View Full Version : Seriously Need Help: Not enough tablets...


TheWaitress
12-12-15, 11:56 PM
Hi, I'd love to hear advice.

I've been prescribed 6 tablets of instant release Dexedrine per day for Adult ADHD by my psychiatrist. These last about 2.5 hours so I need more tablets. My psychiatrist said the government will not allow her to prescribe more than 6 dexedrine a day as the government is nervous about this medication. I think I'd be completely fine if I just had a few more tablets each day, but no matter what I say my psychiatrist says she can't do anything as the government won't raise the limit of 6 tablets per day. I believe my psychiatrist is telling the truth about the government.

What can I do?

Any help would be greatly appreciated!

namazu
12-13-15, 12:07 AM
Is your psychiatrist in the United States? (If not, disregard the next paragraph.)

Although some controlled substance regulations vary from state to state, in general, there is no government-mandated limit on the number of tablets a doctor can prescribe per day. If the doctor feels that it is medically appropriate to prescribe a higher dose than is commonly prescribed, it is within her power to do so. It is possible that an unusually high dose could cause scrutiny of her prescribing habits, but as long as she has done a diligent job of evaluated and monitoring you, and she has medically-justifiable reasons for doing so, she will not be violating any laws simply by prescribing 7 tablets per day instead of 6. (Disclaimer: I'm not a lawyer, and it's possible I could be wrong here....)

If you have an insurance plan, it is also possible that the insurance plan may have a limit on the number of pills they'll cover each month. (Sometimes this can be waived with a letter from your doctor or other prior authorization, sometimes not.) This is not a law or government requirement, just a policy of some insurance plans.

Also, the pharmaceutical companies have recommended maximum doses. They are typically based on the doses tested in the clinical studies required for FDA approval. Again, these are not absolute limits, just the drug company being cautious in endorsing doses that they did not test.

In any case, 6+ doses per day is a lot to remember! Have you tried extended-release dextroamphetamine (e.g. Dexedrine Spansules)? These contain the same active ingredient that you are taking now, but last longer. This might reduce the number of doses you have to remember each day, and also reduce your doctor's concerns (whatever they are) about pill limits.

sarahsweets
12-13-15, 05:43 AM
Namazu- A long time ago, when there was an adderall shortage I had to alternate between adderall xr and ir. Because there was so many doses that were a part of the shortage I had to try and take lower dose pills multiple times a day. At that point I was on 60mg of adderall and at one point the only available ones were five mg. My pharmacy wasnt able to dispense more than (i think) like 90 or 180 pills for the month. My insurance at least wouldnt cover more than that. I should have been taking like 10 or 12 a day to equal the 60mg but I was told that either it was a law, or my insurance wouldnt cover more than 180 pills in a 30 day period. I cant remember the exact amount but I had to make do with less because of that. Not sure if that was a jersey thing or what.
OP:The only advice I have for you would be to have a higher per pill dose so that you do not need as many actual pills per month.

Pilgrim
12-13-15, 05:57 AM
I don't know if this is relevant but in Australia if a specialist goes over 6 5mg Dex they need a second opinion.

I had this issue with my last doctor, sometimes they are surmising from clinical experience or looking to not run foul of the relevant government agencies.

In retrospect I should have tried to pressure my dr sooner.

namazu
12-13-15, 04:52 PM
My pharmacy wasnt able to dispense more than (i think) like 90 or 180 pills for the month. My insurance at least wouldnt cover more than that. I should have been taking like 10 or 12 a day to equal the 60mg but I was told that either it was a law, or my insurance wouldnt cover more than 180 pills in a 30 day period. I cant remember the exact amount but I had to make do with less because of that. Not sure if that was a jersey thing or what.
I stand corrected. Some states do have limits on "dosage units" as well as on how much of a supply (e.g. 1 month) that can be prescribed at one time. In NJ, it's apparently 120 "dosage units". (http://www.drugattorneynj.com/know-the-law/nj-controlled-dangerous-substances-faq/#15)

In many places, the limits are not specified the same way (http://www.cdc.gov/phlp/docs/menu_prescriptionlimits.pdf) (or may be written like "30 day supply or 120 dosage units, whichever is greater"), and dispensing limits are more likely to be related to insurance policies than to state law.

If you are taking a small dose of Dexedrine 6 times a day, it would be worthwhile to ask your doctor if it would be possible to prescribe a higher-dose pill that you could split in half to equal your current dose (if it can be split safely). Or ask about trying an extended-release version of the medication altogether.

Lunacie
12-13-15, 08:39 PM
Hi, I'd love to hear advice.

I've been prescribed 6 tablets of instant release Dexedrine per day for Adult ADHD by my psychiatrist. These last about 2.5 hours so I need more tablets.



I know math isn't my strong suit, but wouldn't 6 tablets that last 2.5 hours each mean coverage for 15 hours a day?

Of course, not everyone sleeps 9 hours at night like I do, but 15 hours coverage would be enough for most.

