Adderall And Heart Rate

[Pokey]

Hi all. Frequent loiterer, occasional poster.

So, I believe I have been dx'd with hyperadrenergic POTS. Elevated norepinephrine, urinary and blood plasma. While I suffered from occasional presyncope prior to medication (Mestinon, 60 mg, TID), my blood pressure usually elevates when I stand, and I become mildly hypertensive, and my heart rate increases 20-26 bpm. Indeed, I am taking an ARB to reduce my BP -- and it doesn't increase my heart rate one bit. I never had much luck with medicines to reduce my heart rate, which is mildly elevated even when seated (but not lying) given my level of conditioning. I tried the betas, coreg, and clonidine; the first two caused interference with sleep, among other issues, and the third actually increased my heart rate. Elavil did the same thing.

FWIW, I tested as OI and hypovolemic during HUT, but Florinef never did me much good, unless mirgraines are good -- I take that back, I was no longer overfilling the 24-hr urine containers, LOL -- gross, I know; I take my humor where ever I can get it.

So, anyhow, here's the interesting thing, and the salient issue of this post: I recently tried a small dose of Adderall (2.5 mgs), and it knocked my pulse down to pre-POTS level -- 59-61 -- and it reduced my BP down to 92/60. And that was for 2 days in a row. Ironically, Provigil, bupropion, and coffee each elevated my pulse and blood pressure.

It's not a perfect fix, as even with the Mestinon, my pulse still jumps 20-26 upon standing, but still, my seated pulse is a good 15 to 20 beats slower than normal, as is my standing pulse -- nothing to sneeze at. It's my hope that I can further my conditioning (as I wont be going over 170 bpms when doing moderate cardio, at least that's my hope) such that POTS becomes less disabling, particularly the fatigue, pain and cognitive impairment.

I was hoping to hear if anyone else has had a similar experience. Additionally, I am wondering if POTS cardiologists are generally comfortable prescribing amphetamine, versus Ritalin, Provigil or Midodrine. (I've read Dr. Grubb's study with Ritalin, and have heard anecdotally that he rx's amphetamine.) I have some left over from when I was suffering from fatigue, before I knew I had POTS, but only a few weeks worth. I am hoping that this is generally deemed within the standard of care, any my doc will approve of a course. My doc is usually open minded.

Thank you very much for any insight.

[Lenna]

That's interesting; my son is about to start taking Adderall, and has been warned that it will probably increase his tachycardia.

[juliegee]

Yes, it is generally prescribed for patients with dysautonomia. In addition to NMH, my son has bradycardia & has tried all of the meds you describe. He's settled on a low dose of concerta.

I'm wondering if your paradoxical response isn't somewhat akin to that of hyperactive children, with ADD, who also have a focusing and slowing down effect from the adderall.... Weird that ONLY adderall did this for you & how fortunate that you had the perseverance to try them all . Hope it keeps working.

Julie

[mkoven]

don't know if it's the same mechanism, but midodrine lowers my hr. It must be an autonomic reflex.

[Pokey]

Julie, it's seemingly paradoxical, but not entirely. As MKoven pointed out, Adderall, like Midodrine, is a vasoconstrictor, that allows for better peripheral circulation and overall autonomic stability. It could be attributable to better functionality of the baroreceptor reflex.

But as you suggest Julie, I am not sure stimulants cause a reduced heart rate in ADD patients. I know it calms them, as a result of increased frontal cortex activity (which removes a lot of noise), but I think it usually elevates heart rate and BP. Indeed, many are prescribed clonidine and betas in the evening, so they can sleep.

As an additional note, apparently a decent percentage of POTS patients suffer from symptoms similar to ADD and bipolar (manic) patients in terms of brain fog, lack of concentration, short-term memory impairment. I know I do. I don' think the doctors have researched this angle enough. We need more neurologists in the field.

Thanks for your thoughts, and hope to hear more personal experiences, as well as the willingness of doctors to prescribe this meds. I am a little reluctant to ask, as I know it takes a lot more administration to RX these drugs. I already feel like a difficult patient.

Thanks much. Have a nice Sunday.

[juliegee]

Julie, it's seemingly paradoxical, but not entirely. As MKoven pointed out, Adderall, like Midodrine, is a vasoconstrictor, that allows for better peripheral circulation and overall autonomic stability. It could be attributable to better functionality of the baroreceptor reflex.

But as you suggest Julie, I am not sure stimulants cause a reduced heart rate in ADD patients. I know it calms them, as a result of increased frontal cortex activity (which removes a lot of noise), but I think it usually elevates heart rate and BP. Indeed, many are prescribed clonidine and betas in the evening, so they can sleep.

As an additional note, apparently a decent percentage of POTS patients suffer from symptoms similar to ADD and bipolar (manic) patients in terms of brain fog, lack of concentration, short-term memory impairment. I know I do. I don' think the doctors have researched this angle enough. We need more neurologists in the field.

Thanks for your thoughts, and hope to hear more personal experiences, as well as the willingness of doctors to prescribe this meds. I am a little reluctant to ask, as I know it takes a lot more administration to RX these drugs. I already feel like a difficult patient.

Thanks much. Have a nice Sunday.

Hey Pokey,

Interesting stuff. The medical literature I've read seems contradictory. I know the stimulants cause an increase in neurotransmitters, like dopamine & norepinepherine. Norepinepherine, in particular, usually causes the HR & BP increases that you describe. But that rise in BP, can in turn can cause a DECREASE in HR (reflex bradycardia) via the baroreceptor reflex. Sort of sounds like what's happening with you.

