20 replies to this topic

[Heisenberg]

I am somewhat confused about combining Ritalin R (normal release) with Piracetam. I have taken 15mg of Ritalin along with 800 mg of Piracetam in the past with the result of the focused Ritalin effect being increased. Occasionally I have tried Ritalin and Oxiracetam with no particular effect.

Meanwhile I read on this forum that Piracetam would induce rapid Ritalin tolerance. Can anyone elucidate on this issue, perhaps from own experience?

[medievil]

Piracetam wont induce rapid tolerance to ritalin.

[Ark]

You should be feeling good at those dosages.

[Guacamolium]

From my experience, racetams usually help the edginess of Rit doses, but I haven't noticed a heightened tolerance to Rit either.

[Heisenberg]

Thanks for your input. I know my post is completely redundant on this forum, and I would let the issue rest in peace, however I stumbled onto this post here:

http://www.imminst.o...__1#entry427750

stop taking piracetam if you're taking prescription amphetamines. the reason it diminishes in effect is because it's causing the excitotoxicity of the amphetamines to skyrocket.

The post quickly veers off into stipulating that racetams in combination with amphetamines promote cell death. I hope I misunderstood these posts as I have combined Ritalin with piracetam for a while with quite satisfactory results. Any elucidation is most welcome!

Edited by Heisenberg, 22 November 2010 - 05:55 AM.

[jadamgo]

Amphetamines and ritalin don't work by the same mechanism. The way amphetamine works is somewhat haphazard and it appears to have some risk of damage to the brain whenever combined with other things that increase excitability. Ritalin's mechnism of action does not have this effect, or if it does, it's way milder and is not possible to detect with current studies on humans.

[aLurker]

No one knows exactly how piracetam works or how it would interact with methylphenidate. Allosteric modulation of NMDA receptors is merely a hypothesis and if it is correct I fail to see how that would increase any hypothetical risks. Piracetam increases NMDA receptor density though and that might be a factor but seeing as methylphenidate doesn't have any problems with excitotoxicity to begin with I still can't see how it would be that dangerous. It might be though, I admittedly have no idea.

As to tolerance I don't know and I haven't seen any anecdotal accounts except Pike's.

Keep us posted on how it goes if you try this.

Edited by aLurker, 22 November 2010 - 08:15 AM.

[medievil]

Piracetam shows antioxidant activity wich should be protective against excitoxiticy, havent seen any study's were piracetam was tested in excitoxic conditions tough.

[Heisenberg]

Thanks, this is hopeful.

Would you then say the post I quoted previously above is bogus?

[ryhan]

Has anyone got thoughts on an antiracetam/ritalin combo?

[longevitynow]

Haven't tried piracetam with ritalin, but with caffeine in higher doses than I usually tolerate and with ephedra in the past, the piracetam seems to enhance focus and to reduce the side-effects/jitters. With caffeine and piracetam I am focused for longer with less of a crash afterwards. I'd speculate that with ritalin you would find a lower dose might be as effectve when combined with piracetam, but that doesn't mean that the piracetam is necessarily making the ritalin more neurotoxic on a normal ritalin dosage. I think that the idea that piracetam increases excitotoxicty is yet another speculation not based on research or personal experience but purely based on supposed mechanisms of action. There is a lot of this on these forums, but sometimes it is all we have to go on. In fact, I appreciate it when some knowledgeable person brings up some knowledge unbeknownst to the rest of us. In the long run I think we will find piracetam to be more neuroprotective. There is also the possibility that multiple mechanisms of action are at play concurrently, and it remains to be seen what the sum total effect of these mechanisms are, as well as how it interacts with an individual's genetic proclivities. IMO regular use of ritalin/adderall and probably modafanil is not good for your brain long-term, but I'm all for anything that can reduce any short or long-term side-effects. Whatever the long-term effects are, I'm interested in more personal testimonials about the combo.

