ADHD meds

[windbeat]

I am a male in my 20's with ADHD.  

A few years ago I tried Ritalin for a period.  It worked very well for my symptoms but caused chest pain, pretty severe actually.  (10 milligrams 2-4x/dy)

I then tried Adderall.  It also caused some minor and fleeting chest discomfort--but much less than Ritalin.  However it caused my heart to really race and beat hard (at around 5 mg) in addition to insomnia.  Like Ritalin, it also worked very well for my symptoms.  

Next I tried Strattera which did not worked and only caused side effects (80 mg/dy).  

I thought perhaps I had an underlying heart condition making me so sensitive to stimulants, so I stopped all medications for nearly 2 years and was checked out by a cardiologist (2 actually).  

Both cardiologists said my heart is fine except for mitral valve prolapse (with minimal regurgitation).  My thyroid is also normal.  I even had a stress echocardiogram which was normal.  They said it would be ok to use stimulants "as tolerated".  

I've tried so hard to do without meds, using fish oils and exercise, avoiding alcohol and getting proper sleep.  However, this is simply just not cutting it and so recently I decided to try Dexedrine at a very low dose.  At 1.25-2.5 mg it was easier on my heart rate than Adderall, but still I could notice a definite, although fleeting chest discomfort (like a little bit of pain and pressure).  

I do not want to try a TCA or MAOI nor add a beta blocker to a stimulant.  

From the research I've done I think that leaves me with about 3 options.  The first is Provigil, but it is contraindicated with mitral valve prolapse.  The other 2 are Focalin and Desoxyn.  

Although Desoxyn is supposed to have the best CNS vs PNS activity, I can just imagine the song and dance I'd have to go through to get someone to prescribe it.  

So, I'm considering Focalin.  My understanding is that methylphenidate has the least peripheral actions of the stimulants and that focalin contains only the active "d" isomer whereas Ritalin is a racemic mixture of "d and l".  

My question is whether Focalin would really present an advantage over Ritalin in terms of peripheral side effects (heart primarily).  Although it's marketed under the premise that it only contains the active "d" isomer, thus allowing for half the dosage and theoretically half the side effects, I've read that the "l" isomer is actually very poorly absorbed.  

What I really liked about Ritalin was it's fast onset and short duration (no insomnia, flexibility of dosing).  Obviously I could not tolerate the chest pain.  

Getting to the point, I have 3 questions:

1. Is the L-methylphenidate isomer very peripherally acting (heart, lungs), or just "inactive"?

2.  Do you think Focalin would truly be a reasonable alternative to Ritalin for me?

3.  What are my other options?

Sorry for the long-winded post. I'm just very frustrated that I won't be able to find an effective and tolerable tx.  Thank you.

[windbeat]

I wouldn't believe in ADHD either if I didn't have it.

[Anything4Money]

ADHD doesnt exist-

[windbeat]

Thank you, sounds very reasonable...I'll talk to my Dr. about giving that a shot.

[Roger Gould, M.D.]

You have certainly done your research, you now know more about the chemistry of Focalin than I do.  But from my experience, here is my advice.  You can't figure these things out in advance.  You are very sensitive to stimulants, so you have to be cautious and systematic about how you experiment.  I would recommend that you retry ritalin, but at an even smaller dose, and less frequently.  If that doesn't work, then do the same for Focalin.   That's the only way to find out...the advertising is not the answer.