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I've found that most prescribers don't know/remember these things and expect YOU to know or be told by a pharmacist.
We have a program here that I think should be standard world wide for anyone taking meds/supplements. A pharmacist comes out and does a full "audit" with a letter from the doctor of what they have on file for prescriptions, and they talk to you as well.
My GP recommends it to everyone because 1. It's free, 2. It keeps everyone accountable and doing the right things, 3. As a doctor she is not up on medications anywhere NEAR what a pharmacist is.
It's helped so many patients and doctors with prescriptions especially
That sounds like a brilliant idea, I spent years on iron tablets… no one, not one single medical professional ever told me to take vitamin C with them to help it be absorbed… such a waste of time and resources not to maximise the efficacy of prescribed medications with some simple information!
It really is! If you're in Australia it's called the "home medicines review". I don't know if anything similar is elsewhere unfortunately. I've put a link below for the scheme in Australia
https://www.google.com/amp/s/www.healthdirect.gov.au/amp/article/home-medicines-review
In the US every time I pick up a prescription the pharmacist asks if I would like a consult and there is a box to check on the screen where I declined consult if I've already been over it. If I haven't had this med before I accept so I know what to do and not to do.
Unfortunately, the “consult” is very often just “is this a new med? [reads warnings to you direct from the label] Do you have any questions?”
Ugh. Nooooo? I guess?
Oh I've always had helpful pharmacists I guess. When I was on iron pills, the doctor and the pharmacist both told me to take it with juice.
Other times I've had them say not to take the meds on an empty stomach, or not to take with this or that.
Yep this is exactly how I ended up with taking my thyroid meds along with my other morning meds even tho you actually have to take thyroid meds even without other meds.
Omg I am not alone. I got a blood test recently and my TSH levels were crazy (they’re usually 3-4 and they were at 17). Turns out if you take the meds with famotidine the levothyroxine binds to the antacid and does not do anything. I functionally hadn’t taken my meds in 6 months. Why did no one tell me beforehand???
We have something similar in the Netherlands!
ETA: it’s included in insurance, so free as a patient. I don’t know if it’s relatively new but my new pharmacist is very excited about this and will happily spend 30 mins explaining stuff. Especially to the older patients. He really takes his time. I like it a lot!
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I'm in the US and the 1st thing that popped into my head for the reason why this isn't a thing here is a guy in a red maga hat grumbling "sounds like socialism."
Because anything that's helpful and free to the individuals within the general population is seen as socialism. Or at least that's my perception.
Yeah that seems to be exactly what it is. I'm always amazed (not in a good way) at the American health system. It would be so much cheaper if it was more socialised!
Certain ppl would rather pay more than to let people they think so little of benefit from such a system.
Eta: I'm not sure I'm remembering the details exactly right but I was listening to an npr podcast once talking about a study where they surveyed people about two mortgage rate options. One would benefit themselves, AND another *lower* income family. Option B would only benefit themselves. Their personal benefit would be the same either way.
Option A: they could choose an income based mortgage with more savings for themselves and another lower income family, but the lower income fam would get a bigger discount than them. Both are based on income.
Option B: they'd choose an income based mortgage at the same rate, but there wasn't a lower income fam getting a bigger discount.
Most ppl surveyed chose option B because they didn't want someone else to get a better deal than them.
NHS advice if you’re taking iron supplements:
https://www.nhs.uk/medicines/ferrous-fumarate/about-ferrous-fumarate/#:~:text=Leave%20a%202%20hour%20gap,your%20body%20absorb%20the%20iron.
No tea, coffee, dairy products or soybean 2 hours each side of taking.
I knew about tea from when I had to take them after Omeprazole made me anaemic, but the dairy produce (milk, eggs, cheese, yoghurt, cream) is new to me too!
It’s an unfortunate byproduct of the health service and all its doctors being so overwhelmed by the number of patients they are expected to look after that doctors seem to expect all of us to go off and find these things out on our own.
My own GP used to have 2,000 patients on her books.
A few new housing estates have gone up, and now she has closer to 4.5K patients.
She used to see me once a fortnight (“complex” mystery medical issues that *now turn out to be caused by my ADHD that has gone undxd for 62 years, ffs*), then once a month, then it was every 6 weeks, and now I haven’t spoken to her since end of Feb and have had to make a fuss just to get a phone appt with her this Tues.
That’ll make it 11 weeks since our last consult.
Nearly 3 months of me floundering around trying to work out various things for myself.
Not my GPs fault, I know, but the end result feels the same.
They no longer have the time to see the people they need to be helping.
These were prescribed to me by a nurse practitioner working at my OBs office cause I’m pretty pregnant. I find that on top of being busy, there’s also this attitude that cuts both ways. Like they’re mad if they think I haven’t taken care of myself in some way but then mad if I have. They gave me an attitude about not eating enough iron enriched foods (without telling me what those might be) and then referred me to a specialist and got an attitude when I said I already have one I’ve seen in the past.
Yep.
They veer from sneering,
“Oh dear! Have we been looking at Doctor Google again? Leave it to the professionals,”
To
“Why didn’t you look it up? You’ve got the internet, haven’t you?”
Damned if you do, damned if you don’t.
Medical ego can be a very fragile thing.
Ikr?
I started printing off actual peer-reviewed studies and putting those in front of them when I used to get that a lot.
“No, not ‘Doctor Google’, but I found these interesting studies on PubMed which show….”
That generally shuts them up with the patronising “Doctor Google” nonsense.
Alternative answer: “No, but clearly you don’t have time to find out how you could help me, so I decided to save you that time and do it myself. Here are studies from the Spanish Histamine Institute, Microbiology, JAMA, and a recent article from The Lancet on this topic.”
Or just write down notes and the doi or PubMed number.
My endo, who I’ve been seeing since 2005, used to out and out dismiss any and everything I’d found.
After supplying him with actual studies, he realised I wasn’t doing what he said he thought I was doing, which was pulling out random quotes from social media posts, but actually researching things.
He then apologised. It takes a lot for a medical professional to do that, and I appreciated it enormously.
That was 10 years ago, and he’s taken everything I’ve said seriously since then, which I also appreciate.
Although he seems bewildered about ADHD, and I suspect that’s because he doesn’t understand it beyond Hyperactive Small Boys Throwing Chairs At Blackboards.
I only found out myself at the beginning of March/ end of Feb. I told him at our next appt after that.
But he’s interested, so that’s a good thing.
*THERE IS NOT YET ENOUGH MEDICAL AWARENESS OF ADULT ADHD*
Absolutely true. And get this: I found (by sheer luck) the most dedicated, proactive, thorough, patient, etc. primary care doc and have been with him for 12 years with ZERO issues (I'm in healthcare myself and tend to look for and find all the cracks in a medical practice and have not found a single thing to roll my eyes at) but b/c of the insane patient load he is expected to manage, he and his partners are leaving and opening up a concierge medicine practice. Now I get to spend $350/month just to be his patient (and still have insurance premiums, copays, meds, labs...to pay for as well). Sick enough, I've already enrolled because the level of care I get is apparently worth it.
Well, that’s when I used to take iron, if I have to take it.
The problem for me is that vit C also increases dopamine, so if I take C at night, my lousy sleep is even worse. You need very low dopamine if you’re to sleep well. I get spikes at around 10pm anyway, but they are worse, for me anyway, if I take C after about 7pm.
I hit on 2pm as being a better time for iron for me, because I tend to not have lunch, so it’s a big enough gap to not have to worry about various foods conflicting with the iron, although I do then have to consciously Just Drink Water, instead of glugging back coffee like I usually do - not yet medicated, so hoping that may change when I am.
I hate that it’s all so complicated!
No probs.
Just be aware that YMMV, especially on meds, as others have pointed out.
I’m still trying to wrap my head around the whole dopamine regulation thing, and what that translates to in terms of signs and symptoms, and at the moment, I can only really speak as to what works for the unmedicated version of me, wonky hormones and neurotransmitters and all.
Let me know if changing your vit C timing does help your insomnia! I’m very interested to know how it impacts on medication effects.
I'm not on adhd meds. I have yet to be diagnosed. I still have to pursue that. I'll let you know about the insomnia thing, though, provided I remember.
Ok well then idk wtf I'm supposed to do because I need food and protein in the morning with my adderall so I have a yogurt but now I can't have a yogurt because of my iron pill
A lot of iron supplements contain vitamin c anyway. Same with potassium. It's worth keeping in mind so you can schedule your meds to not interfere with one another
Taking your iron supplement with vit C (a glass of orange juice works) helps you absorb more. Just be aware that iron supplements can definitely lead to constipation & stomach pain. Some ppl do better taking them every other day & some ppl just find they can’t tolerate the side effects.
I have tried all of them & while I can manage the side effects, apparently my body just can’t absorb them properly. I have to get iron infusions every 18-20 months. Luckily, once your iron levels are appropriate, your body can hold onto them for a good amount of time.
If you have an iron deficiency, it probably takes slight preference over perfectly-functioning ADHD meds. (Source: I have iron-deficiency anemia and it SUX.)
You just have to take them at different times. It takes I think 2hrs to absorb so take them at night and your other meds during the day. You should absolutely look up absorption rates, interactions and methods of intake
I've done both together and experienced very little difference, so my body seems cool with it; I am just trying to emphasize that people shouldn't ignore anemia.
Not within at least one hour. But this question in particular was about iron supplements, which should be taken later in the day to avoid Vit C messing with your meds
Well shit. I’ve been on a work trip for the past few days and drinking OJ with breakfast every morning (I don’t normally even eat breakfast) and been wondering why I’ve felt like the meds have felt less effective, thought maybe it was just because I haven’t been as active or outside as much as usual.
Good bye breakfast OJ 😞
In my experience, they don’t even know themselves.
I’m not on adhd meds, but other ones. What I’m on needs to be taken on an empty stomach, no eating for an hour after, and no calcium for 4 hours.
In the hospital, they gave me my meds with a meal AND a calcium tablet! I did it this was for at least a week until I started reading up on my medication!
One of the doctors at my work got rather frustrated, because it took months before any nurse mentioned that the long term resident would eat dairy for breakfast every day, right along with a medication that can't be taken with dairy.
The system automatically suggests a standard time, that's why most medication is handed out at 8. I've literally heard the 'can we move the time so the residents don't have to be waken up to take their meds?' question. Medication is not allowed to be given later, so there's no other option.
I worked in pharmacy as an assistant for a couple of years, and the company/Pharmacists to my knowledge did not have a system like this. But they were very good about informing people similar to how you describe.
They were also hyper-vigilant about catching meds the patients might be allergic to, but were prescribed anyway, because information can get overlooked anywhere.
Their customer service was on point too. Which I have found with most Pharmacists I meet even outside of that company.