[Heisenberg]

Haven't tried piracetam with ritalin, but with caffeine in higher doses than I usually tolerate and with ephedra in the past, the piracetam seems to enhance focus and to reduce the side-effects/jitters. With caffeine and piracetam I am focused for longer with less of a crash afterwards. I'd speculate that with ritalin you would find a lower dose might be as effectve when combined with piracetam, but that doesn't mean that the piracetam is necessarily making the ritalin more neurotoxic on a normal ritalin dosage. I think that the idea that piracetam increases excitotoxicty is yet another speculation not based on research or personal experience but purely based on supposed mechanisms of action. There is a lot of this on these forums, but sometimes it is all we have to go on. In fact, I appreciate it when some knowledgeable person brings up some knowledge unbeknownst to the rest of us. In the long run I think we will find piracetam to be more neuroprotective. There is also the possibility that multiple mechanisms of action are at play concurrently, and it remains to be seen what the sum total effect of these mechanisms are, as well as how it interacts with an individual's genetic proclivities. IMO regular use of ritalin/adderall and probably modafanil is not good for your brain long-term, but I'm all for anything that can reduce any short or long-term side-effects. Whatever the long-term effects are, I'm interested in more personal testimonials about the combo.

In the past, I combined 800 mg of Piracetam with 15 mg of Ritalin. The Piracetam was administered about 1 hours after Ritalin, when the MPH began showing an effect. This has generally enhanced the Ritalin effect with increased focus and concentration for about 4-5 hours. I stopped combining the two substances after reading about potentially hazardous effect of the combination, but would be more than happy to resume it again.

In general, I believe confusion exists between the notion of amphetamines being toxic vs. the notion of Ritalin and Piracetam being neuroprotective. If anyone has more insight about this, please share.

[jadamgo]

Amphetamine acts as a releasing agent of dopamine, whereas methylphenidate is merely a reuptake inhibitor. Amphetamine is more likely to cause dopamine to diffuse out of the synapses and float around in the extracellular fluid. If the amount of free dopamine is excessive, it can damage non-dopaminergic neurons. Simply put, if a neuron is not equipped to handle dopamine then dopamine can damage it. (Actually, dopamine is even a bit toxic to the neurons that are supposed to use it, but those neurons are usually equipped with stronger mechanisms for preventing and repairing that damage. MAO breakdown of dopamine seems to produce some of the toxic compounds, which may be why selegiline and other MAO inhibitors are neuroprotective against both Parkinson's disease and dopaminergic-induced neurotoxicity.)

Amphetamine also releases norepinephrine, which is excitatory. Excitotoxicity is when neurons are turned on too much, and the products of their metabolism begin to damage and kill cells. Glutamate, as the main excitatory neurotransmitter, plays a big role in this. Piracetam seems to have some excitatory effects. So when you combine regular high doses of amphetamine (enough to cause euphoria) with piracetam, there is a POTENTIAL for damage. Considering that neurons and glia are already not happy with excess dopamine floating around the extracellular fluid, the addition of excitotoxicity would be particularly damaging, if it happened.

But I really don't think an amphetamine + piracetam interaction has been proven to occur! The above is speculation, pieced together from various studies examining different types of things. To my knowledge, nobody has studied mammals given doses of amphetamine and piracetam equivalent to those used by humans for cognitive enhancement or ADHD treatment. Please correct me if I'm wrong because I would love to hear about that research. (I'm not particularly interested in research done on animals given megadoses of amphetamine.)

Now, on to methylphenidate. It's not a releasing agent. It's a dopamine and norepinephrine reuptake inhibitor. That means that when one of those neurotransmitters is released into the synapse during normal neurotransmission, some of it will stay in the synapse longer than usual. However, commonly used doses of methylphenidate only block about 40-50% of the transporters in relevant brain areas. Thus, the dopamine and norepinephrine still get pumped back into the synapses. So unlike strong doses of amphetamine, sub-euphoric doses of methylphenidate do not cause enough dopamine to diffuse out into the extracellular fluid and fuck up the non-dopaminergic neurons.

So yeah, MPH does stimulate excitatory transmission to a degree, because it enhances the activity of noradrenergic signals. But it doesn't provoke a release of norepinephrine, and it doesn't push dopamine out into places it shouldn't be. Furthermore, MPH stimulates the inhibitory circuitry of the prefrontal cortex, which is why it's so helpful in controlling hyperactivity and impulsivity.

Thus, MPH just doesn't present much of a risk for excitotoxicity. Piracetam doesn't appear to either. So, unless somebody has a reason we should suspect a risk, why would you? Sure, there's nothing wrong with caution. But caution does not suggest that one expect damage from the MPH + piracetam combination.

