ADHD and Migraine Meds After Surgery

[HP62442 11]

I am undergoing a revision from gastric sleeve to a MGB in February, and I'm a little worried about my meds. I currently take Vyvanse 70 mg and Adderall 20mg 3x daily. (yes, I am aware that is a crap ton of stimulants). Anywho, how have people's experiences been taking these meds post MGB? Do you crush the IR Adderall tablet? Does it work as well? I assume the Vyvanse doesn't work as well because its extended release. Has anyone switched to IR Ritalin or the patch? What dose were you switched to? The highest patch doesn't seem equivalent to 70mg of Vyvanse and Methylphenidate hasn't worked super well for me historically. To quote my previous psychiatrist after hearing my new doc switched me to it, "But that's for children!"

I currently also take a prescription NSAID for Migraines 1-2 times a month. Do I have to stop taking that? I assume so but Triptans (maxalt, sumpitriptan) make me super sick. What have you switched to? Tylenol will not cut it. Cambia has been the holy grail of migraines for me, so I'm bummed to stop taking it.

Of course, I'm going to speak to my neurologist, psychiatrist, and surgeon, but would love your personal experiences. Thanks!

[Losingit2018 1,170]

Definitely talk to your surgeon. I am not sure how the meds will absorb but, I do know for a fact that you can’t have any nsaids after bypass surgery for life. The risk of ulcers is far too great.

[Darktowerdream 421]

No nsaids, no times release, tablets must be very small to have time to absorb. I am concerned about needing toprol but it’s timed release so I haven’t approached my dr about it. I am autism spectrum and adhd. I started drinking some caffeine in the evening again to try to help with that since I can’t risk adderal. My chronic illness causes meds to have serious side effects. I can paste an informative post about meds post op though. I hope it helps.

my personal tip is to inquire about liquid forms of medication for the first months.

21 medication rules after gastric bypass

There are certain pills that you should not be taking after surgery because they will either irritate your pouch, such as all pills in the NSAIDs catagory or pills that just won't be absorbed like they should. Any pills with enteric coating (kind of like a candy coating) or any extended release type med may not be absorbed like it is supposed to. If any of your meds do fall into those catagories you will want to get them changed. Those meds need the gastric juices to break them down and after RNY those juices just aren't there to do the job until well down your intestinal system which won't be enough time to break those meds down.

So basicly, you want to avoid any meds that are extended release, delayed, controlled, sustained or any medication that is an NSAIDs.

Over-the-counter NSAIDs are:

Aspirin, Motrin, Advil, Aleve, Orudis KT, Ibuprofen, Excederin

Prescribed NSAIDs are:

Motrin, Naprosyn, Anaprox, Toradol, Lodine, Feldene, Indocin, Daypro, Relafen, Voltaren and Celebrex.

There is the belief by some surgeons out there that even one NSAIDs can cause some kind of damage to your pouch and they strongly recommend staying away from them, if possible. If medically there is a reason to be taking them, such as the use of low dose asprin for heart conditions, it is okay to take them but you should also be placed on some kind of protectant such as Carafate or Cytotec.

If you are unsure if any of the meds you are on fall into any of these catagories talk to your Pharmacist, they will know. It isn't a bad idea to let your Pharmacist know that you are a Gastric Bypass patient. They can list it in your information almost like an allergy so that if you are ordered a med that you shouldn't be on an alert will be generated. There are ALOT of physicians out there that don't know this kind of information it is our respondsibility to make sure they are aware of it.

Here are 21 basic rules we should all follow in regards to our meds:

1. If side effects appear or increase, consult your doctor or your pharmacist about dosage or other medication options.

2. First-pass effect medications may not provide effective absorption at the currant dosages. Check dosage or check for alternative medications that do not have first pass effect. (your Pharmacist will know if any of your meds are "first-pass" meds)

3. Medications that are in a liquid or solution form will be absorbed faster than those that are solids. Check for liquid forms of medications.

4. No extended-release, sustained-release, controlled-release, timed-release or osmotic pump medications.

5. Many medications can also have gastrointestinal side-effects like gas, diarrhea, Constipation or intestinal cramping.

6. Read the pamphlet attached to the prescription bag for potential side-effects.

7. You should not take any NSAIDs without a protectant such as Cytotec or Carafate. EVER!!!!

8. Be able to recognize an NSAIDs when you see one.

9. Use a protectant if taking daily low-dose aspirin for heart health or to prevent stroke.

10. Check all PMS over the counter medications (OTC) for NSAID ingredients.

11. Read all OTC medication packaging to check for NSAIDs ingredients.

12. Inhaled steroids for asthma are okay.

13. Taking steroids of any kind, even by injection, requires taking a protectant as well.

14. Medications commonly used in the treatment and prevention of osteoporosis such as Fosamax, Actonel and Boniva have the potential to cause gastrointestinal ulceration. Talk to your doctor or pharmacist about alternatives.