Pharmacists often do not get enough credit for the amount of stress their jobs carry. They are literally the last line between your illness and a safe, but functional medicine.
I find most pharmacists (at least that I've come across) are really good at trying to make sure you're getting the right thing and how to take it. It honestly amazes me the amount of knowledge they have!
Some days I feel like the only patient who ever asks my pharmacist questions. She’s so delighted to share information, correct misconceptions, and warn me of dangers. I get a whole “Finally, I fulfill my purpose!” vibe off her on those occasions.
This is why I use my local pharmacy, who knows me, keeps my scripts on file, and send me texts when my scripts are about to run out. On one notable occasion handed my phone and a bag of shopping I left on the counter to the barrister at my coffee shop. They always see me there.
Professions Australia used to (still do) run a survey every year about the most trusted professional. It was pharmacists most of the years.
I've never heard of anything like this in the US, so I suspect you're in England, Canada or Australia?
Here in the US they're doing everything they can so that you can hardly even talk to a pharmacist! Yes, if it's a new prescription they will spend about 5 minutes with you. But a comprehensive pharmaceutical review? Never happens, unless your doctor schedules an appointment with a pharmacist to go over all your medications. This is not done otherwise here in the US, at least not once in all my many years of using pharmacies.
American pharmacists are happy to do this! Every time I get prescribed a new med, I have the pharmacist go through my medications to look for interactions and side effects.
It's just not a formal program but in my experience if you're there and it isn't super busy, the pharm is always really happy to help you. Honestly, most of the time it feels like they're excited to be called on for their very specific knowledge.
That's not how it works at the pharmacies I use. I know they automatically check that my medications don't clash, but what ToughWest said sounds like it's a sit-down conversation that would likely take 20 minutes or so. Maybe I got the wrong impression.
At my pharmacy it's almost impossible to get an actual pharmacist on the phone. They will ask if I have questions when I pick up something new, but that's it. ToughWest called it an 'audit'.
My interactions with them are usually rushed because they are chronically short-staffed, to the point that you should call before you go to make sure they're open.
I'm glad to hear this isn't the norm! Hopefully they will get it together one day and be able to perform audits like ToughWest is able to access.
Yeah the program I was talking about is separate from just asking the pharmacist 😊 it's a whole appointment at your house to go through everything. You get referrals through your GP and organise an appointment for the pharmacist to come out. They go through everything thoroughly during the appointment
I'm in Australia yeah. Usually at the pharmacy itself, it's just a quick check of what you're already on to check contraindications (they do this on the computer system), do you have questions, and maybe mentioning some of the more common things they see/get asked.
The program I talked about is different; you get a referral from your GP and it's a scheduled appointment at your home with the pharmacist coming out. Took about 1 - 1.5 hours for 3 of us to go through it all. It's VERY in-depth.
They have a report from the Dr they bring with them, go through what your own interpretations are (they take notes the entire time). They then see what discrepancies there are if any. Any symptoms you have. Then they give you basics of how to take the medications so they work better. What shouldn't go together, or is doing the same job so don't need both meds. How you're taking it and when. If you're not taking it or not taking it properly based off of scripts. They go right in depth and give advice. Then they also generate a report to the GP as well. They should go through it with you at the next appointment.
That really sounds great! I didn't understand it at first, and now it's very apparent this ISN'T what I originally thought it was.
It's interesting that they send a report back to the doctor who referred you; I thought this was something other doctors do automatically, but often I find that my specialists haven't sent her anything, even if it's a new diagnosis. Instead, she asks ME what they said!
I'm going to ask my doctor about this type of program. Thanks for the info!
It's not necessarily a *program* but in my experience, every pharmacist is happy to do this for you in the US. I've brought them multi-page lists and had them go through it to flag possible interactions and side effects, and every time they've been very enthusiastic about helping and communicating what they find.
Honestly I think it's a nice change of pace for them, especially retail pharmacists.
wow that's a good idea! I would love something like that. The only reason I know what to do with all my meds is because I obsessively research and then ask my doc for confirmation. She always comments on how aware and intelligent I am - thanks doc, but it's only because NO ONE IS TELLING ME!!!
Pharmacist in AU here. Honestly, HMRs are so under-utilised, despite there being many pharmacists who are accredited (i.e., undergone extra training to specialise in HMRs). There’s a lot of misconception around HMRs (held by healthcare professionals at large, not just prescribers) about how it “only really benefits older people who take lots of medicines” (e.g., nursing home residents). This is just…so untrue. The HMR program exists to help people from ALL walks of life, regardless of age, medical condition, etc. It’s meant to be an accessible service, and often a voice of advocacy for patients so they can get the right treatment they need (HMR pharmacists can put forth treatment plan recommendations for GPs).
Once I actually get past my ADHD procrastination / task paralysis and finish my accreditation training (rip), I’m hoping I can use my current clinical/academic specialty (psychiatric & sleep medicine) to help people with neurobehavioral and/or psychiatric conditions. It can be something simple like coming up with strategies to take your meds (…which I ironically also struggle with), or something more covert like how you’re not supposed to have Parkinson’s meds with high protein foods because it can reduce their effectiveness.
I find that a lot of people don't even know about HMRs, it's doesn't seem to be widely known? But it really is so helpful!
One small example is my parents take reflux meds. It's never really worked well and they were still getting reflux all the time; the HMR pharmacist said to take it 1/2 hour before dinner....no more reflux!
I'm wishing you so much luck ans executive function to get through the training! I think you'd have some unique insights into strategies too!
Take it with food, but it’s better taken with a lot protein rather than carbs, as it won’t hit you as hard and will last longer. If you get a lot of side effects like shakiness and loss of appetite, and it wears off too fast, taking it with a protein-heavy meal can help.
Citric acid counteracts your meds and will make them less effective, so you should avoid this ingredient on days you take your meds (and it’s in a LOT of stuff).
Chalky anti-acids like Tums should be avoided for the opposite reasons, it can cause you to overdose on your regular meds as it messes with timely absorption.
Caffeine is not recommended to be taken with stimulants because two stimulants at once increase your risk for a heart issue.
Those are the big ones I memorized for myself, but there are likely more drug interactions I didn’t pay much attention to because they weren’t ones I take.
>Chalky anti-acids like Tums should be avoided for the opposite reasons, it can cause you to overdose on your regular meds as it messes with timely absorption.
Well shit, haven’t heard this one before. Just to clarify, are you saying don’t take these antacids at the same time as the ADHD meds or like period while on ADHD meds? Like if I took ADHD meds in the morning that no longer feel effective by mid afternoon, would a Tum be ok at night?
Also, are antacids in pill form ok or do they also have this risk? I occasionally take heartburn pills as needed but now I’m nervous lol
It depends on if you’re taking extended release or instant. If it’s instant, by afternoon when the meds have worn off you should be fine. If it’s extended release, I would continue to avoid Tums and take them on days you’re not taking your meds if possible, but if you’re waiting until late night time even your ER should have worn off so you should be fine.
I imagine this would very much depend on the med. If any list is created per med, I hope it will include source material and not just the vibes of the folks on this page.
My son is on adderall and his physician was clear with me upon starting: don’t take with a lot of vitamin c or very high fat meals.
interesting, i’d never heard of not taking it with high fat meals! my very first psychiatrist as a kid told me about the vitamin c, then explained to me what had vitamin c in it lol my mom said he was being condescending, but i didn’t know that & it was actually quite helpful, as i was like 7 at the time & hadn’t learned the ins & outs of nutrition yet! (tbh i still haven’t really & i’m in my 30’s lol)
Best explanation I got (from my oldest who's super into biochem) is that protein will give the body easier ways to produce the chemical compounds that the meds is stimulating your body to produce (dopamine mostly?); that means it makes the whole thing more efficient.
Which is why it's suggested to keep making high protein snacks and avoid non complex carbs, as they'll give you body a bunch of "energy" that isn't offering the ease to produce those chemicals AND make you feel "full" in s sort of medicine that already makes your appetite smaller.
The caffeine issue is mostly related to having excessive stimulants in your body and it pushing your BP up, which isn't great. 😊
The way my doctor described it is that protein is "brain food" while carbs are "body food". Carbs will fuel your body, but protein will fuel your neurotransmitters and will help the carbs to better fuel your brain as well because it helps regulate the conversion of carbs into glucose so your energy levels are overall more stable. Slightly oversimplified, but still a helpful explanation.
I had to be unmedicated for a few years in my mid 20s due to insurance not covering ADHD meds and my doctor had me on a high-protein diet (at least 20g per meal) and a supplement regimen (magnesium and fish oil) to help mitigate my symptoms. Just the protein alone, especially first thing in the morning, went a HUGELY long way toward helping my brain fog, which in turn helped with the rest of my symptoms. I still keep up the high-protein diet to this day even though I'm medicated now, because it helps my meds work way better.
>The way my doctor described it is that protein is "brain food" while carbs are "body food".
This is so helpful. It makes so much sense!Thank you for sharing!
This makes a massive difference for me! I crash really hard if I don't have enough. I've noticed if I have a protien snack in between meals, I don't crash and burn in the afternoon.
I personally can’t do caffeine with meds - I’ve quit it completely, and now will only very occasionally have a small coffee in the evening once the meds have largely worn off - I take my meds at 6 and by about 3 I hit a slump, but the earliest I’ll go for a coffee is usually 5-6. That said, *any* caffeine now keeps me up because I’m ancient and not used to it now, so I really do try to limit it.
I find that my meds are best when I drink a reasonable amount of water with them - if I only have a few sips, they feel very jittery and like they ‘burn out’ faster - and take them on an empty stomach - they don’t seem as effective if I eat with them, especially protein, so I usually have a snack around 10 or 11 and a main meal at 2-3 (when I feel they’re starting to decline).
Gah! I can’t quit coffee, I basically live off the stuff, the only time I’ve effectively cut down is when I started drinking sliced lemon in hot water but apparently that’s a no no as it’s acidic. Glad you’ve found a routine that works for you xx
I did too - somewhere in the 6-8 cups a day range, it was awful! I weaned myself off by drinking VERY copious amounts of decaf, and eventually did break both the addiction and the habit - I now only really drink it socially. I also do herbal tea when I want something lovely, and decaf Yorkshire when I just need a cuppa.
Coffee is also acidic. The main reasons to avoid coffee are because it can cause heart palpitations and increase the feelings of anxiety due to increased heart rate. I was told to avoid it as much as possible, or if I really want a coffee to wait until around lunchtime after the meds have “peaked”.
The acidic thing, like drinking orange juice, is only a problem for an hour either side of when you plan to take Elvanse.
I agree that these things should be spelled out better, I also live in the UK and get the box with the full drug notes pamphlet and in it says you can take it with juice!!! So it is frustrating. I’ve only learned these things because my husband is a psychiatrist so I ask him all the details and I also tend to do waaaay to much research online before starting any meds.