[VoidPointer]

Amphetamine acts as a releasing agent of dopamine, whereas methylphenidate is merely a reuptake inhibitor. Amphetamine is more likely to cause dopamine to diffuse out of the synapses and float around in the extracellular fluid. If the amount of free dopamine is excessive, it can damage non-dopaminergic neurons. Simply put, if a neuron is not equipped to handle dopamine then dopamine can damage it. (Actually, dopamine is even a bit toxic to the neurons that are supposed to use it, but those neurons are usually equipped with stronger mechanisms for preventing and repairing that damage. MAO breakdown of dopamine seems to produce some of the toxic compounds, which may be why selegiline and other MAO inhibitors are neuroprotective against both Parkinson's disease and dopaminergic-induced neurotoxicity.)

Amphetamine also releases norepinephrine, which is excitatory. Excitotoxicity is when neurons are turned on too much, and the products of their metabolism begin to damage and kill cells. Glutamate, as the main excitatory neurotransmitter, plays a big role in this. Piracetam seems to have some excitatory effects. So when you combine regular high doses of amphetamine (enough to cause euphoria) with piracetam, there is a POTENTIAL for damage. Considering that neurons and glia are already not happy with excess dopamine floating around the extracellular fluid, the addition of excitotoxicity would be particularly damaging, if it happened.

But I really don't think an amphetamine + piracetam interaction has been proven to occur! The above is speculation, pieced together from various studies examining different types of things. To my knowledge, nobody has studied mammals given doses of amphetamine and piracetam equivalent to those used by humans for cognitive enhancement or ADHD treatment. Please correct me if I'm wrong because I would love to hear about that research. (I'm not particularly interested in research done on animals given megadoses of amphetamine.)

Now, on to methylphenidate. It's not a releasing agent. It's a dopamine and norepinephrine reuptake inhibitor. That means that when one of those neurotransmitters is released into the synapse during normal neurotransmission, some of it will stay in the synapse longer than usual. However, commonly used doses of methylphenidate only block about 40-50% of the transporters in relevant brain areas. Thus, the dopamine and norepinephrine still get pumped back into the synapses. So unlike strong doses of amphetamine, sub-euphoric doses of methylphenidate do not cause enough dopamine to diffuse out into the extracellular fluid and fuck up the non-dopaminergic neurons.

So yeah, MPH does stimulate excitatory transmission to a degree, because it enhances the activity of noradrenergic signals. But it doesn't provoke a release of norepinephrine, and it doesn't push dopamine out into places it shouldn't be. Furthermore, MPH stimulates the inhibitory circuitry of the prefrontal cortex, which is why it's so helpful in controlling hyperactivity and impulsivity.

Thus, MPH just doesn't present much of a risk for excitotoxicity. Piracetam doesn't appear to either. So, unless somebody has a reason we should suspect a risk, why would you? Sure, there's nothing wrong with caution. But caution does not suggest that one expect damage from the MPH + piracetam combination.

Great post && explanation.
do you have any idea of max numbers of days per week that one could take a therapeutic dose(duration 10+hours) of a stimulant medication, and not experience tolerance issues? My guess is around 3-4.Have there ever been any studies related to this issue?

[JLynne]

I am 53 years old and have been on 20mg 4 times per day of Brand Ritalin for 10 years now and have not experienced any tolerance issues at all. My dose is every 3 hours or so. If people want good facts on ADD and meds, especially for adults, go to http://totallyadd.com/ . Hope I'm not off topic but I have been giving Piracetam a go, keeping a journal but not much to report. I may not be taking enough. I was looking for alternatives to Ritalin because of the expense. (No insurance and generic Ritalin is trash for me, all the Generics!) The best alternatives I have found are Nicotine patches and Rhodiola Rosea root capsules + Magnesium for anxiety. So far all I seem to notice from Piracetam are headaches even though I'm adding Choline, perhaps not enough of that either. I went off Ritalin for a time as an experiment and concluded that ADD is real, Ritalin helps, and I'm really sick of all the hurtful, uninformed opinions out there.. Piracetam, based on my research is a good antioxidant so I'd probably stay on it if it were helping. But not without more research.

