When Did Ritalin Become A Fda Approved

[ramakentesh]

http://en.wikipedia.org/wiki/Methylphenidate

[MamaTrain]

I am shocked to see that is suggested for POTS! It was Ritalin that set this whole dysautonomia off for me....very odd!

[prettyinpink]

ritalin and adderall are both very strong vasoconstrictors plus the cns stimulant part can be a huge help with brain fog/concentration etc. I take adderall strictly for POTS and I don't know what i'd do without it. I didn't know about the fda approval for ritalin though.

[worththewords]

Very interesting although I would like to read it on a different site than Wikipedia since anyone can add information to that site.

[kayjay]

ritalin and adderall are both very strong vasoconstrictors plus the cns stimulant part can be a huge help with brain fog/concentration etc. I take adderall strictly for POTS and I don't know what i'd do without it. I didn't know about the fda approval for ritalin though.

Pink- what kind of pots do you have? Are you hyperaderngenic? I want to ask my dr about this next week.

Thanks

[prettyinpink]

I'm not hyperandregic. Mine secondary to my type 1 diabetes and peripheral neuropathy. I don't know enough about using ritalin/adderall to be able to tell you if its used primarily in any one type of POTS. I know its not just because of my neuropathy though because I know other people with POTS that use it or tried it. You might need to be careful about how you bring up the possibility of trying it to your dr because it is a carefully regulated schedule II drug.

[scarfgirl]

Adderall was awesome for me physically! I could do stuff I never could before. Sadly, it also made me want to kill myself (ironic huh?) so I stopped taking it. Would like to talk to my doctor about trying it again....maybe just on bad brain fog days instead of every day?

Prettyinpink, do you have any addiction problems with it?

[MightyMouse]

It's not odd at all that it's approved to treat POTS. Many docs try POTS patients on coffee first, or on other stimulants b/c they work similarly.

Nina

[prettyinpink]

I would probably have problems to it if i decided to stop suddenly. My body might be addicted and I would just need to go off of it slowly to prevent a dangerous physical crash. I've been taking the same dose for a while now and I never feel like I need to take more if thats what you mean by addiction. I don't feel like i'm taking a stimulant actually. I'm sensitive to caffeine so i know that jittery hyper feeling from stimulants. With adderall I just feel more awake and able to focus/read/pay attention; almost but not quite back to my pre-POTS self. I know some people that do just take it some days but because i use it for its vasocontrictive properties I can't take it sometimes and not others because it would really throw my POTS out of whack.

[juliegee]

My son does well with Concerta, another stimulant type drug. Technically, he has NMH, not POTS. He leans towards bradycardia, but certainly has tachy prior to a faint or near-faint. He is addicted to the vasoconstriction & feels quite lightheaded without it. It also helps with cognitive issues that are secondary to his illness.

I see why Rama is surprised. In POTS, patients deal with tachy. Weird to be given stimulants that INCREASE that?!? A conundrum to be sure, but t works for many. Remember ritalin was originally designed to treat hyperactivity- another conundrum. One would guess that hyperactive patients would benefit from a sedative.

[Notgivinup]

I was told I had the H- form of POTS. My norepinephrine was 987-ish., can't recall exact number now.

I tried adderall. I liked it, but after about a week or so I started getting tight muscles in my neck and shoulders. And I had lots of big knots. One of the side effects could be muscle tightness. Although when I told my GP about this, he acted surprised. Like he'd never heard of that before.

I wish I could of taken it though, it did help with energy. It did not, however seem to help my brain fog at all. Strange.

[ramakentesh]

Sorry i just thought it was odd that this drug is approved yet the only other medication that has received approval is midodrine - all others (beta blockers, mestonin, florinef, etc) are off label.

its interest that it helps in hyper patients assuming it does - you would think it would be paradoxical unless you prescribe to the distal hypersensitivity concept.

For other patients it makes perfect sense - the peripheral poolers and MHS sufferers.

Hyper is so much more paradoxical.

[prettyinpink]

well in some POTS-i think especially those that have hypotension with standing such as myself there tachycardia is a compensatory mechanism to try to raise the bloodpressure. By taking the adderall which constricts my veins, my bloodpressure is higher and my heart rate is lower because its not trying to keep my pressure up. Tachycardia is a side effect but is a "lesser side effect" and so even if you do have it as a side effect it seems like the amount it decreases your high heart rate with standing would be much more significant then the amount it could increase. But different medicines have different degrees of effectiveness and usefullness. I know 2 girls with POTS that tried adderall and couldn't tolerate the side effects. But i don't know enough about how it all works, I tried to some research and then got tired.

