Acid/Vitamin C and ADD Meds
May 14, 2013 6:58 PM Subscribe
For someone who takes Adderall for ADD, will drinking acidic drinks (including say juice, soda, or homemade drink with apple cider vinegar) and/or taking vitamin C supplements mute or dull or interfere with the medication? Talking to pharmacist and googling has yielded some very mixed and confusing answers, and I'd love it if somebody knew enough to give a definitive answer.
When I was prescribed Adderall, they gave me a sheet that listed a bunch of contraindications and drug interactions. It was basically a paper version of this, which does say vitamin C may reduce the effectiveness of the drug.
Since you have an ø in your name I will point out that ammonium chloride is also on that list. Countries that like using the letter ø often use that to make their licorice candy (and liquor) salty.
posted by aubilenon at 7:34 PM on May 14, 2013 [4 favorites]
Since you have an ø in your name I will point out that ammonium chloride is also on that list. Countries that like using the letter ø often use that to make their licorice candy (and liquor) salty.
posted by aubilenon at 7:34 PM on May 14, 2013 [4 favorites]
The PI sheet for instant-release Adderall says: "Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines." So the official answer is "yes."
The guy who runs CrazyMeds says "Your doctor, or at least your pharmacist should tell you not to wash down your Adderall with orange juice or any other fruit juices. Those severely lower the absorption of amphetamines. You can drink fruit juice at other times of the day, just not around when you’re taking your speed. The same goes for vitamin C supplements." He doesn't say what his source is for that second bit, though, and he is Not A Doctor (Or Even A Pharmacist) himself.
(It does sound reasonable — once you've digested that glass of orange juice, your stomach pH should go back up to where it normally is, right? — but I'm also NaD(OEaP) so you shouldn't trust me either.)
posted by Now there are two. There are two _______. at 7:39 PM on May 14, 2013
The guy who runs CrazyMeds says "Your doctor, or at least your pharmacist should tell you not to wash down your Adderall with orange juice or any other fruit juices. Those severely lower the absorption of amphetamines. You can drink fruit juice at other times of the day, just not around when you’re taking your speed. The same goes for vitamin C supplements." He doesn't say what his source is for that second bit, though, and he is Not A Doctor (Or Even A Pharmacist) himself.
(It does sound reasonable — once you've digested that glass of orange juice, your stomach pH should go back up to where it normally is, right? — but I'm also NaD(OEaP) so you shouldn't trust me either.)
posted by Now there are two. There are two _______. at 7:39 PM on May 14, 2013
Yes, this is the case. My Adderall doesn't work as well when I drink soda or juice first thing in the morning. I can drink soda for lunch, and it's not as much of a problem.
posted by aabbbiee at 8:28 PM on May 14, 2013
posted by aabbbiee at 8:28 PM on May 14, 2013
Response by poster: So to clarify, if I've already taken it an hour ago is it still a problem? Or is it just not right at the same time?
posted by skjønn at 8:42 PM on May 14, 2013
posted by skjønn at 8:42 PM on May 14, 2013
For extended release adderall, the part of the dose that's not released immediately will be squooshing around in your digestive system for maybe 4 hours. By then it could still be in the stomach or it may have moved on to the small intestine. In the latter case I would think drinking some OJ wouldn't really affect it, but if it's still in the stomach I could imagine it still having an effect.
As for the opposite question, I don't know how long it takes your stomach acid levels to return to normal after you put something acidic in it. That seems like the kind of thing a pharmacist should be able to tell you.
posted by aubilenon at 8:56 PM on May 14, 2013
As for the opposite question, I don't know how long it takes your stomach acid levels to return to normal after you put something acidic in it. That seems like the kind of thing a pharmacist should be able to tell you.
posted by aubilenon at 8:56 PM on May 14, 2013
I really don't think it will be a problem if you drink orange juice an hour after you take the drug, especially if the standard drug information sheet doesn't say specifically NOT to eat these particular foods at all while you are on the medication. When drugs are tested, they are considering how foods will affect the doses and they assume that people are going to have varied diets throughout the day. I think if you were supposed to limit your diet throughout the day, the drug safety sheet would tell you that.