[VoidPointer]

I am 53 years old and have been on 20mg 4 times per day of Brand Ritalin for 10 years now and have not experienced any tolerance issues at all. My dose is every 3 hours or so. If people want good facts on ADD and meds, especially for adults, go to http://totallyadd.com/ . Hope I'm not off topic but I have been giving Piracetam a go, keeping a journal but not much to report. I may not be taking enough. I was looking for alternatives to Ritalin because of the expense. (No insurance and generic Ritalin is trash for me, all the Generics!) The best alternatives I have found are Nicotine patches and Rhodiola Rosea root capsules + Magnesium for anxiety. So far all I seem to notice from Piracetam are headaches even though I'm adding Choline, perhaps not enough of that either. I went off Ritalin for a time as an experiment and concluded that ADD is real, Ritalin helps, and I'm really sick of all the hurtful, uninformed opinions out there.. Piracetam, based on my research is a good antioxidant so I'd probably stay on it if it were helping. But not without more research.

Ughh, you are not helping support your statement of 'no tolerance' when you are a very high amount of MPH;
80 mg per day??
if you started on any less of a dosage than that, then you have experienced tolerance. And I sure no doctor started you on that dose. That is over 2 times what I take, and I am a 195 pound male.
And MPH is active for around 4-6 hours after initial dose;

I think MPH is a helpful drug, but .. wow;

I'm really sick of all the hurtful, uninformed opinions out there

The discussion here is scientific mainly, and there is no need to attach emotional tags to statements with which you disagree/do not want to hear..

[cougar]

I am 53 years old and have been on 20mg 4 times per day of Brand Ritalin for 10 years now and have not experienced any tolerance issues at all. My dose is every 3 hours or so. If people want good facts on ADD and meds, especially for adults, go to http://totallyadd.com/ . Hope I'm not off topic but I have been giving Piracetam a go, keeping a journal but not much to report. I may not be taking enough. I was looking for alternatives to Ritalin because of the expense. (No insurance and generic Ritalin is trash for me, all the Generics!) The best alternatives I have found are Nicotine patches and Rhodiola Rosea root capsules + Magnesium for anxiety. So far all I seem to notice from Piracetam are headaches even though I'm adding Choline, perhaps not enough of that either. I went off Ritalin for a time as an experiment and concluded that ADD is real, Ritalin helps, and I'm really sick of all the hurtful, uninformed opinions out there.. Piracetam, based on my research is a good antioxidant so I'd probably stay on it if it were helping. But not without more research.

Ughh, you are not helping support your statement of 'no tolerance' when you are a very high amount of MPH;
80 mg per day??
if you started on any less of a dosage than that, then you have experienced tolerance. And I sure no doctor started you on that dose. That is over 2 times what I take, and I am a 195 pound male.
And MPH is active for around 4-6 hours after initial dose;

I think MPH is a helpful drug, but .. wow;

I'm really sick of all the hurtful, uninformed opinions out there

The discussion here is scientific mainly, and there is no need to attach emotional tags to statements with which you disagree/do not want to hear..

I think he meant to say that he was taking a total of 20mg divided into 4 doses. I could be wrong anyways.

Edited by cougar, 05 December 2010 - 06:52 PM.

[JLynne]

I was on 10mg 4x per day for 4 years. Changed doctors and he suggested the dose might be too low to be effective. Ritalin dosage is not weight dependent. It is also metabolized very quickly. My doctor decreased the dosage to 3 times per day because doctors are under enhanced scrutiny now partially due to the Black Box warning cited below, in my opinion.

(Based on my understanding of the word ‘tolerance’ - how can being on the same dosage of medication for 6 years with no need to increase that dosage be defined as tolerance?)

Tolerance:
A phenomenon whereby a drug user becomes physically accustomed to a particular dose of a substance, and requires increasing dosages in order to obtain the same effects.
Mentioned in: Addiction, Analgesics, Opioid, Substance Abuse and Dependence
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.)



[url="http://www.addresour...andelkorn.php"]

WHAT IS THE CORRECT DOSE?