"Ritalin will increase the brain's ability to inhibit itself. This allows the brain to focus on the right thing at the right time, and to be less distracted, and less impulsive. Ritalin will increase the "signal to noise ratio" in the brain." I found this on a website. There are scientific reasons why ritalin and other cns stimulant meds work for some people with adhd. I usually look up the mechanisms for how a medicine works before I take it so I know whats going on in my body and its usually not too hard to find online. I found this article online, maybe its helpful?

http://www.ocweekly.com/2008-08-28/news/th...in-on-adderall/

Oh I take adderall in the morning and around 1pm occasionally I have forgotten to take my 1pm dose until it was 3pm and so I had to skip the dose so I would be able to sleep at night. I didn't have any problems missing one dose although I did take extra midodrine/proamitine to help with the vasoconstriction. I also take extended release so I don't have a big jolt after i take it or a crash when it wears off.

[prettyinpink]

this was an a university of cincinnati hospital ask an expert page. this response is from an md.

http://www.netwellness.org/question.cfm/52818.htm

A guy said he noticed his hr was 10-25 bpm faster then normal depending on the time of day.

The Dr's Response: The increased rate effect you have noticed happens with most people who start a stimulant. Many people will have less of an increase in their pulse after taking the stimulant many months but their pulse is still usually at least a few points higher than prior to using stimulants. There is usually noting to be concerned about as long as the increased pulse is not making you uncomfortable (physically or in terms of anxiety) and is not associated with breathing problems, sudden sweating, dizziness or chest pain.

[yogini]

I was really surprised when I saw this post, b/c I think few, if any, drugs are FDA approved for POTS. Unforutnately, drug cos don't have much of an incentive to spend the time and money getting approval for such a rare, little known condition. I believe most of the treatments in the US are off-label, meaning docs prescribe them for POTS even though they were FDA approved for something else.

Wikipedia can be hit or miss b/c anyone can go on there and edit info... so I checked the website of Novartis, the mrfr of Ritalin. Ritalin is FDA approved for ADHD. It doesn't say anything about dysautonomia.

http://www.pharma.us.novartis.com/products/index.jsp

Setting aside the technicality of FDA approval, people with POTS can sometimes benefit from ADHD meds. The Dinet site mentions Ritalin under "What helps".

Edited December 12, 2009 by yogini

[Kitsakatsa]

I've tried both and the thing is for POTS patients, that those and provigil just bring you up to more normal brain activity.

Ritalin helped but made me secretly mad at EVERYONE. I would get really quite on people and I everyone was irritating as ****. It was the opposite reaction of Percocet- the drug that makes me want to hug everyone and follow them around. I had to be careful with Rit to not blow up at work. It was like eggshells.

Adderall has been phenomenal for me. It is actually a schedule I- extremely addictive. Sometimes I forget to take in on weekends though and I don't notice anything. I'm on 60mg/day. After I started taking it, I noticed that I could work longer hours without getting so sick. My house is scary organized. I won the window office at work and took on extra projects. Now I'm being recruited for a job that will pay almost double what I'm now making by one of the highest Directors in the Corporation. It has really paid off for me- and now its generic so its cheap! It not only takes away the brain fog, but it pulls you out of your POTS misery a bit and gives you mad concentration.

It is a college abuse drug though so I worry that it will be banned in the future due to the street value and abuse potential of it. If you can't take Adderall, I would take Provigil. It helps to break the grogginess of compazine.

Kits

[flop]

I can't be sure but I think the information on the Wikipedia page is wrong. In the DINET documentary that has recently been released one of the doctors says that there are no FDA approved drugs for POTS but that doctors prescribe drugs that were FDA approved for other conditions. For example Florinef / Fludrocortisone is FDA approved for Addison's disease but is commonly prescribed "off-label" for POTS. They also said that there isn't even a medical condition code for POTS. (I think that I am remembering correctly but please do correct me if my memory has messed up).

The problem is that obtaining FDA approval (or similar in other countries) is a lengthy and very expensive process. A pharmaceutical company will only spend that money if the new approval will bring them lots of new prescriptions (ie make them a large profit). As POTS is relatively rare they would never make enough money back to cover the expense of the FDA approval process. The pharmaceutical companies rely on doctors taking the risk of prescribing off-label.

Flop

[prettyinpink]

I can't be sure but I think the information on the Wikipedia page is wrong. In the DINET documentary that has recently been released one of the doctors says that there are no FDA approved drugs for POTS but that doctors prescribe drugs that were FDA approved for other conditions. For example Florinef / Fludrocortisone is FDA approved for Addison's disease but is commonly prescribed "off-label" for POTS. They also said that there isn't even a medical condition code for POTS. (I think that I am remembering correctly but please do correct me if my memory has messed up).

