The sides of the window are puzzling and require a few more office questions. The reason for asking the questions is simple: we want to know exactly how the drug is working in the context of the time of day, the duration of effectiveness, and the predictable expectations of the specific drug in question.
All these questions arise from the essential philosophical description of drug delivery systems: if you know the science and have clear goals, you can objectively measure the outcome of treatment and correctly adjust drugs according to the biochemical and metabolic individuality of that patient. specific individual. Measure that ‘window’ for predictable results.
The simplified version of that statement: traditional medicine based on weight, age, and body size is outdated and simply ineffective. – So we’re going to get the details right every time by starting from the same place using the same predictable grid to measure effectiveness. These 7 Tips for the Sides of the Therapeutic Window, along with the measurements from my other articles here on 7 Tips from the Top and Bottom of the Therapeutic Window, will outline precise treatment goals. I have been using these ‘window strategies’ with thousands of patients for over 12 years and I can assure you that they work like a properly timed clock. Predictable results should be the standard of care.
The 7 tips for the sides of the therapeutic window of stimulant drugs.
- The sides of the window are based on time: Expected DOE – Duration of Effectiveness of that specific medication for that specific person’s metabolic rate, and should be customized for each person from the beginning and throughout the duration of treatment. Each person burns medications at different rates that cannot be predicted by superficial appearances of weight or size. I have an ex-Marine [Nuclear] The commander who is about 6’6″ and looms over me, has to duck when he walks in the door, takes only Adderall 10mg XR and the DOE is a reasonable 10 hours. We want to have a specific match between expected duration Y clinically effective duration.
- Know the DOE’s expectations for medications from the start: Authorities and studies do not agree on some of the following points about specific medications that I am about to discuss. Pharmaceutical companies have done their homework and are focused on these very goals of the DOE: I simply disagree with some of the DOE’s findings based on my own abundant experience in the office. Many studies vary by thousands of patient hours over years of treatment using a given approach on this ‘Window’ grid. See the 7 tips article at the top of the window for more details on specific medications.
- Get to work: Accurately measure DOE time in every meeting: Easy questions: “When did you take it and when does it stop working?” If it’s taken at 7 am and lasts until 3 pm, that’s the DOE. The math is simple: 5 hours in the morning %2B 3 in the afternoon = 8 hours. A drug can work for 8 hours, but still keep the person out of the top of the window if the IR is too high.
- The first side objective – Start AM: All medications should be working within 30-45 min. after taking the medicine. infrared [Immediate Release] The tablets have a quick effect, but the sides of the window are too narrow and the DOE [Duration of Effectiveness] It comes out too fast, which means it only lasts for a small part of the day. IR drugs need dosing 2-3 times a day because the DOE is too short. If the morning onset is more than 45 min, the dose is or very little, doesn’t work at all, or can be too much – see point 4 of the 7 Tips for the Top.
- Morning start regulation: breakfast is essential, breakfast with protein works better more often: With drugs, since we’re now paying attention to the rate of metabolism, the DOE, we’re much more interested in “rate-limiting steps.” Breakfast is an imperative limiting step that is essential for all psychiatric medications to prevent gastric mucosal irritation. [stomach lining]. With breakfast, that early side of the ‘Window’ is smoother and less messy with uncomfortable spikes from over-medication.
- The goal of the second side: the release of PM: when they stop working: Concerta a Adderall XR extended-release capsules are mechanically released and have unpredictable release times depending on acid-base variables in the stomach and intestine and transit time of intestinal contents. Long transit time often means increased drug sensitivity and relative drug accumulation over time, with a narrowing of the ‘Window’. Metabolic challenges with bowel function almost always change the timing of PM release, when medications stop working. Vyvanse is not as vulnerable to rate changes based on acid/base balance or transit time.
- The Mysterious Target: PM Release with Vyvanse: Vyvanse deserves its own advice because it is very effective, with an excellent and predictable DOE of 12-14 hours. Keep this simple point in mind when measuring DOE with Vyvanse: The metabolically released stimulant is so different that many don’t “feel it working” and therefore miss out when it “stops working.” Remember with Vyvanse: look for the original cognitive “mind” targets, not somatic and stimulant effects. When Vyvanse closes in PM, the ability to finish tasks disappears.