Hello Everyone,
As mentioned before I am disabled due to a severe back injury while working that has left me in terrible chronic pain. To combat the pain I take a good amount of morphine everyday. One of the side effects of the morphine is lethargy. It was getting so bad that I was sleeping more than I was awake and my quality of life was getting into the single digits. After long and careful consultation with my doctors and pharmacist the doctor gave me the go ahead to use Aderall (amphetamine) to wake me up during the day.
I have to say that it has been a life saver for me. I am actually awake now and can participate in life again! At this point I am on a very low dose, 5mg three times a day and it seems to be working well. The questions I have are:
1: How does amphetamine work? What does it actually do to your system to make you stay awake? I have read the wiki article on it, but perhaps I need a more layman’s explanation of the process.
2: Why is it that when I first take the morning dosage I don’t seem to get anything immediately as far as a reaction. However long after I have taken the pills (5 or 6 hours afterwards) I am wide awake. I realize that amphetamine has a 12 hour 1/2 life, but my thinking is the effects would be stronger when the pill was initially taken and in my case the “awake” effects seem to feel the strongest many hours after the last pill was taken. So much so that on occasion (last night being one of those times) that I can’t sleep at all and find myself awake all day and night. This is a rare event, but does happen on occasion.
3: Adderal has been in very short supply lately, most pharmacies have been out of stock. Last month the doctor had to switch me to Ridalin because I couldn’t find the Adderal anywhere. For some reason the Ridalin wasn’t nearly as effective as the amphetamine. Almost non-effective. Do they work differently or is Ritalin just not as strong as the other?
To make it clear, I am not very happy about taking amphetamine. Unfortunately it has become a neccassary tool for me in order to have a decent life. I wish that there was some way to deal with the pain other than strong narcotics, then I wouldn’t have the lethargic problem.
Also, I am aware that most of my questions can be answered with a Google search, however I find the different points of view here a better source of information and there always seems to be an expert or two that weighs in on most subjects. I enjoy finding out as much as I can about the medications that I am taking. I figure them more in depth knowledge I have, the better I can discuss these things with my doctor and have an eductated opinion when it comes to my treatments. THANKS!
I think dextroamphetamine (if I spelled that right), the primary ingredient in Adderal, is more rapidly absorbed by the body than methylphenidate (also suspect spelling). So the percieved effect could be much different.
That would make sense. Any idea what these drugs actually do to your system? I can’t seem to figure out how they make you stay awake. I have also been told by people I know that took amphetemine for recreational use that they got a “burst of incredible energy”, although this has never happened to me. I suspect that the small amount I am on wouldn’t produce this.
For the observable physical effects you’d be better off googling the specific drugs. My experiences with methylphenidate and other amphetamines have been mixed. They help my ADDism, and possibly depression as well, but I already have severe sleep problems, and taking these things leaves me needing more pills to sleep at all. And there aren’t any real good drugs for sleep that don’t lead to worse effects. Pretty much the same is true for anti-depressants. Some work for some people, but overall they are limited in usefulness, thus the constant search for new ones.
Now you are in a bad condition, having to counter the effects of one drug with another. I hope you can find a balance that gives you a reasonable quality of life. At least I’m not in great physical pain. I don’t much about the effects of opiates (I get bad side effects from them, but luckily haven’t suffered great pain from the dental and surgical procedures I’ve had). Is it possible that your dosage or means of administering painkillers could lessen the lethargy?
Thanks for your response. I have tried to lessen the amount of narcotics that I am on and have been somewhat successful. I no longer take morphine during the day, getting by on percocet alone. That has cut my morphine intake by a 1/3 (I used to take 30mg during the day and take 60mg at night). The problem I am running into now is that I am once again getting tolerant to the morphine and it looks as though I will have to increase the dosage soon just to keep the same level of pain relief.
This more than anything scares me, as I am only 45. I am afraid that in another 20 years the doctors won’t be able to control the pain because my tolerance will be so high to the medications. Most of the narcotics seem to be cross-tolerant as well, so even switching every couple of months doesn’t look like it will help.
I have to agree that using one drug to combat the side effects of another sucks, but there really isn’t much choice. As I mentioned, I was sleeping so much without the amphetamine that my quality of life sucked big time. I am thankful for what it has done for me, but at the same time concerned about the toll these drugs are going to have on me in the long term. Tolerance also concerns me with the amphetamine, I understand tolerance is developed very rapidly with this medication and I don’t think there are very many alternatives.
As I have mentioned before, I apologize if I seem self absorbed or if it sounds like I am complaining. I am just trying to get as much information about the medical things that affect my life so I am able to talk with my doctor about them and so I can fully understand what is happening. I appreciate everyone’s responses and respect.
Have you considered Provigil (modafinil) or the single isomer version, Nuvigil (armodafinil)? They stimulate alertness with fewer side effects (generally speaking) than amphetamines.
If you have to take an amphetamine, I’ve found Focalin (dexmethylphenidate) to be the most effective.
I tried Povigil without any success. I might as well have been taking a placebo. I talked to the pharmacist and she said that the Provigil in her opinion would be totally ineffective in countering the lethargy brought on by something as strong as morphine. I will look into the Focalin. Right now I am taking the generic form of Adderall as that is what my insurance will cover.
Generic focalin is available but only in the immediate release form, so that should be covered. The XR version is still under patent.
It’s a single isomer version of Ritalin but is definitely stronger on a per mg basis. I think the upper limit has been raised, but it used to be 20mg per day for dexmethylphenidate and 60mg/day for regular methylphenidate