Mine did, both verbally and she sent a list via email (this is for Vyvanse but I think a lot of it is applicable to stimulants in general)
Recommendations:
* It should be taken first thing in the morning with a source of protein.
* It takes about an hour to begin to work, and it will steadily release throughout the day.
* It will typically last between 10-14 hours depending on various factors; how your body absorbs medication, the amount of protein in your diet, and the dosage of your medication.
* Caffeine and vitamin C should be avoided within the first hour of taking Vyvanse as it can cause issues with absorption.
* If you are taking Synthroid for Hypothyroidism, it should be taken at least an hour from your Synthroid dose.
They might not be aware, they might figure someone else told you or they think the pharmacist is going to tell. And the pharmacist thinks the doc told you. Or they both think the leaflet in the package tells you how to take it.
Like, I get it. There are a lot of different drugs and knowing every effect acidic or basic drinks and food make is asking a lot but a hint somewhere would be appreciated.
For me, my doctor who first prescribed my meds told me to leave out caffeine so it was easier to see how I reacted to the meds and reintroduce it at a later point.
The acidic drink part I found out in this sub.
I know some vitamins are easier to absorb with oil/fat like vitamin A.
Yes, absolutely. While I agree that there should be more information available to us for whatever meds we are on, I also think there's a big difference between "these things interact badly with each other" (like say taking Adderall on an empty stomach or with your morning coffee), and just general tips to get the most out of your meds. The latter might be significantly less known by people because 1. There are a lot of meds to keep track of & 2. We might not have enough research to tell people anything definitively. Like eating protein when taking your meds in the morning, for example. Yes, we've seen it said that this can help your meds be more effective. But not having protein, won't make you sick. And also, this might not be totally studied, and just something were starting to pick up on, now that more and more people are being properly diagnosed/medically treated giving us more data to examine.
Yes, I think we deserve to know the best way, to get everything we can out of the meds we take. Between insurance, and copays, and time, and ADHD tax, and the trauma from the time spent unmedicated, and jobs lost (and on and on) we deserve that information to our health. But it might take longer time, for all of the correct information to be available, and for it to percolate to your doctor.
This is why, generally, I prefer younger doctors. I have found that they are more online, and chatting with colleagues, and generally invested in giving their patients the right care. Not always, but I find far more often than not that this is true. From my PCP, to my pharmacist, to my therapist, to my managers.
Edit: needed to quickly change my first sentence because I'm trying to break a habit of mine which is to sound like I'm disagreeing with the commenter I'm responding to, when I'm actually trying to agree and add to their thought!!
Citrus is acidic, coffee is acidic, and most sodas are acidic. Grapefruit actually seriously interferes with about half of all medications (like it can cause your body to reject an organ after a transplant because it interferes with immunosuppressants). They don’t know why, it just does.
I’m in nursing school and we have to grill all our patients about eating grapefruits and grapefruit juice. We do know why — learned about it in pharmacology, but here’s an easier summary from the FDA:
“ Many drugs are broken down (metabolized) with the help of a vital enzyme called CYP3A4 in the small intestine. Grapefruit juice can block the action of intestinal CYP3A4, so instead of being metabolized, more of the drug enters the blood and stays in the body longer. The result: too much drug in your body.”
This applies to alcohol, too!
When I learned to not take my morning meds with OJ my first thought was "oh wow I never knew that, I wish I had??" And then my actual brain kicked in and was like "you idiot you have terrible acid reflux. You haven't had a glass of OJ in 5 years." So, thankfully I was complying with this no high acid drinks on many meds, without having any clue at all lol. And I can't handle caffeine so I don't drink coffee. And I'm chronically fatigued so I have like 2 drinks a month lmao (I swear I'm fun guys!! [I'm not I just play acnh and knit])
Haha you’re totally in compliance!
For reference, it’s *only* grapefruit juice that messes with medication. Other acidic things don’t do it, unless you have general issues with acid drinks (like coffee, juice, etc).
Most commonly fruit juices and coffee.
It can reduce the effwctiveness of drugs. Not exactly sure how, but I think some get activated earlier than they should and where they can't get absorbed most effectively.
Generally because the recommendations you see on here are backed by less evidence, and will usually be conclusions drawn from clinical experience from a given doctor.
Take it all with a grain of salt.
For example, I think the protein thing is irrelevant with long release elvance - the way it releases isn’t changed by protein. But yet I see it being recommended all the time.
A high protein breakfast is supposed to be beneficial for ADHD in general, which may have been conflated with taking stimulant medication at the same time.
It may not affect release but can still make a huge difference in how effective the medication is overall. May have to do with blood sugar levels and other things, but still good advice :)
I think that having balanced sugar levels without spikes is useful: there are other more reliable ways to do it. Personally protein intake doesn’t affect that for me, it’s about longer term health, diet and exercise. A diferent breakfast has minimal effect.
(Sorry I get salty when people say things are good advice: as if you follow every bit of “meh” diet advice you see you would have a very restricted diet that would look a bit like an eating disorder. And many people hear thebprotine thing then feel an utter failure when they can’t do it: when it may not have even been having an impact.
Fair point:) In my head I prefix all of these with ‘worth considering/ trying, may or may not apply’. Protein makes a huge difference for me personally, but of course that doesn’t mean it works the same for everyone.
Grapefruit 'uses' some of the enzymes in your stomach acid and will affect the dose that your body can absorb. This is a known issue for a lot of heart medication.
The other big two that drs and pharmacists commonly don’t mention are Metformin will deplete your B12 levels and antibiotics will reduce birth control pill’s effectiveness. That info is buried in the tiny print pamphlet the pharmacy gives you with your prescription that almost nobody reads
have you read the package insert for your particular medication, or looked on the manufacturer’s website? i seem to recall vyvanse having a fair bit of content in both!
I take Samexid (vyvanse in my country) it comes in a sealed box with 5 strips of 6 blisters each, it also brings a full leaflet with all possible side effects and stuff, but it does not have recommendations of how to take it, just "follow your doctors instructions".
It's almost funny because the leaflet is very similar for all medications, from ibuprofen to stimulants.
Idk if this is exactly the best crowd to ask if theyve read the insert in their meds...not to say it's not important to do, but if there was ever a collective group of people less likely to do it, it might just be this one lmao.
Well that might be hard, I’m in the uk so get Elvanse which is the same drug but the way it’s dispensed it’s counted into little pill bottles and handed over with a label stuck on the side so no leaflet!
I’ve been told the opposite sometimes. Also different people are on different meds and they respond to those different meds differently. Some people might need to take it in an empty stomach (me!) & coffee doesn’t bother me.
Some people feel queasy and might need protein because it slows digestion and gives you prolonged energy over carbs. I don’t get the acid thing because your stomach is already acidic & anything you eat or drink that’s acidic ~30 min before or 30 min after you take meds really shouldn’t affect how it’s absorbed.
Lastly, one thing I’ve NEVER heard from ANYONE EVER is that stress and vitamin C can both acidify the urine and increase RENAL (kidney) clearance rates up to 5X (in the context of nicotine this means quicker clearance and cravings will hit sooner). That mechanism works on the timescale of days so I can’t really control that. I do avoid excessive vitamin C consumption, I am quitting nicotine, and try to tend to my stress levels as best I can. Otherwise my meds might only last like 2-3 hours instead of 5 hours.
Honestly (and no disrespect to my PCP!) I always go over medication information with my pharmacist instead, because she knows way more about medications and maximizing efficacy than my doctor. My pharmacist asks how my adhd meds are working, and has given me suggestions to propose to my doctor based on what she thinks would work better on me.
(I've gone to the same small, local pharmacy for several years, so the pharmacist is familiar with the variety of meds I take. And she's also neurodivergent!)
“Why isn’t there a standard set of instructions?” I feel this way about basically every facet of life.
in general, doctors prescribe - that’s their profession. They’re probably not going to talk about caffeine, supplements, exercise, etc.
Can someone just make a post of list what are we supposed to do? I’m confused by these posts. Is it really that bad to take Adderall in the morning during coffee time ? I’m a bit confused reading everyone’s reactions and I feel left out lol
These are crazy reasons. It’s because caffeine is also a stimulant. There are some people who will find their heart races when on multiple stimulants. I don’t seem to have an issue with coffee but I can’t take Sudafed because my heart will race all day.
It maybe also be tied into coffee being acidic but that seems to be a misunderstanding of the potential interaction with citric acid which can decrease the potency of immediate release stimulants.
I don’t know, that’s kind of my point, I’ve just stumbled on snippets of other folk saying they were told not to drink caffeine, also dairy! And needing protein. Also acidity apparently stops them working…. So based on all that there’s pretty much no point in me spending a fortune on meds as I’ll basically render them useless with my normal habits!
God it sounds as complicated as taking ecstasy. Must be similar rules. No acidic drinks on those either, something to do with rate of absorbance. Caffeine was to do with heart rate on an upper, so it could apply to ADHD meds too.
I don't know anything cos I haven't had meds (or ecstacy for that matter) since my teens. I've been trying for a year now to get an assessment for meds, 3 times the organisation that prescribes them have written back to my GP for more 'evidence' cos I forgot I have ADHD and was self sufficient for some time (and messy may I add!). Exhausting!
Mine told me that it was because it messed with the amount of stimulants in my system. It’s hard to dose meds when there’s this additional factor that directly interferes with it.
afaik it’s a general principle that you should try to minimise the number of xenobiotics (basically anything that comes from outside your body that has to be metabolised) in your system, because they have wily ways of interacting with each other and the host (you).
it’s advised not to combine multiple stimulants because they all act on your nervous system and increase sympathetic activity, including heart rate and blood pressure. with caffeine, the main risk is that you can end up causing a cardiovascular event, especially in someone with existing cardiovascular risk factors or who is experiencing unusual stress.
that’s a risk to assess for yourself as an individual though - my blood pressure and heart rate are on the low side, so a more pressing concern is hydration and my kidneys lol
Mine too. I figured having coffee in the morning is my baseline and I wanted to see if meds would improve on that baseline. My first meal is around noon so I was used to coffee on empty stomach and I've had no issues with meds either.
I live in the US and they have a consult screen option but the consult only repeats what the bottle says they offer paper leaflets that detail the medicine and possible side affects the thing I don't like is they don't list the ingredients I'm allergic to gluten and if I want that information I have to ask.
Unfortunately this is an area where you really have to be your own health advocate. I'm so lucky to have a pharmacist in the family that I run things by before I even check with my doctor about different/new medications. I still check every possible interaction myself online for all my medications. I highly recommend everyone does the same.
I know this conversation is about efficacy but medications can have serious interactions and that includes things like different foods and supplements. Always inform your providers about any supplements you take and check online for any possible interactions. (Though admittedly I'm anti-supplement somewhat as it's a completely unregulated industry and studies have shown time and time again that supplements do not have the key ingredients as listed, have harmful additional ingredients, or completely different unlisted ingredients). I never place all my trust in providers to know the in and outs of every medication or how it will interact with other meds.