BTW, I've never heard of ADD/ADHD patients also being prescribed clonidine & BB's to sleep. Seems like a delicate balancing act...but I get the idea. For awhile, my son was taking both (not to help with sleep though.) The clonidine was supposed to increase appetite, etc. It just made him unbearably sleepy and he stopped after a few weeks.

We've chatted here before about the overlap of ADD/ADHD symptoms and autonomic dysfunctions- definitely there! I agree that a lot more research needs to be done to understand this phenomenon.

I know what you mean about the dispensing of stimulants being a hassle for both the doc and patient. That's one of few drugs that I have to very carefully manage monthly as docs aren't allowed to write prescriptions for longer. Don't worry about being a "difficult" patient. You're lucky enough to find something that's helping. Fight for it!

Julie

[lieze]

Thanks for sharing what is working for you.

I think the elevated heart rate is what concerns me most right now.

[Pokey]

Julie, it's seemingly paradoxical, but not entirely. As MKoven pointed out, Adderall, like Midodrine, is a vasoconstrictor, that allows for better peripheral circulation and overall autonomic stability. It could be attributable to better functionality of the baroreceptor reflex.

But as you suggest Julie, I am not sure stimulants cause a reduced heart rate in ADD patients. I know it calms them, as a result of increased frontal cortex activity (which removes a lot of noise), but I think it usually elevates heart rate and BP. Indeed, many are prescribed clonidine and betas in the evening, so they can sleep.

As an additional note, apparently a decent percentage of POTS patients suffer from symptoms similar to ADD and bipolar (manic) patients in terms of brain fog, lack of concentration, short-term memory impairment. I know I do. I don' think the doctors have researched this angle enough. We need more neurologists in the field.

Thanks for your thoughts, and hope to hear more personal experiences, as well as the willingness of doctors to prescribe this meds. I am a little reluctant to ask, as I know it takes a lot more administration to RX these drugs. I already feel like a difficult patient.

Thanks much. Have a nice Sunday.

Hey Pokey,

Interesting stuff. The medical literature I've read seems contradictory. I know the stimulants cause an increase in neurotransmitters, like dopamine & norepinepherine. Norepinepherine, in particular, usually causes the HR & BP increases that you describe. But that rise in BP, can in turn can cause a DECREASE in HR (reflex bradycardia) via the baroreceptor reflex. Sort of sounds like what's happening with you.

BTW, I've never heard of ADD/ADHD patients also being prescribed clonidine & BB's to sleep. Seems like a delicate balancing act...but I get the idea. For awhile, my son was taking both (not to help with sleep though.) The clonidine was supposed to increase appetite, etc. It just made him unbearably sleepy and he stopped after a few weeks.

We've chatted here before about the overlap of ADD/ADHD symptoms and autonomic dysfunctions- definitely there! I agree that a lot more research needs to be done to understand this phenomenon.

I know what you mean about the dispensing of stimulants being a hassle for both the doc and patient. That's one of few drugs that I have to very carefully manage monthly as docs aren't allowed to write prescriptions for longer. Don't worry about being a "difficult" patient. You're lucky enough to find something that's helping. Fight for it!

Julie

Thanks for your thoughts, Julie. I altready take an ARB for paroxysmal elevated HP, but ironically, the stimulant is dropping it even more. It's somehow giving me greater autonomic stability -- and removing lability. I worked out for the first time on the stimulant today, and was well able to keep my HR under 163, which is a success for me. Usually moderate intensity takes me up to 180+, which is not comfortable.

I have an email into my doctor. We'll see if she responds.

[Pokey]

Thanks for sharing what is working for you.

I think the elevated heart rate is what concerns me most right now.

fwiw, the stimulant is dropping my HR. hang in there.

[juliegee]

YAY!!!! Hope the benefit lasts. Keep us posted. You've almost talked me into trying it.

Julie

[Pokey]

YAY!!!! Hope the benefit lasts. Keep us posted. You've almost talked me into trying it.

Julie

FWIW, I've tried most of the mainstream things. Anything else that made my hear rate drop made me feel crappy.

Most of us have sleep issues (which I partly attribute to alpha intrustons -- HR spikes -- during sleep movement) and beta blockers and clonidine reduce melatonin production, making it more difficult to fall asleep. One of the additional benefits for the stims for me is that come late at night, I get pooped from the stim wearing out. The only downside is that when I come off my initially instant-release dose, I feel a little low; then I take another small dose. The XR could resolve that, but I am always concerned with sleep interference, and would rather take small doses over the day.

After a 3-day trial, I have no doubt this is for real.

Hang in there. I'll keep you posted.

[It'sMyLife]

Thanks so much, Pokey! I just asked my psychologist for a script for something to give me more energy and I don't think he really understood why I was crying to him about being so tired. He said we all wish we could stay awake 36 hours a day. The nerve!

So, at this point I will ask my EPcardio after I get my referral to see him again. Thanks again!

[Pokey]

Thanks so much, Pokey! I just asked my psychologist for a script for something to give me more energy and I don't think he really understood why I was crying to him about being so tired. He said we all wish we could stay awake 36 hours a day. The nerve!

So, at this point I will ask my EPcardio after I get my referral to see him again. Thanks again!

Getting the script was a challenge, as my cardiologist didn't have the secure RX pad necessary for this level of controlled substance. (Cardiologists don't typically prescribe this type of med, obviously.) But it worked out.

All is still well, though it is disturbing my sleep some. I am astonished that something so energizing has no effect on my pulse. However, it can cause a little anxiety, at least for me. I am still figuring out the dosing.

Take care and good luck.