Accurate measurement from the bottom of the window, accurate understanding and precise application of the medication based on the ‘Efficacy Duration’, it is the only way to apply pharmacist science to the individual metabolism of the person. We cannot fully know or appreciate the beauty of looking at the Therapeutic Window unless we have the specific measurement tool: ‘The DOE’. – DOE, Duration of Efficacy should be measured from the first visit to the last visit at each medication review. DOE stands for precise dosage. Without the DOE in mind it’s like building a house without a level, like going on a trip without a map.

Each of the stimulant drugs has its own characteristic metabolic rates, which are typical of each drug, regardless of each person’s rate-based challenges or issues. If we know these expected “burn rates”, then when other problems arise based on other metabolic variables, we can accurately correct for metabolic problems in the context of expected and predictable rates of drug delivery duration.

Our teams want to make sure the stimulant medication is at the bottom of the ‘Window’ – actually working clinicallyforks not off the top with side effects.

Consider this clinical example: I work with a 45-year-old male adult patient, electrical engineer, with a history of severe constipation. [BM 1-2X/wk] his entire life, and a history of severe concussive head injuries suffering from ADD. Head injury and constipation in your history predict a specific sensitivity to stimulant medications, which will metabolize stimulant medications more slowly. This metabolic background noise must be accounted for, but even before that, I must know the expected DOE of the drug, or I won’t know how to measure its specific metabolism effects at the expected dose, and I won’t be able to properly titrate the stimulant medication. to work all day.

1. Medicines don’t work long enough: the duration of effectiveness [DOE] it is not apropiate: Each stimulant drug, each family of stimulant drugs has its own expected DOE. This DOE is not discussed in the literature as a measurement tool, but is common knowledge to anyone who closely observes drug action and duration throughout the day.
2. If you know both the expected duration of the drug and your own metabolism, it’s like knowing exactly where you are on a map by sailing off the coast of New England. Each measure will give you a specific solution for that geography and that tide.
3. All stimulant medications have an expected duration of less than 24 hours.. This is an obvious point, but it is so often overlooked as an essential tool. If the medications last less than 24 hours, how long should each last?
4. Marking the specific duration is essential to obtain the best action of each specific drug. [AMP=Amphetamine Family, MPH=Methylphenidate Family]
• vyvanse [AMP] and daytrana [MPH patch] both win DOE race with 12-14 hours predicted
• Adderall-XR [AMP] is next with 10 hr DOE – sometimes you can get 12, but often 12 DOE is too much
• Concert [MPH] and focalin [MPH] both run 8-10 hours if dialed in effectively; some studies show longer, my experience is over 10 with any of these is too much; see other items at the ‘top of window’
• CR metadata [MPH] and Ritalin LA [MPH] both are correct at 8 hours, rarely longer, with side effects if dose is increased
• Immediate release stimulants, tablets that do not wait longer, last only part of the day with Adderall IR [AMP] [Immediate Release Tabs] lasting around 5-6 hours, Ritalin IR [MPH] It is 4 hours maximum duration.
5. None of the IR [Immediate Release] – Short-acting doses last past noon without significant side effects such as: overfocus in the afternoon and a strong drop around 1-2 PM.
6. It is important to be completely accurate about the DOE’s expectations for each specific drug. If it doesn’t show an effect, focus and concentration don’t fix, it needs to be increased to get it into the window. If Vyvanse only lasts 8 hours, most of the time an insufficient dose is taken. If Ritalin IR lasts only 3 hours, you are underdosing. Daytrana is tricky because it can last well, but the dosage may be insufficiently effective during the day; it is best to measure the effectiveness of Daytrana with PPT. The effective time after the patch: must be 3 hours.
7. Use these specific steps to keep the radar on for these commonly used medications. Each drug not covered here has its own duration of effectiveness. Remember that Strattera is not a stimulant, but it has consistently poor clinical results even though it works very well for some.