]

Tom Simpson
Died on speed at the TDF
Amphetamines hugely over prescribed to adults and kids
for decades now
VERY irresponsible
mojo
cyclothymic shrink since 1990

[XXtwindad]

Exactly my thoughts. I'd be very careful with this.

[tctyres]

Could this be a bad combination? There is definitely risk of heart disease in my family, so id like to avoid anything that will put me at even more risk..

It could be, but none of us have your medical history.
Speak to the prescribing doctor first. If you are uncomfortable with her/his response, then find a doctor who has experience with endurance athletes. They will have a better idea of what works for athletes and what doesn't.

[Clean39T]

It could be, but none of us have your medical history.

Speak to the prescribing doctor first. If you are uncomfortable with her/his response, then find a doctor who has experience with endurance athletes. They will have a better idea of what works for athletes and what doesn't.

Solid advice here and from Steve. My partner has dealt with some difficult to diagnose heart issues and if anything it's taught me that seeking the advice of professionals in person is 100% necessary.

The Tom Simpson references are tangential at best...... So much more in play there.

[Mzilliox]

you need professional advice, and from more than one source.

dont know you or anything about you, but id be asking myself real hard like, "do i need this drug?"

Adderall seems (to me) to be prescribed all too often.

[fmradio516]

Yikes! Alright, this is all good info. I'll probably start to ween myself off, or maybe only take as needed for work instead of every day.

Thanks for the words, everyone!

[buddybikes]

Have you tried or discussed Atomoxetine with your doctor?

[glepore]

Also discuss Vivance. Much more effective and subtle than Adderal.

[daker13]

Take what everyone says on the internet with a grain of salt, sure, but that extends to the Tom Simpson references, too.

My two cents, there are a ton of athletes both amateur and professional on ADHD medications.

[weiwentg]

Tom Simpson
Died on speed at the TDF
Amphetamines hugely over prescribed to adults and kids
for decades now
VERY irresponsible
mojo
cyclothymic shrink since 1990

Tom Simpson abused amphetamines. Probably on a lot higher than therapeutic doses. Amphetamines may be over-prescribed, but you and I have no knowledge if that's the case for the OP.

[joosttx]

I hear it only works only in cold weather as a PED for cycling. FWIW, if you are around 35-45 being prescribed with ADHD is another way of saying you are getting old and you cannot work as hard as you did when you were younger. Ask yourself if that is the case? Also, ask yourself how you are ever going to get off an additive drug once you start taking it and is it worth dealing with the withdrawals. I would say talk to your doctor but it is not like the medical profession can protect you from becoming addicted to their products.

[gasman]

Another med to ask about is Provigil if you are having difficulty with staying awake. It has supplanted amphetamines in some branches of the military for use when extended missions are critical but I’ve never seen its use for ADHD though have heard of it.
It works very differently than amphetamines so it will not give you a high heart rate.

Just a thought to bring up with your doctor.

[dddd]

I would be most leery of combining any two stimulants, such as if the OP were already a coffee-drinker and was adding another stimulant drug to that.

I'm leery of using amphetamines in general, but if I was going to try it then I would have to be caffeine-free for some time before starting on another stimulant drug.

Caffeine by itself is already a potent de-regulator of adrenal secretion, so might itself cause an apparent need for a stimulant at certain times of the day.

[Heisenberg]

vyvanse is solid, though no generics avail so it's pretty $ if you don't have good insurance. prodrug of amphetamine so it's a steady trickle via the liver instead of the instant hit of adderall that cranks everything to 12 and can deliver some hefty heart rate jumps. it's also got much less potential for abuse because of this.

modafinil (aka provigil) does get off-label prescribed for adhd, but it's pretty dependent on the individual as far as effectiveness at treatment. it isn't a true stimulant, and its long-term effects aren't really well known yet.

focalin is another one. it's a stimulant (dexmethylphenidate), but isn't as powerful as amphetamine/adderall/vyvanse. some folks do well with it.

but, not a doctor, just an ex-bike rider who's had a dozen+ concussions over 15 years, resulting in decaying-ass grey matter. definitely talk with a doc who has familiarity with athletes+stimulants if your current one is a) clueless and brushes it off or b) freaks out about it.

[jfranci3]

A few thoughts:
1) Try the extended release
2) There IS a difference between generics and brandname. One generic might use a different filler/release formula than another. The brandname likely has the best release control.
3) You get used to stimulants somewhat quickly.


Short term - I would suggest you call your doc and ask to take your rx in two parts during the day. Longer term - try the extended release version.

[C40_guy]

Strattera caused similar symptoms -- jittery, higher heart rate, tunnel vision. Never had that issue with Ritalin, either short acting or extended release, brand or generic.

Sometimes it takes a while to figure out which med works best for you...family member tried pretty much all of them, can only tolerate the Daytrana patch...

I do ask my MD to specify "Brand Only" on prescriptions. Costs more but meds are consistent...

As others have said, have a conversation with your MD, or get in touch with the Hallowell Center in Sudbury. Lots of expertise there...