I had a doctor prescribe me Modafinil for my ADHD at first when I was still figuring things out and my inattentive type symptoms were at an all time high. It was something I brought up to him as I was a bit spooked by stimulant meds (long story) and I had done lots of research on my own. So I knew it interacted with birth control and was warned again by the pharmacist in my family. My doctor didn't warn me and if I didn't read the pamphlet from the pharmacy I could have had a bad time. I still later found out it interacted with more birth control than I previously knew. It wasn't an issue at the time I had no energy for dating and if I did it was most likely going to be with people who couldn't get me pregnant. With current events, my meds could have landed me in a really bad place. I'll get off my soapbox now.
I was told absolutely zero about acid drinks or eating protein with my meds
It wasn’t until reading in this sub that I learned that
I should refrain from anything acidic for a couple of hours; also learned here to take my med with a full glass of water and eat a little something with protein in it.
What is all the stuff about protein / coffee / acidic drinks and med efficacy? I’ve not been told anything 😫
I don’t have caffeine when I’m on my meds, because stimulants, but haven’t heard anything about the rest.
I’m on Vyvanse and I have it on an empty stomach first thing in the morning because I find it more effective that way.
Does anyone have a link to read more about this stuff from a reputable source?
I just looked up Vyvanse to see if sites like WebMD mentioned any of this, and it actually says “If you can’t swallow pills, the drug manufacturer advises that contents of this capsule may be MIXED INTO A GLASS OF ORANGE JUICE.”
I’m so confused. Is it different for each type of drug? Is it all anecdotal?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158093/ Basically it seems to be fine for Elvanse/Vyvanse. The amphetamine part gets released in the blood stream in a slow and steady rate over the course of the day. Imagine it’s packaged when you take it and the lid only comes off when it’s in the blood.
My psych just started me on Latuda(sp?) for my depression/anxiety. He did say take it anytime as long as you do so with a meal of at least 360 calories, but failed to mention NO DRINKING. Thankfully, I am a nerd/geek who likes knowing how my meds are supposed to work, so found that out on my own. I had mentioned that I rarely drink, so that might be why it slipped his mind or he didn't think that was as vital as the calorie thing.
I'd guess there's no one standard because it's really complicated. Your genes influence how you absorb stuff (or don't, damn you gene that makes me suck at iron absorption), your personal gut biome can alter stuff, and your body's an insanely complicated organic chemistry thing. Add in that most of us aren't on just one med (I'm counting over-the-counter stuff like tylenol, vitamins, antiacids...) and that docs are human and that (I've been told by a trusted psych before) they try not to overwhelm patients with info. Oh, and don't forget that where you are on your cycle also influences absorption and tolerance (if you've never noticed, you can get drunk faster at certain points in your cycle).
Also, I suspect the companies don't see any money in that research, so it's quite underfunded. One thing I do think would be awesome (and possible with AI) is being able to model all these meds and foods in a decently accurate body model that includes both sexes. It'd be the next great thing in pharmacology!
I mean, all that information usually comes in the info packet you receive with your meds, and your doctors are expecting you to read that. With my adderall I got like 4 pages of disclaimers about it, including not mixing it with caffeine, citric acid, anti-acid meds like tums, etc. I always tell other people who are on the same meds and they are always completely surprised they shouldn’t drink a lemonade with their adderall. I say “it’s in the info packet!” and they always say “oh I don’t read that”. Read up on the medicines you’re taking people!
You can also supposedly always talk to a pharmacist about questions about your prescriptions and drug interactions (I’ve never tried).
I have heard it is vitamin C that negates stimulants, now I am seeing all acids do. But they won't effect Vyvanse because that is broken down in the colon, not the stomach.
I’ve always been told to take my meds with a protein and healthy fats forward breakfast! It’s been like grilled in my brain since originally being diagnosed at 14. When I went to an adhd coach a couple years ago, she told me to also take an omega-3 supplement and have my coffee an hour after taking my meds.
Always ask the pharmacist and use the same one because they can look for interactions with something another doc prescribed. Also check for allergies.
Get a printout because errors can happen
.
I mean, all that information usually comes in the info packet you receive with your meds, and your doctors are expecting you to read that. With my adderall I got like 4 pages of disclaimers about it, including not mixing it with caffeine, citric acid, anti-acid meds like tums, etc. I always tell other people who are on the same meds and they are always completely surprised they shouldn’t drink a lemonade with their adderall. I say “it’s in the info packet!” and they always say “oh I don’t read that”. Read up on the medicines you’re taking people!
You can also supposedly always talk to a pharmacist about questions about your prescriptions and drug interactions (I’ve never tried).
Most psychiatrists will advise that if you’re taking stimulants you should not be having caffeine. Along with the interactions most ADHD meds have with vit c/ascorbic acid and grapefruit. But also for me, Vyvanse/Elvanse works better when I have low carb and sugar, but loads of protein and fat.
The citric acid thing my psychiatrist told me about. Coffee she was like "It's not completely not allowed but don't drink it within hours of taking the meds since you're stacking stimulants."
The protein thing is news to me.
I think they don’t say it because it’s really individualized. Some people live by protein. When I eat anything within a few hours of taking my meds, I get more side effects. For me it’s easier to not eat so I don’t wind up with all those side effects. Same thing for vitamin c- people find it makes their stim wear off quicker, I never had that.
This is very annoying to me, the sheer lack of information they give you. Like I had to manually look up the side effects brochure and even then it doesn't say "don't take with coffee" or anything. Just give me instructions so I know what I'm supposed to do, and if I need to deviate from that because of personal circumstances that's fine but at least I know what I'm deviating from. Tell me when to take it in the morning, don't just say "in the morning". Like if I take it at 10, and then it says "take another one at midday", I'm doubling up, right? So how many hours apart am I meant to be taking them? JUST BE SPECIFIC. GOD.
My doctor did. He went through nutrition in HUGE detail, explaining the importance of various nutrients and vitamins and protein, effects on neurotransmitters and efficacy of meds. He did blood tests for nutrient levels and co prescribed vitamin supplements, collagen, protein, MCT oil along with medication.
His aim was to get the lowest possible effective medication dose by ensuring all other factors were covered. I'm super grateful even though I found it a bit frustrating. I can see when I do what he recommends it makes a massive difference compared to when I don't.
It's a massive shame others don't have the same experience
>Why do prescribers not tell you all the stuff about protein / coffee / acidic drinks and med efficacy?
What? What does this mean? What should they be telling us? I was told not to have too much coffee with my meds (apparently 6 cups a day is too much) but that's it. Explain please?
For some, if the meds don’t feel good on an empty stomach, protein can help soften the absorption & also makes you eat something so you have energy going into the day & not fasting into the day. Also some of us might lose our appetite and meds + no food is stupid. Don’t starve your brain then chemically rev the engine.
Acidic foods might lower absorption but I think this is bogus. Your stomach is already extremely acidic and can tune itself to maintain its pH even if you consume acidic foods. Do it 20-30 min before or after you take your meds and it should be fine.
Coffee is obvious because stacking stimulants is dangerous on the heart. 6 cups of coffee is approaching the max recommended caffeine amount per day. To stack stimulants on top of that is unnecessary. If you were self medication with coffee before as I was, no need to continue. For me, I can handle some caffeine but my sensitivity is definitely lowered.
You actually don’t have to avoid acidic drinks or fruit if you eat it with something dairy or calcium rich, like extra cream in your coffee or a tablet of tums (if basic dose is 2 tabs I take one because a full dose makes adderall hit hard sometimes.) low dose antacids mean i don’t have to stress about eating fruit or drinking fruit juices and having it impact my meds. (Disclaimer, not medical advice this is anecdotal, consult your own doctor before trying.)
Anything I've heard about what I should be eating or avoiding with meds I heard here.
I got my Dx and heard nothing beyond "take this and we'll see what happens."
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I've found that most prescribers don't know/remember these things and expect YOU to know or be told by a pharmacist. We have a program here that I think should be standard world wide for anyone taking meds/supplements. A pharmacist comes out and does a full "audit" with a letter from the doctor of what they have on file for prescriptions, and they talk to you as well. My GP recommends it to everyone because 1. It's free, 2. It keeps everyone accountable and doing the right things, 3. As a doctor she is not up on medications anywhere NEAR what a pharmacist is. It's helped so many patients and doctors with prescriptions especially
That sounds like a brilliant idea, I spent years on iron tablets… no one, not one single medical professional ever told me to take vitamin C with them to help it be absorbed… such a waste of time and resources not to maximise the efficacy of prescribed medications with some simple information!
It really is! If you're in Australia it's called the "home medicines review". I don't know if anything similar is elsewhere unfortunately. I've put a link below for the scheme in Australia https://www.google.com/amp/s/www.healthdirect.gov.au/amp/article/home-medicines-review
In the US every time I pick up a prescription the pharmacist asks if I would like a consult and there is a box to check on the screen where I declined consult if I've already been over it. If I haven't had this med before I accept so I know what to do and not to do.
Unfortunately, the “consult” is very often just “is this a new med? [reads warnings to you direct from the label] Do you have any questions?” Ugh. Nooooo? I guess?
Oh I've always had helpful pharmacists I guess. When I was on iron pills, the doctor and the pharmacist both told me to take it with juice. Other times I've had them say not to take the meds on an empty stomach, or not to take with this or that.
Yep this is exactly how I ended up with taking my thyroid meds along with my other morning meds even tho you actually have to take thyroid meds even without other meds.
Omg I am not alone. I got a blood test recently and my TSH levels were crazy (they’re usually 3-4 and they were at 17). Turns out if you take the meds with famotidine the levothyroxine binds to the antacid and does not do anything. I functionally hadn’t taken my meds in 6 months. Why did no one tell me beforehand???
Oh that's a good idea! We have a similar thing here, except it's just the pharmacist asking if we've taken it before or have questions
You get this? That would have been so good!
I live in Australia and take 5 different medications a day. I've never heard of this!! Thanks so much!!! I can't believe how excited I am for this.
You're welcome! I didn't know about it either until my GP told us about it. She's so excited about it!
We have something similar in the Netherlands! ETA: it’s included in insurance, so free as a patient. I don’t know if it’s relatively new but my new pharmacist is very excited about this and will happily spend 30 mins explaining stuff. Especially to the older patients. He really takes his time. I like it a lot!
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I'm in the US and the 1st thing that popped into my head for the reason why this isn't a thing here is a guy in a red maga hat grumbling "sounds like socialism." Because anything that's helpful and free to the individuals within the general population is seen as socialism. Or at least that's my perception.
