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Adderall: IR versus XR

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My p-doc initially put me on Adderall IR, 20 mg (10 mg x 2).

A week later, I called her mentioning that I seemed to have crashed after a week of functioning wonderfully. She put me on 40 mg (20 mg x 2), and mentioned the possibility of putting me on XR. But at my next appointment, she seemed surprised that I was taking such a large dose.

So when she wrote out the script for Adderall XR, she prescribed me 20 mg x 1 per day. I was a little confused and worried that she'd halved my dose, and asked her about it. She hesitated, we talked some more, then she rewrote it for 30 mg x 1 per day. I ultimately chose to say with the IR, 40 mg a day. (We also talked about getting ADHD-specific CBT from my current therapist to help.)

I guess my question is, is 20 mg of XR somehow equivalent in efficacy to 40 mg of IR? If not, why would she do this?

Also, how do you know when you need to go up on your Adderall? I've noticed that I'm not quite as alert as I used to be, but this time the change is happening so subtly that I find myself doubting whether it's the Adderall. Too many factors - my tendency to get lethargic every spring (has anyone ever experienced this?), my slight decrease in Wellbutrin (450 -> 300 mg). I usually go into my appointments kind of knowing what I think I need, but for the first time, I'm utterly confused and clueless. ;)

Also, would XR really benefit me if I don't feel as if I have major peaks and valleys? It seems like I'm more energetic overall on Adderall, although there *might* be smaller peaks and valleys. Is it normal NOT to have peaks and valleys, or does it mean I'm on too much of it? I'm so confused. I'd appreciate any insight anyone might have.

And um, would it be weird to ask one of my pharmacology professors about this, being that it's my personal life?

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And um, would it be weird to ask one of my pharmacology professors about this, being that it's my personal life?

It depends on how much of your personal life you trust that professor with.

As to the other questions:

- 20 mg of extended release is equal to 20 mg of standard release. The difference is that the extended release should be dumping 10 mg into your system now and 10 mg in about 3-4 hours. How well that works out depends on how well you absorb the med in each timeframe and how fast your body can make it go away.

- You didn't ask, but you still can't wash the XL down with orange juice or a cola and expect to get full absorption

- There's a possibility that you crashed from being on too high a dose. Amphetamine releases the neurotransmitters you have. If you can't replenish your stores as fast as they're being depleted, the end result is more of a crash than a soft landing.

- Also, the initial feeling of an "energy boost" is really just a side effect as far as ADHD is concerned. That should stop happening fairly quickly on a regular dose/schedule as your body figures out how to adjust for it.

- I'm partial to split doses of the IR, because at best you'll get 8-10 hours from the extended release and that may leave you fuzzy-headed or worse at a time of day you need to be clear-headed... like an evening highway commute

All of the above are things your doctor should have taken a minute to explain. Some patients are too young for that sort of explanation, but not too very many of them have pharmacology professors, Doogie Howser notwithstanding.

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