[jfranci3]

Strattera caused similar symptoms -- jittery, higher heart rate, tunnel vision. Never had that issue with Ritalin, either short acting or extended release, brand or generic.

Sometimes it takes a while to figure out which med works best for you...family member tried pretty much all of them, can only tolerate the Daytrana patch...

I do ask my MD to specify "Brand Only" on prescriptions. Costs more but meds are consistent...

As others have said, have a conversation with your MD, or get in touch with the Hallowell Center in Sudbury. Lots of expertise there...

Strattera is non-stimulant. Shouldn't do any of that. You might have a problem going pee though.

[C40_guy]

Strattera is non-stimulant. Shouldn't do any of that. You might have a problem going pee though.

That was almost 15 years ago, and yes, those were the symptoms when taking Strattera. Stopped taking it, no more symptoms.

15 years later, no problem peeing. In fact, I'll be right back.

....

There, that's better. :)

[whateveronfire]

Not a doctor (medical) and about to cite a single case:

friend was on adderall for years and her aorta ruptured (otherwise healthy, early 50s).

all of which is to say, consult your doctor and be careful with that drug.

[weiwentg]

...
2) There IS a difference between generics and brandname. One generic might use a different filler/release formula than another. The brandname likely has the best release control...

I'd disagree with some qualifications. For the average person, there should be no significant difference between generics and branded drugs, or between generics from different manufacturers. However there's a lot we don't know about how humans metabolize both drugs and the inactive ingredients (i.e. fillers) in drugs.

When a manufacturer releases a generic drug, they have to prove that (https://www.ncbi.nlm.nih.gov/pubmed/26132680) all the relevant pharmacokinetic parameters are close enough to equal to those of the branded drug. The drug itself should be identical. That said, any one person may be sensitive to something in the non-active ingredients in a way that affects how they metabolize the drug in question.

If you do not respond to a particular stimulant, I'd probably try different stimulants first before trying the branded version of the original stimulant. If you've switched from the branded version, do be aware of the placebo effect, but it's certainly possible that you do respond better to the branded version. Same applies if you had one version of a generic, and your pharmacy switched the version. I've heard some people on Reddit swear that they needed one specific manufacturer's generic. I've had my meds switched among generic manufacturers with no issue to me.

[C40_guy]

Not a doctor (medical) and about to cite a single case:

friend was on adderall for years and her aorta ruptured (otherwise healthy, early 50s).

all of which is to say, consult your doctor and be careful with that drug.

Guy on my bike racing team was not on Adderall, as far as I know, and his aorta ruptured. He was lucky to survive.

Also completely irrelevant to this conversation, statistically speaking.

[jfranci3]

That was almost 15 years ago, and yes, those were the symptoms when taking Strattera. Stopped taking it, no more symptoms.

15 years later, no problem peeing. In fact, I'll be right back.

....

There, that's better. :)

Were you the first one taking it? :-) maybe you got a bad batch

I'd disagree with some qualifications. For the average person, there should be no significant difference between generics and branded drugs, or between generics from different manufacturers. However there's a lot we don't know about how humans metabolize both drugs and the inactive ingredients (i.e. fillers) in drugs.

When a manufacturer releases a generic drug, they have to prove that all the relevant pharmacokinetic parameters are close enough to equal to those of the branded drug. The drug itself should be identical. That said, any one person may be sensitive to something in the non-active ingredients in a way that affects how they metabolize the drug in question.

If you do not respond to a particular stimulant, I'd probably try different stimulants first before trying the branded version of the original stimulant. If you've switched from the branded version, do be aware of the placebo effect, but it's certainly possible that you do respond better to the branded version. Same applies if you had one version of a generic, and your pharmacy switched the version. I've heard some people on Reddit swear that they needed one specific manufacturer's generic. I've had my meds switched among generic manufacturers with no issue to me.

You're absolutely wrong. You're only thinking about the active and inactive ingredients, not the whole process. IIRC, the approval is only on the active ingredient and the testing found to be bio-equivalent +/- 25% for brand name during the duration of the dosage. Generics get approved with their own formulation of active and inactive, so the inactive ingredient is probably different in almost all cases. There are some cases where generic is no where as good as brand name - I'm thinking Omeprazole / Prilosec from my own experience.

For example, time release mechanisms - a generic only needs to show the same type of time release (extended, 12hr, etc) not the same method. One might use a different method of time release, they might apply that time release to the active ingredient a different way with a different release curve. Those active and inactive ingredients are packed into a pill of a slightly different surface to mass ratio. Time release mechanisms are usually protected by separate patents. Application of those mechanisms may be tricky. For example, some pills use the outer casing as the time release - this is shot up by lasers. Is the laser setup on one production line here the same as the one in another factory? Probably not.

Ingredient sourcing - one company will use a different supplier than the other. Think about the size of the grains before they are made into pills. That grain size will affect intake a great deal. Think about the difference in taste between normal sugar and powdered sugar.