15. Do not continue to take medications that have been discontinued.

16. If dosages have been changed, do not finish out a previous dosage just because it is there. CHange the dosage immediately unless instructed otherwise by your physician.

17. Ask your doctor or pharmacist if any of your medications are fat soluble. If so, stay in touch with the prescribing physician and report your currant weight every month for possible dosage changes. (as the amount of fat in your body changes your dosages may also need to be changed)

18. Tell all medical providers about your status as a weight loss surgery patient. (Lap-Banders too!)

19. Keep all your scripts at one pharmacy if possible.

20. Meet and get to know your local pharmacists. They truly can be invaluable friends.

21. Remember to have everyone work as a team for you! You're worth it!

(Used with permission of Little Victories Medical/Legal Consulting & Training. All rights reserved)

One other word of warning when it comes to taking Tylenol. You MUST watch the amount of Tylenol you are taking. No more than 4,000mg in a 24 hour period. You can cause yourself liver damage with Tylenol overdose. You need to read your labels. Look to see if things have Tylenol or acetamenophin in them. Vicodan has Tylenol so if you are taking Vicodan or Lortab make sure you aren't adding a lot of Tylenol on top of it. That is why it is important to read the information on those pharmacy bags and on otc medications.

[Ninja-slash-nerd 12]

I'm interested to know if you found an answer to your question. I also take vyvanse 70 mg + 10 mg of methlyphenidate

[Lynda486 788]

I took vyvanse after my sleeve along with a couple others and had no issues, it should be okay!

[PepperCat 30]

My surgeon told me Vyvanse was fine to take. Check with your doc, but my psychiatrist told me Vyvanse (versus other stimulants) absorbs differently and can be opened.

[chelsea1188 0]

Hi guys - ive just stumbled across this thread, and am also looking for information regarding stimulant medications and gastric bypass, i was bypassed a few years before i was diagnosed with ADHD,

i was prescibed dexamphetimine by my psych, but he has never treated a patient with ADHD who has had a gastric bypass, my stimulants seems to go in, barely work for 2 hours and wear off - i recently switch from IR Dex 5mg (10x per day) as i found myself topping up more often than i should have been, so i requested to switch to a XR, and was prescribed Vyvanse 70mg 1x per day.. this barely touched the sides, and infact i had no increase in focus or motivation, and found that i was struggling to keep my eyes opne at work at 1pm! so ive switched back to IR dex, but the duration of effectiveness per dose is rediculous!

i did a UDS for my psych last week, and it appears that ther was alot of amphetamine traces in my urine sample..

anyone had similar? or have any recomendations?

i was also wondering, does IR stimulant medication work more effectively or less effectively if your prone to forget to quite often?

Thanks, i hope to hear fomr someone soon!!

[Darktowerdream 421]

3 hours ago, chelsea1188 said:

Hi guys - ive just stumbled across this thread, and am also looking for information regarding stimulant medications and gastric bypass, i was bypassed a few years before i was diagnosed with ADHD,

i was prescibed dexamphetimine by my psych, but he has never treated a patient with ADHD who has had a gastric bypass, my stimulants seems to go in, barely work for 2 hours and wear off - i recently switch from IR Dex 5mg (10x per day) as i found myself topping up more often than i should have been, so i requested to switch to a XR, and was prescribed Vyvanse 70mg 1x per day.. this barely touched the sides, and infact i had no increase in focus or motivation, and found that i was struggling to keep my eyes opne at work at 1pm! so ive switched back to IR dex, but the duration of effectiveness per dose is rediculous!

i did a UDS for my psych last week, and it appears that ther was alot of amphetamine traces in my urine sample..

anyone had similar? or have any recomendations?

i was also wondering, does IR stimulant medication work more effectively or less effectively if your prone to forget to quite often?

Thanks, i hope to hear fomr someone soon!!

I wish I had a solid answer but I've never taken medication for my ADHD, I'm also on the Autism spectrum with sensory processing disorder, and OCD. But as well have lifelong chronic illness, immunodeficiency with many medical conditions that started with Myalgic Encephalomyelitis.

i haven to be careful with what meds I take. As I've multiple chemical sensitivities. And allergies.

I can say that XR means it's an extended release drug and will not work in a gastric bypass surgery patient digestive system. I'm going to have to figure that out myself since I need something for POTS/orhtostatic intolerance.

Personally? My ADHD treatment? I drink caffeine in the evening and time it a certain way. But dealing with severe chronic fatigue every day. I don't take stimulants. tBH If I time it right I get a bit of a clear head and sleep a little better. Usually around 6pm I drink a 300mg caffeine energy drink. For some reason I had to stop coffee though.

So I think some things can go through the system to quick to be metabolized. Probably if I were answering at a better time of day I might make better sense. I hope it's at the least a little helpful.