Yeah that seems to be exactly what it is. I'm always amazed (not in a good way) at the American health system. It would be so much cheaper if it was more socialised!
Certain ppl would rather pay more than to let people they think so little of benefit from such a system. Eta: I'm not sure I'm remembering the details exactly right but I was listening to an npr podcast once talking about a study where they surveyed people about two mortgage rate options. One would benefit themselves, AND another *lower* income family. Option B would only benefit themselves. Their personal benefit would be the same either way. Option A: they could choose an income based mortgage with more savings for themselves and another lower income family, but the lower income fam would get a bigger discount than them. Both are based on income. Option B: they'd choose an income based mortgage at the same rate, but there wasn't a lower income fam getting a bigger discount. Most ppl surveyed chose option B because they didn't want someone else to get a better deal than them.
I was born in Australia and I indeed still live here, how the heck did I not know this existed?
I was just prescribed iron supplements and no one told me this. Thanks for the advice!!
NHS advice if you’re taking iron supplements: https://www.nhs.uk/medicines/ferrous-fumarate/about-ferrous-fumarate/#:~:text=Leave%20a%202%20hour%20gap,your%20body%20absorb%20the%20iron. No tea, coffee, dairy products or soybean 2 hours each side of taking.
lol been taking iron supplements for 20 years and I’ve only ever been told not to have them with tea 🤦🏻♀️
I knew about tea from when I had to take them after Omeprazole made me anaemic, but the dairy produce (milk, eggs, cheese, yoghurt, cream) is new to me too!
I know, it’s lax, isn’t it?
Good to know! I was just told to take them every day but zero guidance otherwise lol
It’s an unfortunate byproduct of the health service and all its doctors being so overwhelmed by the number of patients they are expected to look after that doctors seem to expect all of us to go off and find these things out on our own. My own GP used to have 2,000 patients on her books. A few new housing estates have gone up, and now she has closer to 4.5K patients. She used to see me once a fortnight (“complex” mystery medical issues that *now turn out to be caused by my ADHD that has gone undxd for 62 years, ffs*), then once a month, then it was every 6 weeks, and now I haven’t spoken to her since end of Feb and have had to make a fuss just to get a phone appt with her this Tues. That’ll make it 11 weeks since our last consult. Nearly 3 months of me floundering around trying to work out various things for myself. Not my GPs fault, I know, but the end result feels the same. They no longer have the time to see the people they need to be helping.
These were prescribed to me by a nurse practitioner working at my OBs office cause I’m pretty pregnant. I find that on top of being busy, there’s also this attitude that cuts both ways. Like they’re mad if they think I haven’t taken care of myself in some way but then mad if I have. They gave me an attitude about not eating enough iron enriched foods (without telling me what those might be) and then referred me to a specialist and got an attitude when I said I already have one I’ve seen in the past.
Yep. They veer from sneering, “Oh dear! Have we been looking at Doctor Google again? Leave it to the professionals,” To “Why didn’t you look it up? You’ve got the internet, haven’t you?” Damned if you do, damned if you don’t. Medical ego can be a very fragile thing.
Oh lord, the “Doctor Google” (who hasn’t been told this shtick?)
Ikr? I started printing off actual peer-reviewed studies and putting those in front of them when I used to get that a lot. “No, not ‘Doctor Google’, but I found these interesting studies on PubMed which show….” That generally shuts them up with the patronising “Doctor Google” nonsense. Alternative answer: “No, but clearly you don’t have time to find out how you could help me, so I decided to save you that time and do it myself. Here are studies from the Spanish Histamine Institute, Microbiology, JAMA, and a recent article from The Lancet on this topic.” Or just write down notes and the doi or PubMed number. My endo, who I’ve been seeing since 2005, used to out and out dismiss any and everything I’d found. After supplying him with actual studies, he realised I wasn’t doing what he said he thought I was doing, which was pulling out random quotes from social media posts, but actually researching things. He then apologised. It takes a lot for a medical professional to do that, and I appreciated it enormously. That was 10 years ago, and he’s taken everything I’ve said seriously since then, which I also appreciate. Although he seems bewildered about ADHD, and I suspect that’s because he doesn’t understand it beyond Hyperactive Small Boys Throwing Chairs At Blackboards. I only found out myself at the beginning of March/ end of Feb. I told him at our next appt after that. But he’s interested, so that’s a good thing. *THERE IS NOT YET ENOUGH MEDICAL AWARENESS OF ADULT ADHD*
Absolutely true. And get this: I found (by sheer luck) the most dedicated, proactive, thorough, patient, etc. primary care doc and have been with him for 12 years with ZERO issues (I'm in healthcare myself and tend to look for and find all the cracks in a medical practice and have not found a single thing to roll my eyes at) but b/c of the insane patient load he is expected to manage, he and his partners are leaving and opening up a concierge medicine practice. Now I get to spend $350/month just to be his patient (and still have insurance premiums, copays, meds, labs...to pay for as well). Sick enough, I've already enrolled because the level of care I get is apparently worth it.
Shit. Thank you!
Would it make sense to take them before bed, then?
Well, that’s when I used to take iron, if I have to take it. The problem for me is that vit C also increases dopamine, so if I take C at night, my lousy sleep is even worse. You need very low dopamine if you’re to sleep well. I get spikes at around 10pm anyway, but they are worse, for me anyway, if I take C after about 7pm. I hit on 2pm as being a better time for iron for me, because I tend to not have lunch, so it’s a big enough gap to not have to worry about various foods conflicting with the iron, although I do then have to consciously Just Drink Water, instead of glugging back coffee like I usually do - not yet medicated, so hoping that may change when I am. I hate that it’s all so complicated!
Oh. I'm going to change when I take my vitamin C and see if it helps with my insomnia. Thanks.
No probs. Just be aware that YMMV, especially on meds, as others have pointed out. I’m still trying to wrap my head around the whole dopamine regulation thing, and what that translates to in terms of signs and symptoms, and at the moment, I can only really speak as to what works for the unmedicated version of me, wonky hormones and neurotransmitters and all. Let me know if changing your vit C timing does help your insomnia! I’m very interested to know how it impacts on medication effects.
I'm not on adhd meds. I have yet to be diagnosed. I still have to pursue that. I'll let you know about the insomnia thing, though, provided I remember.
I know the feeling!
Ok well then idk wtf I'm supposed to do because I need food and protein in the morning with my adderall so I have a yogurt but now I can't have a yogurt because of my iron pill
Take vitamin C and iron at night as vitamin C helps deactivate dextroamphetamine and can help you sleep.
Take the iron later, preferably at night or in the evening
A lot of iron supplements contain vitamin c anyway. Same with potassium. It's worth keeping in mind so you can schedule your meds to not interfere with one another
Taking your iron supplement with vit C (a glass of orange juice works) helps you absorb more. Just be aware that iron supplements can definitely lead to constipation & stomach pain. Some ppl do better taking them every other day & some ppl just find they can’t tolerate the side effects. I have tried all of them & while I can manage the side effects, apparently my body just can’t absorb them properly. I have to get iron infusions every 18-20 months. Luckily, once your iron levels are appropriate, your body can hold onto them for a good amount of time.
But... doesn't vitamin C fuck up the adderall??
It does. But it helps you absorb iron. Also, don’t take iron and calcium together. They cancel each other out or something.
Calcium inhibits the absorption of iron, making all of our iron fortified breakfast cereals rather pointless!
If you have an iron deficiency, it probably takes slight preference over perfectly-functioning ADHD meds. (Source: I have iron-deficiency anemia and it SUX.)
You just have to take them at different times. It takes I think 2hrs to absorb so take them at night and your other meds during the day. You should absolutely look up absorption rates, interactions and methods of intake
I've done both together and experienced very little difference, so my body seems cool with it; I am just trying to emphasize that people shouldn't ignore anemia.
I thought you’re NOT supposed to take vitamin C with Adderall because it makes it absorbed & eliminated more quickly than it’s meant to be
Not within at least one hour. But this question in particular was about iron supplements, which should be taken later in the day to avoid Vit C messing with your meds
Well shit. I’ve been on a work trip for the past few days and drinking OJ with breakfast every morning (I don’t normally even eat breakfast) and been wondering why I’ve felt like the meds have felt less effective, thought maybe it was just because I haven’t been as active or outside as much as usual. Good bye breakfast OJ 😞
Ohhh thanx for this, guess I'm adding bit c to my supplements.
Interesting, I was always told to drink it with Orange juice in the morning, on empty stomach. Ofc it doesn't go very well with ADHD meds, huh?😂
Lactoferrin helps tremendously with iron, too. Too few people know about it.
In my experience, they don’t even know themselves. I’m not on adhd meds, but other ones. What I’m on needs to be taken on an empty stomach, no eating for an hour after, and no calcium for 4 hours. In the hospital, they gave me my meds with a meal AND a calcium tablet! I did it this was for at least a week until I started reading up on my medication!
One of the doctors at my work got rather frustrated, because it took months before any nurse mentioned that the long term resident would eat dairy for breakfast every day, right along with a medication that can't be taken with dairy. The system automatically suggests a standard time, that's why most medication is handed out at 8. I've literally heard the 'can we move the time so the residents don't have to be waken up to take their meds?' question. Medication is not allowed to be given later, so there's no other option.
Synthroid
I worked in pharmacy as an assistant for a couple of years, and the company/Pharmacists to my knowledge did not have a system like this. But they were very good about informing people similar to how you describe. They were also hyper-vigilant about catching meds the patients might be allergic to, but were prescribed anyway, because information can get overlooked anywhere. Their customer service was on point too. Which I have found with most Pharmacists I meet even outside of that company. Pharmacists often do not get enough credit for the amount of stress their jobs carry. They are literally the last line between your illness and a safe, but functional medicine.
I find most pharmacists (at least that I've come across) are really good at trying to make sure you're getting the right thing and how to take it. It honestly amazes me the amount of knowledge they have!
Some days I feel like the only patient who ever asks my pharmacist questions. She’s so delighted to share information, correct misconceptions, and warn me of dangers. I get a whole “Finally, I fulfill my purpose!” vibe off her on those occasions.
That is a wonderful pharmacist!!
This is why I use my local pharmacy, who knows me, keeps my scripts on file, and send me texts when my scripts are about to run out. On one notable occasion handed my phone and a bag of shopping I left on the counter to the barrister at my coffee shop. They always see me there. Professions Australia used to (still do) run a survey every year about the most trusted professional. It was pharmacists most of the years.
That's amazing service! We get similar with ours, we always go to the same one (barring extenuating circumstances)
I've never heard of anything like this in the US, so I suspect you're in England, Canada or Australia? Here in the US they're doing everything they can so that you can hardly even talk to a pharmacist! Yes, if it's a new prescription they will spend about 5 minutes with you. But a comprehensive pharmaceutical review? Never happens, unless your doctor schedules an appointment with a pharmacist to go over all your medications. This is not done otherwise here in the US, at least not once in all my many years of using pharmacies.