Another thing to consider.... when you think of drugs, there are "two-part" cocktails, delicate cocktails with a lot of technique, and wholly complex concoctions. Everyone will or can make the 'two-part' cocktails (asprin), no one wants to make the complex oil refinery level ones (insulin and pseudoephedrine), and there's a lot of drugs in between where a generics firm can make money making the drugs that are somewhat difficult to make because other firms can't or won't make them. They're difficult to make and they will therefore be different than the brand name. The brand name is generally made the best because there was a lot riding the FDA testing and they wanted good market uptake.

[whateveronfire]

Guy on my bike racing team was not on Adderall, as far as I know, and his aorta ruptured. He was lucky to survive.

Also completely irrelevant to this conversation, statistically speaking.

Which I admitted at the outset.

Her doctors said Adderall was a major contributing factor. Aorta rupture is much more common in men (60+) and very rare in women in their 50s.

Anyway, it's worth what anything on an Internet forum is worth.

[Dekonick]

Another med to ask about is Provigil if you are having difficulty with staying awake. It has supplanted amphetamines in some branches of the military for use when extended missions are critical but I’ve never seen its use for ADHD though have heard of it.
It works very differently than amphetamines so it will not give you a high heart rate.

Just a thought to bring up with your doctor.

Beat me to it - Provigil is presently one of the few medications used for narcolepsy. It is used by our SWAT for extended missions. Worth discussing with your doctor, but remember neurologists are not cardiologists. A multidisciplinary team needs to be involved any time you are talking about working at maximums. Ever had a true maximal stress test? Do you know what your max heart rate really is and what is safe for you? All things to consider.

[Dekonick]

I hear it only works only in cold weather as a PED for cycling. FWIW, if you are around 35-45 being prescribed with ADHD is another way of saying you are getting old and you cannot work as hard as you did when you were younger. Ask yourself if that is the case? Also, ask yourself how you are ever going to get off an additive drug once you start taking it and is it worth dealing with the withdrawals. I would say talk to your doctor but it is not like the medical profession can protect you from becoming addicted to their products.

Just thought I would point out that true ADHD patients treated with stimulants have a different reaction than non ADHD brain responses to stimulants. The stimulants for ADHD actually paradoxically slow impulses through over stimulation, while a non ADHD brain just gets high. Oversimplification, but it is the non ADHD brain that will become an addict. On a tangent, but interesting - there is research supporting using opioids to treat narcolepsy as they raise brain levels of orexin (aka hypocretin), a neurotransmitter absent or at extremely low levels in narcoleptics, (due to a suspected autoimune response killing the neurons that produce it) but that same neurotransmitter is found in extremely high levels in opioid addicts. The point is not all brains are the same; not all brains are as likely to become addicted. Good stuff... and why it is important to confer with specialists and a multidisciplinary team. It is almost impossible to stay current in any single field, much less area's that overlap. Best of luck!

[joosttx]

Just thought I would point out that true ADHD patients treated with stimulants have a different reaction than non ADHD brain responses to stimulants. The stimulants for ADHD actually paradoxically slow impulses through over stimulation, while a non ADHD brain just gets high. Oversimplification, but it is the non ADHD brain that will become an addict. On a tangent, but interesting - there is research supporting using opioids to treat narcolepsy as they raise brain levels of orexin (aka hypocretin), a neurotransmitter absent or at extremely low levels in narcoleptics, (due to a suspected autoimune response killing the neurons that produce it) but that same neurotransmitter is found in extremely high levels in opioid addicts. The point is not all brains are the same; not all brains are as likely to become addicted. Good stuff... and why it is important to confer with specialists and a multidisciplinary team. It is almost impossible to stay current in any single field, much less area's that overlap. Best of luck!

Understood. My point wasn't to say ALL are like this but I have seen very high functioning workers start to burn out around 40 and try to use stimulants as a way to keep on the same way oppose to adjust their work styles. I have often wonder if adult ADHD diagnosis sometimes is misdiagnosed as a person just getting older and can grind as hard as they did in their 20 and early 30's. To me symptoms of Adult ADHD are similar to a person who is just freaking exhausted or under chronic stress.

[Dekonick]

Understood. My point wasn't to say ALL are like this but I have seen very high functioning workers start to burn out around 40 and try to use stimulants as a way to keep on the same way oppose to adjust their work styles. I have often wonder if adult ADHD diagnosis sometimes is misdiagnosed as a person just getting older and can grind as hard as they did in their 20 and early 30's. To me symptoms of Adult ADHD are similar to a person who is just freaking exhausted or under chronic stress.

Anything that is diagnosed with a check list is suspect.

[unterhausen]

the proper protocol for prescribing a controlled substance like adderall involves extensive psychological testing. I'm sure that there are some docs that shortcut the process, but assuming it's done on a whim is wrong.

[glepore]

the proper protocol for prescribing a controlled substance like adderall involves extensive psychological testing. I'm sure that there are some docs that shortcut the process, but assuming it's done on a whim is wrong.

In theory. But you should do a poll at Goldman or another investment bank. You'd be shocked.