Abi
12-13-15, 08:42 PM
I know math isn't my strong suit, but wouldn't 6 tablets that last 2.5 hours each mean coverage for 15 hours a day?

Of course, not everyone sleeps 9 hours at night like I do, but 15 hours coverage would be enough for most.

Yup. That's what I was thinking.

TheWaitress
12-20-15, 07:37 AM
Thank you so much for all the replies!

When I said the 6 tablets last about 2.5 hours, I meant that in TOTAL they last for 2.5 hours. Each tablet is only 5mg of Dexedrine. There are no larger tablets.

The government believes this medication is addictive and my psychiatrist said this is why the government has a limit on it.

Vyvanse is not available for me.

What can I do?

Little Missy
12-20-15, 09:04 AM
Thank you so much for all the replies!

When I said the 6 tablets last about 2.5 hours, I meant that in TOTAL they last for 2.5 hours. Each tablet is only 5mg of Dexedrine. There are no larger tablets.

The government believes this medication is addictive and my psychiatrist said this is why the government has a limit on it.

Vyvanse is not available for me.

What can I do?

Are you taking them all at once?

Lunacie
12-20-15, 11:21 AM
Thank you so much for all the replies!

When I said the 6 tablets last about 2.5 hours, I meant that in TOTAL they last for 2.5 hours. Each tablet is only 5mg of Dexedrine. There are no larger tablets.

The government believes this medication is addictive and my psychiatrist said this is why the government has a limit on it.

Vyvanse is not available for me.

What can I do?

Are you in the U.S.?

If so, your psych doesn't understand the dosing guidelines or else is lying to you.

5 mg is the strongest tablet but there are higher dose capsules available.

5 mg is the usual starting dose, but it can be increased. Generally no more than 40 mg per day.

Here's what it says at drugs.com:

http://www.drugs.com/dosage/dexedrine.html

Question
12-27-15, 11:36 PM
Thank you so much for all the replies!

When I said the 6 tablets last about 2.5 hours, I meant that in TOTAL they last for 2.5 hours. Each tablet is only 5mg of Dexedrine. There are no larger tablets.

The government believes this medication is addictive and my psychiatrist said this is why the government has a limit on it.

Vyvanse is not available for me.

What can I do?

Thats weird, how many tablets are you taking per dose? My dose was 10mg twice daily, up to 3 times daily if necessary.

If its lasting only 2.5 hours total for all 6...then it doesnt sound like dexamphetamine is doing much for you. Have you tried Ritalin?

Ive heard mostly bad things about the capsule (slow release) version of dexamphetamine (mostly that it doesnt work as well as the tablets) and in my experience, the slow release form of dexamphetamine just makes me super sleepy. I can take it and start yawning like crazy about 15 minutes after.

Greyhound1
12-28-15, 12:02 AM
Are you in the U.S.?

If so, your psych doesn't understand the dosing guidelines or else is lying to you.

5 mg is the strongest tablet but there are higher dose capsules available.

5 mg is the usual starting dose, but it can be increased. Generally no more than 40 mg per day.

Here's what it says at drugs.com:

http://www.drugs.com/dosage/dexedrine.html
Just to clarify because I went through so much confusion between the pharmacy, my Dr. and the insurance company. It was such a mess and I had to do all the research to get them all on the same page.

Dexedrine brand name no longer makes any IR tablets. They do still make capsules which are the extended release spanuals. Instant release tablets only come in the form of the generic dextroamphetamine. Most IR generics go up to 10mg. I am prescribed 4 tablets a day broken into a morning does of 20mg. and afternoon dose of 20mgs.

Question
12-28-15, 10:47 AM
But theres no difference between a generic and branded medication right?

Greyhound1
12-28-15, 12:22 PM
But theres no difference between a generic and branded medication right?

There are some differences allowed with inactive ingredients and many would debate there is a difference in effectiveness.

The FDA on generics below.

http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingGenericDrugs/ucm167991.htm

FACT: FDA requires generic drugs to have the same quality and performance as brand name drugs.

Generics have the same quality as brand name drugs. When a generic drug product is approved, it has met rigorous standards established by the FDA with respect to identity, strength, quality, purity, and potency. However, some variability can and does occur during manufacturing, for both brand name and generic drugs. When a drug, generic or brand name, is mass-produced, very small variations in purity, size, strength, and other parameters are permitted. FDA limits how much variability is acceptable.

Generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration as the brand name product. Generic drugs do not need to contain the same inactive ingredients as the brand name product.

The generic drug manufacturer must prove its drug is the same as (bioequivalent) the brand name drug. For example, after the patient takes the generic drug, the amount of drug in the bloodstream is measured. If the levels of the drug in the bloodstream are the same as the levels found when the brand name product is used, the generic drug will work the same.

Through review of bioequivalence data, FDA ensures that the generic product performs the same as its respective brand name product. This standard applies to all generic drugs, whether immediate or controlled release.
All generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand name drugs, and the generic products must meet the same exacting specifications as any brand name product. In fact, many generic drugs are made in the same manufacturing plants as brand name drug products.

FACT: Research shows that generics work just as well as brand name drugs.