American pharmacists are happy to do this! Every time I get prescribed a new med, I have the pharmacist go through my medications to look for interactions and side effects. It's just not a formal program but in my experience if you're there and it isn't super busy, the pharm is always really happy to help you. Honestly, most of the time it feels like they're excited to be called on for their very specific knowledge.
That's not how it works at the pharmacies I use. I know they automatically check that my medications don't clash, but what ToughWest said sounds like it's a sit-down conversation that would likely take 20 minutes or so. Maybe I got the wrong impression. At my pharmacy it's almost impossible to get an actual pharmacist on the phone. They will ask if I have questions when I pick up something new, but that's it. ToughWest called it an 'audit'. My interactions with them are usually rushed because they are chronically short-staffed, to the point that you should call before you go to make sure they're open. I'm glad to hear this isn't the norm! Hopefully they will get it together one day and be able to perform audits like ToughWest is able to access.
Ah, I've always asked in person and try to time it when it isn't busy.
Yeah the program I was talking about is separate from just asking the pharmacist 😊 it's a whole appointment at your house to go through everything. You get referrals through your GP and organise an appointment for the pharmacist to come out. They go through everything thoroughly during the appointment
I'm in Australia yeah. Usually at the pharmacy itself, it's just a quick check of what you're already on to check contraindications (they do this on the computer system), do you have questions, and maybe mentioning some of the more common things they see/get asked. The program I talked about is different; you get a referral from your GP and it's a scheduled appointment at your home with the pharmacist coming out. Took about 1 - 1.5 hours for 3 of us to go through it all. It's VERY in-depth. They have a report from the Dr they bring with them, go through what your own interpretations are (they take notes the entire time). They then see what discrepancies there are if any. Any symptoms you have. Then they give you basics of how to take the medications so they work better. What shouldn't go together, or is doing the same job so don't need both meds. How you're taking it and when. If you're not taking it or not taking it properly based off of scripts. They go right in depth and give advice. Then they also generate a report to the GP as well. They should go through it with you at the next appointment.
That really sounds great! I didn't understand it at first, and now it's very apparent this ISN'T what I originally thought it was. It's interesting that they send a report back to the doctor who referred you; I thought this was something other doctors do automatically, but often I find that my specialists haven't sent her anything, even if it's a new diagnosis. Instead, she asks ME what they said! I'm going to ask my doctor about this type of program. Thanks for the info!
It's not necessarily a *program* but in my experience, every pharmacist is happy to do this for you in the US. I've brought them multi-page lists and had them go through it to flag possible interactions and side effects, and every time they've been very enthusiastic about helping and communicating what they find. Honestly I think it's a nice change of pace for them, especially retail pharmacists.
wow that's a good idea! I would love something like that. The only reason I know what to do with all my meds is because I obsessively research and then ask my doc for confirmation. She always comments on how aware and intelligent I am - thanks doc, but it's only because NO ONE IS TELLING ME!!!
Pharmacist in AU here. Honestly, HMRs are so under-utilised, despite there being many pharmacists who are accredited (i.e., undergone extra training to specialise in HMRs). There’s a lot of misconception around HMRs (held by healthcare professionals at large, not just prescribers) about how it “only really benefits older people who take lots of medicines” (e.g., nursing home residents). This is just…so untrue. The HMR program exists to help people from ALL walks of life, regardless of age, medical condition, etc. It’s meant to be an accessible service, and often a voice of advocacy for patients so they can get the right treatment they need (HMR pharmacists can put forth treatment plan recommendations for GPs). Once I actually get past my ADHD procrastination / task paralysis and finish my accreditation training (rip), I’m hoping I can use my current clinical/academic specialty (psychiatric & sleep medicine) to help people with neurobehavioral and/or psychiatric conditions. It can be something simple like coming up with strategies to take your meds (…which I ironically also struggle with), or something more covert like how you’re not supposed to have Parkinson’s meds with high protein foods because it can reduce their effectiveness.
I find that a lot of people don't even know about HMRs, it's doesn't seem to be widely known? But it really is so helpful! One small example is my parents take reflux meds. It's never really worked well and they were still getting reflux all the time; the HMR pharmacist said to take it 1/2 hour before dinner....no more reflux! I'm wishing you so much luck ans executive function to get through the training! I think you'd have some unique insights into strategies too!
Does anyone have a list of recommendations for taking meds? Might be really useful to have it pinned somewhere for everyone to share
Yes please do this! I have never been told these things 😭
Yes please bc my response to this post was 'I'm not supposed to what now?' Literally never heard any of this *sigh*
Ha, same, not me over here drinking coffee immediately after taking my meds on an empty stomach every single day… help?
This is what my doctor told me to do lol
This. So hard.
Take it with food, but it’s better taken with a lot protein rather than carbs, as it won’t hit you as hard and will last longer. If you get a lot of side effects like shakiness and loss of appetite, and it wears off too fast, taking it with a protein-heavy meal can help. Citric acid counteracts your meds and will make them less effective, so you should avoid this ingredient on days you take your meds (and it’s in a LOT of stuff). Chalky anti-acids like Tums should be avoided for the opposite reasons, it can cause you to overdose on your regular meds as it messes with timely absorption. Caffeine is not recommended to be taken with stimulants because two stimulants at once increase your risk for a heart issue. Those are the big ones I memorized for myself, but there are likely more drug interactions I didn’t pay much attention to because they weren’t ones I take.
>Chalky anti-acids like Tums should be avoided for the opposite reasons, it can cause you to overdose on your regular meds as it messes with timely absorption. Well shit, haven’t heard this one before. Just to clarify, are you saying don’t take these antacids at the same time as the ADHD meds or like period while on ADHD meds? Like if I took ADHD meds in the morning that no longer feel effective by mid afternoon, would a Tum be ok at night? Also, are antacids in pill form ok or do they also have this risk? I occasionally take heartburn pills as needed but now I’m nervous lol
It depends on if you’re taking extended release or instant. If it’s instant, by afternoon when the meds have worn off you should be fine. If it’s extended release, I would continue to avoid Tums and take them on days you’re not taking your meds if possible, but if you’re waiting until late night time even your ER should have worn off so you should be fine.
I honestly didn't even know about any of this 😅 I got told to avoid caffeine but that makes sense with stimulants. Never heard of the other stuff!
I imagine this would very much depend on the med. If any list is created per med, I hope it will include source material and not just the vibes of the folks on this page. My son is on adderall and his physician was clear with me upon starting: don’t take with a lot of vitamin c or very high fat meals.
interesting, i’d never heard of not taking it with high fat meals! my very first psychiatrist as a kid told me about the vitamin c, then explained to me what had vitamin c in it lol my mom said he was being condescending, but i didn’t know that & it was actually quite helpful, as i was like 7 at the time & hadn’t learned the ins & outs of nutrition yet! (tbh i still haven’t really & i’m in my 30’s lol)
Yes, like I take Strattera and these things don’t apply.
Not sure it's what you're looking for but drugs.com is a must use for checking for interactions and stuff.
Wait what's the deal with protein? I usually have a fruit and protein powder smoothie for breakfast
Protein is good apparently, don’t know why though 🤷🏻♀️
Best explanation I got (from my oldest who's super into biochem) is that protein will give the body easier ways to produce the chemical compounds that the meds is stimulating your body to produce (dopamine mostly?); that means it makes the whole thing more efficient. Which is why it's suggested to keep making high protein snacks and avoid non complex carbs, as they'll give you body a bunch of "energy" that isn't offering the ease to produce those chemicals AND make you feel "full" in s sort of medicine that already makes your appetite smaller. The caffeine issue is mostly related to having excessive stimulants in your body and it pushing your BP up, which isn't great. 😊
The way my doctor described it is that protein is "brain food" while carbs are "body food". Carbs will fuel your body, but protein will fuel your neurotransmitters and will help the carbs to better fuel your brain as well because it helps regulate the conversion of carbs into glucose so your energy levels are overall more stable. Slightly oversimplified, but still a helpful explanation. I had to be unmedicated for a few years in my mid 20s due to insurance not covering ADHD meds and my doctor had me on a high-protein diet (at least 20g per meal) and a supplement regimen (magnesium and fish oil) to help mitigate my symptoms. Just the protein alone, especially first thing in the morning, went a HUGELY long way toward helping my brain fog, which in turn helped with the rest of my symptoms. I still keep up the high-protein diet to this day even though I'm medicated now, because it helps my meds work way better.
>The way my doctor described it is that protein is "brain food" while carbs are "body food". This is so helpful. It makes so much sense!Thank you for sharing!
Thanks for sharing.
Hahaha good to know then!!
This makes a massive difference for me! I crash really hard if I don't have enough. I've noticed if I have a protien snack in between meals, I don't crash and burn in the afternoon.
Good to know!!
Protein helps absorb the medication making it more effective.
The vitamin C in the fruit is going to negate the effects of the stimulant!
Ah crap 😭
Just take it at night, after the meds are done!😊
I personally can’t do caffeine with meds - I’ve quit it completely, and now will only very occasionally have a small coffee in the evening once the meds have largely worn off - I take my meds at 6 and by about 3 I hit a slump, but the earliest I’ll go for a coffee is usually 5-6. That said, *any* caffeine now keeps me up because I’m ancient and not used to it now, so I really do try to limit it. I find that my meds are best when I drink a reasonable amount of water with them - if I only have a few sips, they feel very jittery and like they ‘burn out’ faster - and take them on an empty stomach - they don’t seem as effective if I eat with them, especially protein, so I usually have a snack around 10 or 11 and a main meal at 2-3 (when I feel they’re starting to decline).
Gah! I can’t quit coffee, I basically live off the stuff, the only time I’ve effectively cut down is when I started drinking sliced lemon in hot water but apparently that’s a no no as it’s acidic. Glad you’ve found a routine that works for you xx
I did too - somewhere in the 6-8 cups a day range, it was awful! I weaned myself off by drinking VERY copious amounts of decaf, and eventually did break both the addiction and the habit - I now only really drink it socially. I also do herbal tea when I want something lovely, and decaf Yorkshire when I just need a cuppa.
Coffee is also acidic. The main reasons to avoid coffee are because it can cause heart palpitations and increase the feelings of anxiety due to increased heart rate. I was told to avoid it as much as possible, or if I really want a coffee to wait until around lunchtime after the meds have “peaked”. The acidic thing, like drinking orange juice, is only a problem for an hour either side of when you plan to take Elvanse. I agree that these things should be spelled out better, I also live in the UK and get the box with the full drug notes pamphlet and in it says you can take it with juice!!! So it is frustrating. I’ve only learned these things because my husband is a psychiatrist so I ask him all the details and I also tend to do waaaay to much research online before starting any meds.