The problem is that obtaining FDA approval (or similar in other countries) is a lengthy and very expensive process. A pharmaceutical company will only spend that money if the new approval will bring them lots of new prescriptions (ie make them a large profit). As POTS is relatively rare they would never make enough money back to cover the expense of the FDA approval process. The pharmaceutical companies rely on doctors taking the risk of prescribing off-label.

Flop

I'm soooooo jealous you have live in the uk and have access to ivabradine. I would really like to try that medicine for my tachycardia but its not fda approved in the us

[ramakentesh]

I think Flop is right - at least that is what i thought was the status quo until I read that recently.

It was the opposite reaction of Percocet- the drug that makes me want to hug everyone and follow them around

Sounds like fun LOL.

[jesse1919]

Get it from the horse's mouth as they say....

http://www.fda.gov/downloads/Drugs/DrugSafety/ucm089090.pdf

"RITALIN? is a central nervous system stimulant prescription

medicine. It is used for the treatment of Attention-Deficit

Hyperactivity Disorder(ADHD)."

That's it, only ADHD.

It's an interesting idea though. I tried a beta blocker- definitely bad. So maybe we need the a stimulant or beta agonist?

[erik]

I don't see "FDA approval" mentioned in the wikipedia article, just "approved". I hadn't personally heard of any FDA approval for anything to do with POTS (but haven't done exhaustive search or anything), just heard fludrocortisone is approved for OH & OI, and maybe mestinon for similar recently added (but not sure). You see, POTS does not exist. It is only in my head. You all are only in my head!!! (Sorry, just a little synaptic overflow episode there, I'm back now

Stimulants are in various lists of things to try for POTS, OI, OH, NMH, etc. The "pressor" effect should be something akin to midodrine or other alpha-agonist. Sometimes, if you help the basic process of handling orthostatic stress, you can actually mitigate the need for subsequent "body panic" via sympathetic overactivity (despite the drug itself generally contributing to "sympathetic activation"). It might be informative to consider that the vascular beta-receptor complex is special in that it is supposed to inhibit it's own firing when activated in certain ways. That's a fine line of course, and semi-paradoxical. Stimulants are generally DNRI as well as direct agonists of both (which is what makes them extra potent). It is also handy that they are temporary, meaning like midodrine they can be timed with "uprightness" and "activity". Slower and more general "activators" can be problematic in those regards, like potentiating supine hypertension, disrupting sleep, etc.

It is mentioned in dinet "what helps" page, Grubb lists it for POTS, it is kind of standard to consider as symptomatic treatment of fatigue, also see here for NCS which can be comorbid with POTS (some estimates are 30%, IIRC). ADHD is reportedly associated with POTS, so cognitive treatment of symptoms can lead to a "two birds with one stone" for some patients that respond well... of if you're in the 30% with NCS maybe that is 3 birds... or an double-eagle as Tiger would say on the golf course??? (a triple sanstendre there

Ignoring the FDA question, there is this prior thread... one thing that catches my eye personally is that traditional stimulants are so much cheaper than midodrine and ProVigil... though the later 2 options can be necessary compromises for various reasons. In my personal case, that might be 4 birds! Happy hunting!

[ramakentesh]

The POTS paradox - NET deficiency peripherally and in the heart increases sympathetic transduction through potentiating norepinephrine's pressor effects while NET deficiency in the brain reduces sympathetic outflow through a2 receptor stimulation similar to what clonodine does.

The varied presentations in NET deficiency are explained by stating that NET deficiency effects the central and peripheral systems differentially in patients depending on their beta 2 receptor genetics and other genetic factors. Also perhaps the NET deficiency is at different levels in different locations.

[mountain girl]

I just got home from my Dr appt in PA with Dr. Goodkin. He wants me to try Ritalin to help with the fatique I still have, so I came to the dinet site to see what others may have experienced. My insurance is requiring prior authorization, so I could not get it filled yet. Just wondered how many people found it helpful.

[runningshoe]

I am singing ritalin's (concerta) praises at my house. After a long potsy day I can still think enough to help the kids with homework and not be curled up in a ball on the couch. What dose are folks taking?? I didn't like Midodrin. I tend to have high bp but so far no problem.

[bella27]

Adderall is definitely what CAUSED my POTS. I'm sure it can work as a quick fix for the brain fog (but then again, so would cocaine) but it is causing serious long term havoc on the rest of the body, making pots as well as the brain fog worse off in the long run.