A study evaluated the results of 38 published clinical trials that compared cardiovascular generic drugs to their brand name counterparts. There was no evidence that brand name heart drugs worked any better than generic heart drugs.[1]

3.5% is the average difference in absorption into the body between the generic and the brand name.

FACT: FDA does not allow a 45 percent difference in the effectiveness of the generic drug product.

FDA recently evaluated 2,070 human studies conducted between 1996 and 2007. These studies compared the absorption of brand name and generic drugs into a person’s body. These studies were submitted to FDA to support approval of generics. The average difference in absorption into the body between the generic and the brand name was 3.5 percent[2]. Some generics were absorbed slightly more, some slightly less. This amount of difference would be expected and acceptable, whether for one batch of brand name drug tested against another batch of the same brand, or for a generic tested against a brand name drug. In fact, there have been studies in which brand name drugs were compared with themselves as well as with a generic. As a rule, the difference for the generic-to-brand comparison was about the same as the brand-to-brand comparison.

Any generic drug modeled after a single, brand name drug must perform approximately the same in the body as the brand name drug. There will always be a slight, but not medically important, level of natural variability – just as there is for one batch of brand name drug compared to the next batch of brand name product.

TheWaitress
12-31-15, 06:02 AM
I appreciate the replies!

I'm VERY happy with my current 5mg instant-release De tablets, but I just don't have the quantity I need.

I don't want to try the Vyvanse because I keep reading bad things about it.

I tried Ritalin before the Dex and the Ritalin didn't help me, but the Dex helps me a great deal!

TheWaitress
12-31-15, 06:10 AM
Are you taking them all at once?

Definitely not. I take each tablet separately.

TheWaitress
12-31-15, 06:14 AM
If anyone has ideas of what I can try to get more than 6 Dex tablets a day, I'd really appreciate it!

namazu
12-31-15, 12:45 PM
If your state has a hard cap on the number of tablets that the doctor can prescribe/pharmacy can dispense each month, then you're not going to be able to get more than 6 tablets/day.

You can discuss with your doctor your options, which would seem to be to either splitting higher-dose pills (10mg) in half if it is safe to do so, or trying Dexedrine Spansules, which are the longer-acting form of Dexedrine.

Socaljaxs
12-31-15, 01:53 PM
Thank you so much for all the replies!

When I said the 6 tablets last about 2.5 hours, I meant that in TOTAL they last for 2.5 hours. Each tablet is only 5mg of Dexedrine. There are no larger tablets.

The government believes this medication is addictive and my psychiatrist said this is why the government has a limit on it.

Vyvanse is not available for me.

What can I do?

Definitely not. I take each tablet separately.

Ok a little confused here.. Each time you take a dose, it last 2.5 hours? Or in total the 6 tablets combined last on 2.5 hours? If each dose last 2.5 how many hours, what times are your u taking each dose? How far apart are they?

TheWaitress
01-02-16, 12:01 AM
Thank you so much for your replies!

I need someone's opinion on this:
I could try writing a letter to the government agency who has put the limit of 6tablets of Dex per day and listing the reasons why I want more tablets.
Would this work? I want to say how I want 2016 to be a productive and good year for me and how I want to be able to study and work more.

I'd be grateful for any help!

namazu
01-02-16, 12:43 AM
I need someone's opinion on this:
I could try writing a letter to the government agency who has put the limit of 6tablets of Dex per day and listing the reasons why I want more tablets.
Would this work? I want to say how I want 2016 to be a productive and good year for me and how I want to be able to study and work more.
Such a letter is very unlikely to get you a personal exemption from state law.

If you can direct it to the right people in your state's government, and/or (perhaps more effective) get some consumer or disability advocacy people to join you in your message, there's a small chance that you could affect the policy for everyone in your state in the future.

TheWaitress
01-10-16, 05:44 AM
Thank you for your reply!

I'm not sure if it's actually a law or not. Even if it's just a government policy, do you think it'd be worth it for me to try writing a letter or could the government actually reduce the amount of Dexedrine tablets I receive?

Little Missy
01-10-16, 08:43 AM
Thank you for your reply!

I'm not sure if it's actually a law or not. Even if it's just a government policy, do you think it'd be worth it for me to try writing a letter or could the government actually reduce the amount of Dexedrine tablets I receive?

Perhaps it may be best to either discuss this with your doctor or find a different doctor.

Little Missy
01-10-16, 09:08 AM
Thank you for your reply!

I'm not sure if it's actually a law or not. Even if it's just a government policy, do you think it'd be worth it for me to try writing a letter or could the government actually reduce the amount of Dexedrine tablets I receive?

Probably not unless you write threatening letters.

Quiet-eyes
01-13-16, 06:39 AM
There are some differences allowed with inactive ingredients and many would debate there is a difference in effectiveness.

The FDA on generics below.

http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingGenericDrugs/ucm167991.htm


NOT in my experience. The Generic Dexedrine Spansules made by CorePharma didn't work for me. They made me feel awfull. Im now in the process of trying other generics.