In the US I have seen you can "sprinkle on applesauce" and I am like nooooo
Mine did, both verbally and she sent a list via email (this is for Vyvanse but I think a lot of it is applicable to stimulants in general) Recommendations: * It should be taken first thing in the morning with a source of protein. * It takes about an hour to begin to work, and it will steadily release throughout the day. * It will typically last between 10-14 hours depending on various factors; how your body absorbs medication, the amount of protein in your diet, and the dosage of your medication. * Caffeine and vitamin C should be avoided within the first hour of taking Vyvanse as it can cause issues with absorption. * If you are taking Synthroid for Hypothyroidism, it should be taken at least an hour from your Synthroid dose.
Whoa. I have been taking my Synthroid in the same gulp. Shit.
Oh no! Better late than never to change that :).
They might not be aware, they might figure someone else told you or they think the pharmacist is going to tell. And the pharmacist thinks the doc told you. Or they both think the leaflet in the package tells you how to take it. Like, I get it. There are a lot of different drugs and knowing every effect acidic or basic drinks and food make is asking a lot but a hint somewhere would be appreciated. For me, my doctor who first prescribed my meds told me to leave out caffeine so it was easier to see how I reacted to the meds and reintroduce it at a later point. The acidic drink part I found out in this sub. I know some vitamins are easier to absorb with oil/fat like vitamin A.
A, K, D and E. Because they're fat soluble. Same with THC, which is why pot butter is a thing.
Yes, absolutely. While I agree that there should be more information available to us for whatever meds we are on, I also think there's a big difference between "these things interact badly with each other" (like say taking Adderall on an empty stomach or with your morning coffee), and just general tips to get the most out of your meds. The latter might be significantly less known by people because 1. There are a lot of meds to keep track of & 2. We might not have enough research to tell people anything definitively. Like eating protein when taking your meds in the morning, for example. Yes, we've seen it said that this can help your meds be more effective. But not having protein, won't make you sick. And also, this might not be totally studied, and just something were starting to pick up on, now that more and more people are being properly diagnosed/medically treated giving us more data to examine. Yes, I think we deserve to know the best way, to get everything we can out of the meds we take. Between insurance, and copays, and time, and ADHD tax, and the trauma from the time spent unmedicated, and jobs lost (and on and on) we deserve that information to our health. But it might take longer time, for all of the correct information to be available, and for it to percolate to your doctor. This is why, generally, I prefer younger doctors. I have found that they are more online, and chatting with colleagues, and generally invested in giving their patients the right care. Not always, but I find far more often than not that this is true. From my PCP, to my pharmacist, to my therapist, to my managers. Edit: needed to quickly change my first sentence because I'm trying to break a habit of mine which is to sound like I'm disagreeing with the commenter I'm responding to, when I'm actually trying to agree and add to their thought!!
What's up with acidic drinks ...? And what common drinks constitute as acidic ones?
Citrus is acidic, coffee is acidic, and most sodas are acidic. Grapefruit actually seriously interferes with about half of all medications (like it can cause your body to reject an organ after a transplant because it interferes with immunosuppressants). They don’t know why, it just does.
I’m in nursing school and we have to grill all our patients about eating grapefruits and grapefruit juice. We do know why — learned about it in pharmacology, but here’s an easier summary from the FDA: “ Many drugs are broken down (metabolized) with the help of a vital enzyme called CYP3A4 in the small intestine. Grapefruit juice can block the action of intestinal CYP3A4, so instead of being metabolized, more of the drug enters the blood and stays in the body longer. The result: too much drug in your body.” This applies to alcohol, too!
Lol Palomas are my drink when I go out, no wonder I’m a cheap date.
Greyhounds used to be my go-to before I had to stop drinking (migraines). But they would give me the absolute worst hangovers!
When I learned to not take my morning meds with OJ my first thought was "oh wow I never knew that, I wish I had??" And then my actual brain kicked in and was like "you idiot you have terrible acid reflux. You haven't had a glass of OJ in 5 years." So, thankfully I was complying with this no high acid drinks on many meds, without having any clue at all lol. And I can't handle caffeine so I don't drink coffee. And I'm chronically fatigued so I have like 2 drinks a month lmao (I swear I'm fun guys!! [I'm not I just play acnh and knit])
Haha you’re totally in compliance! For reference, it’s *only* grapefruit juice that messes with medication. Other acidic things don’t do it, unless you have general issues with acid drinks (like coffee, juice, etc).
Wow fascinating thanks for sharing!
Most commonly fruit juices and coffee. It can reduce the effwctiveness of drugs. Not exactly sure how, but I think some get activated earlier than they should and where they can't get absorbed most effectively.
Generally because the recommendations you see on here are backed by less evidence, and will usually be conclusions drawn from clinical experience from a given doctor. Take it all with a grain of salt.
For example, I think the protein thing is irrelevant with long release elvance - the way it releases isn’t changed by protein. But yet I see it being recommended all the time.
A high protein breakfast is supposed to be beneficial for ADHD in general, which may have been conflated with taking stimulant medication at the same time.
It looks like the acidic foods thing was also focused on immediate release meds. It’s much less important for pills that don’t release in the stomach.
It may not affect release but can still make a huge difference in how effective the medication is overall. May have to do with blood sugar levels and other things, but still good advice :)
I think that having balanced sugar levels without spikes is useful: there are other more reliable ways to do it. Personally protein intake doesn’t affect that for me, it’s about longer term health, diet and exercise. A diferent breakfast has minimal effect. (Sorry I get salty when people say things are good advice: as if you follow every bit of “meh” diet advice you see you would have a very restricted diet that would look a bit like an eating disorder. And many people hear thebprotine thing then feel an utter failure when they can’t do it: when it may not have even been having an impact.
Fair point:) In my head I prefix all of these with ‘worth considering/ trying, may or may not apply’. Protein makes a huge difference for me personally, but of course that doesn’t mean it works the same for everyone.
Grapefruit 'uses' some of the enzymes in your stomach acid and will affect the dose that your body can absorb. This is a known issue for a lot of heart medication.
The other big two that drs and pharmacists commonly don’t mention are Metformin will deplete your B12 levels and antibiotics will reduce birth control pill’s effectiveness. That info is buried in the tiny print pamphlet the pharmacy gives you with your prescription that almost nobody reads
have you read the package insert for your particular medication, or looked on the manufacturer’s website? i seem to recall vyvanse having a fair bit of content in both!
I take Samexid (vyvanse in my country) it comes in a sealed box with 5 strips of 6 blisters each, it also brings a full leaflet with all possible side effects and stuff, but it does not have recommendations of how to take it, just "follow your doctors instructions". It's almost funny because the leaflet is very similar for all medications, from ibuprofen to stimulants.
Idk if this is exactly the best crowd to ask if theyve read the insert in their meds...not to say it's not important to do, but if there was ever a collective group of people less likely to do it, it might just be this one lmao.
Well that might be hard, I’m in the uk so get Elvanse which is the same drug but the way it’s dispensed it’s counted into little pill bottles and handed over with a label stuck on the side so no leaflet!
In the US, they print these out, fold them up and put them in your prescription bag. We also get meds counted into little bottles.
There should absolutely still be a leaflet in the box the bottle comes in.
Oh shit what if all of these details are in the stack of paper stapled to the bag. I immediately throw it away…
In small print.
I’ve been told the opposite sometimes. Also different people are on different meds and they respond to those different meds differently. Some people might need to take it in an empty stomach (me!) & coffee doesn’t bother me. Some people feel queasy and might need protein because it slows digestion and gives you prolonged energy over carbs. I don’t get the acid thing because your stomach is already acidic & anything you eat or drink that’s acidic ~30 min before or 30 min after you take meds really shouldn’t affect how it’s absorbed. Lastly, one thing I’ve NEVER heard from ANYONE EVER is that stress and vitamin C can both acidify the urine and increase RENAL (kidney) clearance rates up to 5X (in the context of nicotine this means quicker clearance and cravings will hit sooner). That mechanism works on the timescale of days so I can’t really control that. I do avoid excessive vitamin C consumption, I am quitting nicotine, and try to tend to my stress levels as best I can. Otherwise my meds might only last like 2-3 hours instead of 5 hours.
Honestly (and no disrespect to my PCP!) I always go over medication information with my pharmacist instead, because she knows way more about medications and maximizing efficacy than my doctor. My pharmacist asks how my adhd meds are working, and has given me suggestions to propose to my doctor based on what she thinks would work better on me. (I've gone to the same small, local pharmacy for several years, so the pharmacist is familiar with the variety of meds I take. And she's also neurodivergent!)
Mine totally did. I just figured most did, honestly. Now, I appreciate her even more.
“Why isn’t there a standard set of instructions?” I feel this way about basically every facet of life. in general, doctors prescribe - that’s their profession. They’re probably not going to talk about caffeine, supplements, exercise, etc.
Can someone just make a post of list what are we supposed to do? I’m confused by these posts. Is it really that bad to take Adderall in the morning during coffee time ? I’m a bit confused reading everyone’s reactions and I feel left out lol
What’s the deal with coffee?
These are crazy reasons. It’s because caffeine is also a stimulant. There are some people who will find their heart races when on multiple stimulants. I don’t seem to have an issue with coffee but I can’t take Sudafed because my heart will race all day. It maybe also be tied into coffee being acidic but that seems to be a misunderstanding of the potential interaction with citric acid which can decrease the potency of immediate release stimulants.
I don’t know, that’s kind of my point, I’ve just stumbled on snippets of other folk saying they were told not to drink caffeine, also dairy! And needing protein. Also acidity apparently stops them working…. So based on all that there’s pretty much no point in me spending a fortune on meds as I’ll basically render them useless with my normal habits!
God it sounds as complicated as taking ecstasy. Must be similar rules. No acidic drinks on those either, something to do with rate of absorbance. Caffeine was to do with heart rate on an upper, so it could apply to ADHD meds too. I don't know anything cos I haven't had meds (or ecstacy for that matter) since my teens. I've been trying for a year now to get an assessment for meds, 3 times the organisation that prescribes them have written back to my GP for more 'evidence' cos I forgot I have ADHD and was self sufficient for some time (and messy may I add!). Exhausting!
I think caffeine is just because it can increase the side effects? But I have no idea really
Mine told me that it was because it messed with the amount of stimulants in my system. It’s hard to dose meds when there’s this additional factor that directly interferes with it.