I did find one manuscript that looked at the effects of different foods on the absorption of daily dose adderall. You can read the abstract here. It basically concludes that different diets cause changes not just in gastrointestinal pH but also changes in how long the stomach contents stay in the stomach and how fast they travel through your whole gastrointestinal system. All of these and other things like enzymatic activity (which I believe is a main hypothesis for why grapefruit interacts badly with some drugs) are going to have an effect on the bioavailability of the drug. As an aside, the stomach pH can be as low as 1-2 when you're fasting, and even really acidic foods don't have pH that low. So again, it's not just the pH (acidity) per se, but rather the reaction of your body to the food in your stomach.
posted by gubenuj at 9:59 PM on May 14, 2013
I did find one manuscript that looked at the effects of different foods on the absorption of daily dose adderall. You can read the abstract here. It basically concludes that different diets cause changes not just in gastrointestinal pH but also changes in how long the stomach contents stay in the stomach and how fast they travel through your whole gastrointestinal system. All of these and other things like enzymatic activity (which I believe is a main hypothesis for why grapefruit interacts badly with some drugs) are going to have an effect on the bioavailability of the drug. As an aside, the stomach pH can be as low as 1-2 when you're fasting, and even really acidic foods don't have pH that low. So again, it's not just the pH (acidity) per se, but rather the reaction of your body to the food in your stomach.
posted by gubenuj at 9:59 PM on May 14, 2013
There's two things in play. Firstly, the amount of the meds that you absorb while digesting is highly dependent on the pH in your gastrointestinal system. Secondly, the speed that the meds leave your system is dependent on the PH later in the digestive chain - like your bladder.
Short version: avoid anything with vit. c (ascorbic acid), citric acid, etc. within an hour or so of taking them, either side. The actual speed of your digestive system is highly variable - if you've just had a huge meal, and then add a litre of OJ on top, it probably is going to take a lot longer to digest it.
It's never going to actually cause you health problems, but it might make your meds more effective :) I suspect the lack of publicity on this is somewhat due to the amphetamine side of things.
For example, antacid tablets increase the effect from amphetamines, which has an obvious relation to drug abuse - however, they also increase the rate at which it leaves your system! As a sidenote cranberry juice is somewhat effective at making them wear off a lot faster, if say you can't sleep - and unlike OJ, you may want to avoid drinking it during the day as a result. I can't think of any other common foods with a similar effect.
posted by Ashlyth at 1:49 AM on May 15, 2013
Short version: avoid anything with vit. c (ascorbic acid), citric acid, etc. within an hour or so of taking them, either side. The actual speed of your digestive system is highly variable - if you've just had a huge meal, and then add a litre of OJ on top, it probably is going to take a lot longer to digest it.
It's never going to actually cause you health problems, but it might make your meds more effective :) I suspect the lack of publicity on this is somewhat due to the amphetamine side of things.
For example, antacid tablets increase the effect from amphetamines, which has an obvious relation to drug abuse - however, they also increase the rate at which it leaves your system! As a sidenote cranberry juice is somewhat effective at making them wear off a lot faster, if say you can't sleep - and unlike OJ, you may want to avoid drinking it during the day as a result. I can't think of any other common foods with a similar effect.
posted by Ashlyth at 1:49 AM on May 15, 2013
I don't have a citation either but I'm definitely sure I read a study a few years ago saying no citrus, no apple juice, definitely no grapefruit juice with your meds - any meds - because it ruins the bioavailability.
The advice not to chase your speed with orange juice was floating around for a few years before that, but no-one told me - stumbled across it in a book.
posted by tel3path at 7:24 AM on May 15, 2013
The advice not to chase your speed with orange juice was floating around for a few years before that, but no-one told me - stumbled across it in a book.
posted by tel3path at 7:24 AM on May 15, 2013
My comments are only based on my own experience. I take Adderall XR, which releases slowly over the day rather than all at once. If I drink soda while the pill is still releasing the medication, the acid will keep me from absorbing as much of the medication as it would otherwise do. It's my experience that I want to wait at least 4-5 hours after I've taken my pill before I drink soda. So I take the pill when I wake up, and I avoid soda until lunchtime. I used to start the day with a Diet Coke, so it really did affect my habits. But Adderall makes me much more productive than Diet Coke did, and it also doesn't give me heartburn.
posted by aabbbiee at 2:35 PM on May 15, 2013
posted by aabbbiee at 2:35 PM on May 15, 2013
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(Lots of tangential literature is available if you look around).
posted by wrok at 7:34 PM on May 14, 2013