If medications work, there is a best dose for each individual. Unfortunately, medical knowledge is not at a point where it can predict what the correct dose will be. This is not an unusual circumstance in medicine, however. For a person with diabetes, we must try different forms and amounts of insulin to achieve the best control of blood sugar levels. For people with high blood pressure, there are many medications that can be effective, and often a trial of multiple medications and dosages is needed to determine the best treatment. For ADHD medications, there is no magic formula. The dose cannot be detemined by age, body weight, or severity of symptoms.

In fact, it appears that the correct dose is extremely individual and is not really predictable. Again, similar to people who need glasses, the kind of prescription and the thickness of the lenses is not dependent on any measurable parameter other than what you say enables you to see well. The dose of medication is determined solely by what ADHD patients need to improve their symptoms.

You must be willing to experiment with carefully observed dosage changes to determine your child's correct dosage. Once the correct dosage is determined, it does not seem to change significantly with age or growth. Medication continues to work effectively through the teenage years and into adulthood if needed.

For atomoxetine, the dosage at the present time is calculated according to weight. This is the only medication for ADHD for which this is true.

SAFETY PROFILE

The stimulant medications are one of the most studied treatments in the history of medicine. The medications have been used extensively in children and adults over the past 50 years with no evidence to date of long term concerning side effects. At this time there is no conclusive evidence that use of stimulants causes any long term lasting effects on growth, although there may be some delay in height and weight gain in some individuals.

The short acting stimulants are extremely abusable and are valued highly on the street. It is best to always use the long acting preparations which are not abusable to avoid the temptation of misuse and abuse.

There have been recent concerns expressed by the FDA and the press with regard to the use of stimulant medications and the risk of sudden unexpected death. This concern was a consequence of a study done in 1999-2003 in which they looked at a large number of individuals taking stimulants and felt that there may be a slight risk. As reported in an excellent article in the New York Times Feb 14, 2006 the apparent calculated risk of sudden unexpected death in those using amphetamines was 0.35/million (1 in 3 million) prescriptions and the risk for those on stimulants was 0.18/million (1 in 5 million) prescriptions. There is no real evidence that this is any different from that which occurs in the normal population. These extraordinary events of unexpected death tended to occur in individuals with congenital cardiac defects. For this reason the FDA issued a BLACK BOX warning to all physicians that stimulants should be used very cautiously or not at all in individuals with congenital cardiac defects.

METHYLPHENIDATE TABLETS 2-4 hours (Ritalin IR)
Form:
Short acting tablets administered by mouth. Methylphenidate (MPH)5 mg, 10 mg, 20 mg
Dosage:
Very individual. Average 5 mg – 20 mg every 4 hours. I prescribe 5 mg to start and raise by 5 mg every 4–5 days with close observation until correct dose is achieved.

Duration of Action:

Rapid acting Ritalin starts to work in 15–20 minutes, which is extremely helpful for some individuals who has trouble starting their day, Some children will need medication 20 minutes BEFORE time to get up, followed by a long–acting medicaiton at breakfast. Often used as a booster for evening coverage.

Possible Side Effects:

See above
Pros:
Very easy to use for short periods of coverage, such as early morning and evening.
Cons:
Must be administered frequently during the day (3-5 times/day). Inconvenient to use at school. Often causes rebound and roller coaster effect. Very abusable.

Edited by JLynne, 05 December 2010 - 09:00 PM.

[VoidPointer]

Like I said I think MPH is a helpful drug. You are on a very high dose relative to other patients(close to legal limit that can be prescribed), and you did increase your dose over time because it was not as effective.
Cut and pasting information about stimulants does not change that fact.
Believe me I would much rather have you on MPH than not, but you are old enough to know that you do not get anything for free in life. Drug tolerance is not some 'myth', and you admitted that you are mixing in other stimulants. Why would you feel the need to do that if you were not experiencing some degree of tolerance to MPH?

I am all for personal freedom when it comes to medication, and hope you use your medicated time wisely.

[riloal]

Hi, i know this thread is old, but i take ritalin because ADD, and i want to add piracetam. Anyone here is in this combo? How are you doing? I read mixed reviews, some say it works great and some say it doesn,t. Anyone want to share his experiencies with this combo? Thanks

[riloal]

Hi, i have used the combo ritalin with piracetam, for a week, and seems that piracetam lowers the effects of ritalin. Anyone have personal experiences about this combo? I don,t know if to stop piracetam or not? Thanks