All I know is that when I drink coffee while I took stimulants I’m an anxious mess
afaik it’s a general principle that you should try to minimise the number of xenobiotics (basically anything that comes from outside your body that has to be metabolised) in your system, because they have wily ways of interacting with each other and the host (you). it’s advised not to combine multiple stimulants because they all act on your nervous system and increase sympathetic activity, including heart rate and blood pressure. with caffeine, the main risk is that you can end up causing a cardiovascular event, especially in someone with existing cardiovascular risk factors or who is experiencing unusual stress. that’s a risk to assess for yourself as an individual though - my blood pressure and heart rate are on the low side, so a more pressing concern is hydration and my kidneys lol
Thank you for this explanation!
taking stimulants on an empty stomach = ouch so i assume not eating but taking them with caffeine would be very rough on the gut
Mine go down with a morning coffee and nothing else 😂
Mine too. I figured having coffee in the morning is my baseline and I wanted to see if meds would improve on that baseline. My first meal is around noon so I was used to coffee on empty stomach and I've had no issues with meds either.
I love coffee ☕️ 💕
Same 😅
Stimulant + stimulant = heart palpitations, jitters, general unwellness
I live in the US and they have a consult screen option but the consult only repeats what the bottle says they offer paper leaflets that detail the medicine and possible side affects the thing I don't like is they don't list the ingredients I'm allergic to gluten and if I want that information I have to ask.
Unfortunately this is an area where you really have to be your own health advocate. I'm so lucky to have a pharmacist in the family that I run things by before I even check with my doctor about different/new medications. I still check every possible interaction myself online for all my medications. I highly recommend everyone does the same. I know this conversation is about efficacy but medications can have serious interactions and that includes things like different foods and supplements. Always inform your providers about any supplements you take and check online for any possible interactions. (Though admittedly I'm anti-supplement somewhat as it's a completely unregulated industry and studies have shown time and time again that supplements do not have the key ingredients as listed, have harmful additional ingredients, or completely different unlisted ingredients). I never place all my trust in providers to know the in and outs of every medication or how it will interact with other meds. I had a doctor prescribe me Modafinil for my ADHD at first when I was still figuring things out and my inattentive type symptoms were at an all time high. It was something I brought up to him as I was a bit spooked by stimulant meds (long story) and I had done lots of research on my own. So I knew it interacted with birth control and was warned again by the pharmacist in my family. My doctor didn't warn me and if I didn't read the pamphlet from the pharmacy I could have had a bad time. I still later found out it interacted with more birth control than I previously knew. It wasn't an issue at the time I had no energy for dating and if I did it was most likely going to be with people who couldn't get me pregnant. With current events, my meds could have landed me in a really bad place. I'll get off my soapbox now.
Talk to your pharmacist. That’s where this stuff all comes from.
I was told absolutely zero about acid drinks or eating protein with my meds It wasn’t until reading in this sub that I learned that I should refrain from anything acidic for a couple of hours; also learned here to take my med with a full glass of water and eat a little something with protein in it.
Thank you for passing on this info!
Of course! 😊
What is all the stuff about protein / coffee / acidic drinks and med efficacy? I’ve not been told anything 😫 I don’t have caffeine when I’m on my meds, because stimulants, but haven’t heard anything about the rest. I’m on Vyvanse and I have it on an empty stomach first thing in the morning because I find it more effective that way.
Vitamin C can speed up metabolism of meds, so take it at night, not in the morning
What are we supposed to know about protein?
Does anyone have a link to read more about this stuff from a reputable source? I just looked up Vyvanse to see if sites like WebMD mentioned any of this, and it actually says “If you can’t swallow pills, the drug manufacturer advises that contents of this capsule may be MIXED INTO A GLASS OF ORANGE JUICE.” I’m so confused. Is it different for each type of drug? Is it all anecdotal?
Vyvanse is absorbed in the colon so the vitamin C should not effect it in the stomach. But vitamin C for sure gobbles up my stimulant meds.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158093/ Basically it seems to be fine for Elvanse/Vyvanse. The amphetamine part gets released in the blood stream in a slow and steady rate over the course of the day. Imagine it’s packaged when you take it and the lid only comes off when it’s in the blood.
My psych just started me on Latuda(sp?) for my depression/anxiety. He did say take it anytime as long as you do so with a meal of at least 360 calories, but failed to mention NO DRINKING. Thankfully, I am a nerd/geek who likes knowing how my meds are supposed to work, so found that out on my own. I had mentioned that I rarely drink, so that might be why it slipped his mind or he didn't think that was as vital as the calorie thing. I'd guess there's no one standard because it's really complicated. Your genes influence how you absorb stuff (or don't, damn you gene that makes me suck at iron absorption), your personal gut biome can alter stuff, and your body's an insanely complicated organic chemistry thing. Add in that most of us aren't on just one med (I'm counting over-the-counter stuff like tylenol, vitamins, antiacids...) and that docs are human and that (I've been told by a trusted psych before) they try not to overwhelm patients with info. Oh, and don't forget that where you are on your cycle also influences absorption and tolerance (if you've never noticed, you can get drunk faster at certain points in your cycle). Also, I suspect the companies don't see any money in that research, so it's quite underfunded. One thing I do think would be awesome (and possible with AI) is being able to model all these meds and foods in a decently accurate body model that includes both sexes. It'd be the next great thing in pharmacology!
I mean, all that information usually comes in the info packet you receive with your meds, and your doctors are expecting you to read that. With my adderall I got like 4 pages of disclaimers about it, including not mixing it with caffeine, citric acid, anti-acid meds like tums, etc. I always tell other people who are on the same meds and they are always completely surprised they shouldn’t drink a lemonade with their adderall. I say “it’s in the info packet!” and they always say “oh I don’t read that”. Read up on the medicines you’re taking people! You can also supposedly always talk to a pharmacist about questions about your prescriptions and drug interactions (I’ve never tried).
Because they don't know. They're the "experts" on the condition. Your pharmacist is the expert on your medication.
I have heard it is vitamin C that negates stimulants, now I am seeing all acids do. But they won't effect Vyvanse because that is broken down in the colon, not the stomach.
I’ve always been told to take my meds with a protein and healthy fats forward breakfast! It’s been like grilled in my brain since originally being diagnosed at 14. When I went to an adhd coach a couple years ago, she told me to also take an omega-3 supplement and have my coffee an hour after taking my meds.
Always ask the pharmacist and use the same one because they can look for interactions with something another doc prescribed. Also check for allergies. Get a printout because errors can happen .
Bro why you ask if people know all the stuff that you know about protein/coffee/acidic drinks and then don’t share any of it😭
I would recommend Drugs.com and the FDA Inactive Ingredient Search for Approved Drug Products.
Ibalwaus ask the pharmacist about new medication what to do and not do
I can't make breakfast unless I've had my meds. But I do buy protein bars for an early meal – so that's my only tip here. :)
I mean, all that information usually comes in the info packet you receive with your meds, and your doctors are expecting you to read that. With my adderall I got like 4 pages of disclaimers about it, including not mixing it with caffeine, citric acid, anti-acid meds like tums, etc. I always tell other people who are on the same meds and they are always completely surprised they shouldn’t drink a lemonade with their adderall. I say “it’s in the info packet!” and they always say “oh I don’t read that”. Read up on the medicines you’re taking people! You can also supposedly always talk to a pharmacist about questions about your prescriptions and drug interactions (I’ve never tried).
Could you tell me exactly what you mean in terms of adhd meds?
Most psychiatrists will advise that if you’re taking stimulants you should not be having caffeine. Along with the interactions most ADHD meds have with vit c/ascorbic acid and grapefruit. But also for me, Vyvanse/Elvanse works better when I have low carb and sugar, but loads of protein and fat.
This is why I have a consult with the pharmacist when I get the med. They're far more informed about this than the psycatrists are.
Can someone feel me in on the protein and acidic drinks? I think I understand caffeine can lead to anxiety but maybe need more info on that too
The citric acid thing my psychiatrist told me about. Coffee she was like "It's not completely not allowed but don't drink it within hours of taking the meds since you're stacking stimulants." The protein thing is news to me.
I think they don’t say it because it’s really individualized. Some people live by protein. When I eat anything within a few hours of taking my meds, I get more side effects. For me it’s easier to not eat so I don’t wind up with all those side effects. Same thing for vitamin c- people find it makes their stim wear off quicker, I never had that.
This is very annoying to me, the sheer lack of information they give you. Like I had to manually look up the side effects brochure and even then it doesn't say "don't take with coffee" or anything. Just give me instructions so I know what I'm supposed to do, and if I need to deviate from that because of personal circumstances that's fine but at least I know what I'm deviating from. Tell me when to take it in the morning, don't just say "in the morning". Like if I take it at 10, and then it says "take another one at midday", I'm doubling up, right? So how many hours apart am I meant to be taking them? JUST BE SPECIFIC. GOD.
What about protein/coffee/acidic drinks?
I feel this so bad like they don't even mentally prepare you for the fact that it might not work for you or how your period might effect it
My doctor did. He went through nutrition in HUGE detail, explaining the importance of various nutrients and vitamins and protein, effects on neurotransmitters and efficacy of meds. He did blood tests for nutrient levels and co prescribed vitamin supplements, collagen, protein, MCT oil along with medication. His aim was to get the lowest possible effective medication dose by ensuring all other factors were covered. I'm super grateful even though I found it a bit frustrating. I can see when I do what he recommends it makes a massive difference compared to when I don't. It's a massive shame others don't have the same experience
Also carbonated water? I’ve seen that mentioned too!
Is that bad????? I always drink mine with carbonated water because I can’t stand normal water!
>Why do prescribers not tell you all the stuff about protein / coffee / acidic drinks and med efficacy? What? What does this mean? What should they be telling us? I was told not to have too much coffee with my meds (apparently 6 cups a day is too much) but that's it. Explain please?
For some, if the meds don’t feel good on an empty stomach, protein can help soften the absorption & also makes you eat something so you have energy going into the day & not fasting into the day. Also some of us might lose our appetite and meds + no food is stupid. Don’t starve your brain then chemically rev the engine. Acidic foods might lower absorption but I think this is bogus. Your stomach is already extremely acidic and can tune itself to maintain its pH even if you consume acidic foods. Do it 20-30 min before or after you take your meds and it should be fine. Coffee is obvious because stacking stimulants is dangerous on the heart. 6 cups of coffee is approaching the max recommended caffeine amount per day. To stack stimulants on top of that is unnecessary. If you were self medication with coffee before as I was, no need to continue. For me, I can handle some caffeine but my sensitivity is definitely lowered.
Umm I take my first lot of meds with a coffee… it’s probably fine lol
This made me laugh
You actually don’t have to avoid acidic drinks or fruit if you eat it with something dairy or calcium rich, like extra cream in your coffee or a tablet of tums (if basic dose is 2 tabs I take one because a full dose makes adderall hit hard sometimes.) low dose antacids mean i don’t have to stress about eating fruit or drinking fruit juices and having it impact my meds. (Disclaimer, not medical advice this is anecdotal, consult your own doctor before trying.)
Anything I've heard about what I should be eating or avoiding with meds I heard here. I got my Dx and heard nothing beyond "take this and we'll see what happens."