Request for comments - Ritalin, Focalin, micromanagement of effects and side-effects

[no-go]

Swim has determined therapeutic use of methylphenidate Hcl (Ritalin and generics immediate release) is best achieved by oral administration, and now will only dose through this route, for lately its CNS is needed, not the high.

However, oral administration has always been ... complicated, the effects unreliable. Until recently (since 2 months ago). Swim controlled the first wave, now suffers a second wave of separate side-effects.

Swim is asking for anyone with any pertinent knowledge or similar experiences to comment on the following, to determine whether permanent MPH cessation is necessary.

For the following, the dose is 20-40mg of generic IR ritalin, taken orally. No other drugs present, never taken within 4 hours of Vitamin-B, occasionally taken within 2 hours of 500mg vitamin C.

1. Swim always had a (welcome) bowel movement when it kicks in. Since the side-effects, the bowel movements stopped, replaced by mild abdominal pain.
2. Swim began to sweat profusely, temperature increased by up to 1.8 degrees F.
3. His urine smells sulfurous for the whole day *following* the dose.
4. Little to no CNS or DRI-induced mental energy and focus
5. Visual distortion (mostly things seem brighter)
6. Blood sugar spike if taken with a few glasses of coca-cola.
7. Shaking, twitching
8. itching/crawling skin.

To mitigate against these, swim began taking the pills along with saltines (6-12). The result: Saltines therefore mitigated against 1, 2, 4, 6, 7, leaving 3, 5, 8 as acceptable side-effects. In other words, saltines make Ritalin work again.

Swim suspects therefore that sodium-Dependant neurotransmitters have been disturbed OR liver enzymes are not functioning correctly. Upon reading that the l-isomer *may* disrupt metabolism of the d-isomer of MPH, swim this month (third month of enduring side effects) switched to Focalin, 10mg twice a day, taking just the d-isomer.

The result:

1. Inflammation of the nasal passage (excessive mucuous production). Doctor just prescribed steroids alleviate this problem, beginning next week.
2. Virtually no CNS or DRI effect, even after attempted re-dosing. No therapeutic effect at all.
3. Visual disturbance NOT TOLERABLE.
4. No sweating.
5. Blood pressure increases. Never happened w/ Ritalin.
6. Urine never smells odd
7. Digestion slowed, weight gained
8. No itchy/crawling skin
9. Shaking/twitching persists
10. Troubling drowsiness within two hours of dose

Overall, Focalin feels like Wellbutrin. The blood pressure issue is alarming, swim suspects the d-isomer, without the l-isomer, gives more adrenergic response. Saltines or sodium-rich foods do nothing to alleviate any of these side-effects of Focalin, as they do with Ritalin.

What is going on here? Tia

[staples]

Any other medications? Other conditions, such as diabetes or low blood sugar?

Originally Posted by no-go

3. His urine smells sulfurous for the whole day *following* the dose.
5. Visual distortion (mostly things seem brighter)
8. itching/crawling skin.

So from what I understand, the switch to focalin fixed #3 and #8, but #5 got worse?

Originally Posted by no-go

In other words, saltines make Ritalin work again.

Swim suspects therefore that sodium-Dependant neurotransmitters have been disturbed OR liver enzymes are not functioning correctly.

Hm, can you elaborate more? I'm not sure I understand what you mean, and I'm not sure why saltines would help... As a thought, though, perhaps SWIY could try a protein-rich breakfast and see if that makes a difference?

Originally Posted by no-go

Upon reading that the l-isomer *may* disrupt metabolism of the d-isomer of MPH, swim this month (third month of enduring side effects) switched to Focalin, 10mg twice a day, taking just the d-isomer.

The result:

1. Inflammation of the nasal passage (excessive mucuous production). Doctor just prescribed steroids alleviate this problem, beginning next week.
2. Virtually no CNS or DRI effect, even after attempted re-dosing. No therapeutic effect at all.
3. Visual disturbance NOT TOLERABLE.
4. No sweating.
5. Blood pressure increases. Never happened w/ Ritalin.
6. Urine never smells odd
7. Digestion slowed, weight gained
8. No itchy/crawling skin
9. Shaking/twitching persists
10. Troubling drowsiness within two hours of dose

Overall, Focalin feels like Wellbutrin. The blood pressure issue is alarming, swim suspects the d-isomer, without the l-isomer, gives more adrenergic response. Saltines or sodium-rich foods do nothing to alleviate any of these side-effects of Focalin, as they do with Ritalin.

If a more adrenergic response were the culprit, I don't see why #4 occurs. The doctor more than likely knows more than me on #1, but has SWIY tried an antihistamine (something non-drowsy like loratadine/claritin)?

To say it feels like Wellbutrin (Bupropion, to use the chemical name) seems like a direct contradiction with #2, as Wellbutrin is a DRI as well. I'm not sure what you mean by a "CNS effect", but it seems you believe it to be distinct from "DRI effect" (?).

I'm not sure what would help with #3 without causing more drowsiness, and even then that SWIY's doctor would be ready to prescribe...

For many other symptoms, specifically #7, #9, and #10, and maybe even #1 and #2, I might attribute these to the fact that methylphenidate only blocks reuptake, it doesn't stimulate release of dopamine or agonize dopamine receptors. It may be necessary to stop with the Vitamin C for a bit, and try dosing with L-Tyrosine, L-Phenlalanine, and Vitamin B6 a little while before taking ritalin. That should ensure that dopamine can be readily metabolized, but SWIY may also, or instead, want to try using a small dose of caffeine, which blocks adenesine receptors to stimulate release of dopamine (start with a low dose, especially if SWIY doesn't use caffeine very often, and be careful--it is not usually advised to take caffeine with ritalin). These things may make #5 and #3 worse, however. Another option entirely would be to switch to an amphetamine based ADHD med, but if I remember correctly, you mentioned in other threads that SWIY has already tried them and does not like them.

Originally Posted by no-go

What is going on here? Tia

I'm not sure, I hope something I said helps, though

Good luck

Edit: I also meant to mention that if SWIY has insurance which covers it, Daytrana (methylphenidate patch) may be an option.

[thenightwatch]

Just to clarify... are you taking Focalin IR or XR?

Also, I have no idea if its relevant to this situation or not, but I have heard of people taking a daily, theraputic-level dose of DXM (~30mg) and a Magnesium supplement to help tolerance and decrease side-effects of stimulants.

Some Google-ing may turn up something useful.