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Does Vyvanse Interact With Effexor XR?

Posted on Mon, 14 Nov 2016

Question: Hi Doctor:

I recently wrote to you about using vyvanse to manage concentration and wakefullness while taking effexor. I guess you can see my history?

I am trying to NOT taking the vyvanse every day. Even at 10mgs I find it makes me a little impatient and sometimes my thoughts are a little more suspicious (I wouldn't go so far as to say paranoid). Should I be concerned that such a small dose (combined with 37.5 mgs Effexor XR and lamictal) would make me feel so overstimulated?

I have been trying to take days off. I've heard mixed reports about whether this is a good idea. What do you think?

Also, I am feeling some shakiness in the past couple of days...mostly in my hands. I am taking cold medicine at night as well.

Answered by Dr. Dr. Chintan Solanki (7 hours later)

Brief Answer:
taking days off would be a good idea

Detailed Answer:
Hi,

Thanks for writing to me directly.

You should not be concerned much about over-stimulation with vyvanse when you are getting benefit with that also. If no other side effect, I recommend continuing in less dose (5 or 7.5 mg) or you can take days off. In few patients I also use days off (drug holiday) strategy.

Shakiness in hands can be due to side effect of vyvanse but I usually never get in my clinical practice.

Can you tell more about your shakiness?

- Is it started after starting vyvanse?

- At which time of the day is it there?

- Tremors are course or fine?

- Does it occur on rest or o doing some work?

- Do you have any past history of such problem?

I will be happy to help further after your response.
Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Chintan Solanki (14 hours later)

I did not take vyvanse today so as to take a day off and I have less/no tremor, and I have taken all my other meds (effexor, lamictal), but I'm just starting to type and use my hands. I can't gauge the weakness yet.

i guess my concern with the vyvanse was that I might be having a hypomanic reaction...I get very driven to smoke and drink and my sex drive returns almost compulsively. Again I get mean and have some paranoid streams of thought. My father is bipolar and my maternal grandmother was schizophrenic. I have a trauma history and am very sensitive to meds. I have some friends in the field that think stims are a terrible idea.

I have had tremors in the past (i think it depended on meds) and I wake up shaking frequently.

Answered by Dr. Dr. Chintan Solanki (11 hours later)

Brief Answer:
dose reduction of vyanse is needed

Detailed Answer:
Hi,

Thanks for information and sorry for delayed response.

Vyvanse is likely responsible for your tremors. If I were your treating doctor I would like to reduce the dose of vyvanse. For a while to treat tremors, trihexyphenidyl or propranolol can be used. You should not worry about hypomania because I probably have never seen such reaction with vyvanse and as you are also taking lamictal there which is used in treatment of hypomania.

In any case if you feel that your over excitation remains continue, stopping vyvanse is a good option in my opinion and start with bupropion.

Discuss these aspects with your treating doctor.

All the best.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Chintan Solanki (13 hours later)

I have been toying with the notion of wellbutrin instead of vyvanse. In the past, when I took it with an SSRI (celexa), I felt good and focused for a few days before becoming easily agitated and strangely dissociated. It reproduced in each of the three trials i did.

When I took it with just lamictal it would also it helped some with the depression but would also "zone" me out frequently/make me tired during the day; and add to my irritability. I have always attributed these "zoned out/washed out" and irritable states with the neurepinephrine activity. And the effexor alone makes me feel very detatched and bored (which is one one of the reasons I tried adding vyvanse).

Knowing this do you think Wellbutrin is still advisable?

Thanks,

Answered by Dr. Dr. Chintan Solanki (11 hours later)

Brief Answer:
Then wellbutrin is not a good option for you

Detailed Answer:
Hi,

Thanks for clarification.

Considering such history about wellbutrin in your case I do not recommend it now.

Other remaining option is atomoxetine. It is less potent stimulant. It is like wellbutrin so there may be chances that you cannot tolerate. But it is a worth trying for concentration if Vyvanse has to be stopped.

Good luck.

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Dr. Chintan Solanki (15 hours later)

thanks I will look into this.

BTW I have been noticing some violent thoughts while taking the vyvanse and effexor together that seem to come up out of no where. should I be concerned. My grandmother was schizophrenic. I've also had violent thoughts on some antipsychotics, taken as an add-on to antidepressants

Answered by Dr. Dr. Chintan Solanki (9 hours later)

Brief Answer:
cause of violent thought should be established

Detailed Answer:
Hi,

Violent thoughts can be due to following reasons.

As you told it can be due to side effect of drugs vyvanse and effexor.

You have family history of schizophrenia so these thoughts can be de novo (arising on its own).

And the last possibility is excessive concerned about drugs and psychiatric illness can cause such thoughts out of anxiety.

Doctor can establish cause with detail history,mental status examination and timing of thoughts with starting of drugs.

Wish you healthy time.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar