View Full Version : Almost at the end of the rope


AED1955
02-12-16, 02:47 PM
Over the last 3 years my Dr. has prescribed 3 different meds for my ADD. The first was IR Ritalin, which worked well for about the first 2 then slowly started to lose it's effectiveness. He the switched me to IR Adderall which I only took for about a month because it would work for about an hour then made me very drowsy. Just received a script for IR Dexedrine 5 mg to be taken 3 times a day. It worked well for the first 3 days, but now it seems to have little effect. BTW I am not a drug seeker trying to chase a high, I just want something that helps me focus and stay on track with everyday tasks.

The Dexedrine script is only for a 2 week supply and I am supposed to call him in about a week to advise how it is working out. He said we may have to up the dosage a bit, as he stated this is a very low dose, but he prefers to start out this way mostly to make sure I don't experience any significant side effects. He said the most common complaint he receives from patients taking this drug is a reduction in appetite and dry mouth which may or may not be severe enough to discontinue the drug.

If increasing the dose doesn't help I fear that maybe I have just built up a tolerance to stimulant type drugs and may have to just deal with my ADD without them.

As a side note, my insurance does not cover Dexedrine at all and this appears to be a fairly expensive drug. After checking at 3 other pharmacies I could only find it at a Walgreens, where at first they said it would cost $113 but when I picked it up they only charged me $50 as they stated they found some kind of coupon that provided a discount for customers that did not have insurance. Also when I asked the pharmacist why nobody seemed to carry it, he stated that very few doctors write scripts for it anymore so most pharmacies don't bother to stock it. He said Adderall has pretty much become the drug of choice for treating ADD.

dvdnvwls
02-12-16, 03:57 PM
You are too worried about tolerance. It is (most of the time, pretty much) a myth, as far as prescription stimulants are concerned. Addicts do have this problem - they get onto a cycle of needing more and more. In general, we just don't ever reach that territory.

It sounds to me like if your doctor and you can do some careful experimenting with the dosage to see exactly what works, either Dexedrine or Adderall will probably end up working pretty well.

Don't fall into the trap of wanting your medication to feel like it did on the first day. You are supposed to stop feeling it work after a few days. It's still working, you just don't notice anymore. Judge the drug's performance by the way it controls your symptoms, not by how you feel. (The only exception - if it makes you feel bad, then do something about that.)

Lunacie
02-12-16, 05:32 PM
Good info from dvd, I'd just add that changing the dose a few times is more important than changing to a new med.

Side effects may go away in a week or two, or may not even be a problem at a different dose. Some need more, some need less.

All stimulant meds should be started at a low dose and titrated upwards until either the benefit is as good as it gets, or the side effects outweigh the benefits ... and then you go back down a dose and see how that works.

It takes a lot of patience to sort out these meds, and we're notorious for being impatient. ;)

namazu
02-12-16, 07:46 PM
Contrary to what dvdnvwls stated, whether or not tolerance to stimulants occurs at therapeutic doses, and with what frequency, is still an open question for research. There is very little solid evidence one way or the other, because it's difficult to conduct the kind of long-term follow-up study that would yield useful information, and long-term treatment of ADHD in adulthood has only relatively recently become a topic of scientific research. Some people certainly do benefit from a stable dose of medication for years, but others report decreased efficacy over time, and the reduction in benefit can't always be explained away by other factors (even though sometimes it can).

All of that said, I agree that you're putting the cart before the horse. If you make yourself sick with worry about hypothetical worst-case scenarios, it's going to have an adverse effect on you now -- and the worry won't help prevent future issues, in any case.

Focus on treating your ADHD now, and on living your life. Work with your doctor to titrate the dose slowly and carefully, and with any luck, you'll see a sustained improvement in your ability to function. (And who knows what the future will bring? Maybe new treatment options...that you may not even need!)

As for availability -- Dexedrine may not be the most-prescribed ADHD drug, but it's common enough that (absent major shortages) you shouldn't have too much difficulty finding it at major chains. Stock levels may not be as high as with other meds. In my experience, it's been helpful to stick with a single pharmacy. Once you settle on a dose of medication, so that you can anticipate your needs, you can even ask the pharmacy to order it for you. With stimulants, they're usually hesitant to do things like that without a prescription in hand, but if they know you and know that you do show up with a scrip tin hand every month, they may be able to be sure it's in stock.

As for price, are you taking the brand-name or a generic? Have you looked into the possibility of appealing your insurance plan's non-coverage of the medication? In some cases, with a letter of medical necessity from your doctor (which usually has to state that you've tried other covered medications without success), you may be able to get an exception. It may not work, but couldn't hurt to find out.

It's harder to shop around for low prices or get discounts on stimulants than it is for other meds because of restrictions due to its CII status, but there are discount cards available, as you're aware. Some people here have recommended GoodRx as a comparison-shopping site, though if there's limited supply in your area, there may be only so much you can do.

Anyway, I wish you the best in your quest!

Snake-Eater
02-13-16, 08:16 AM
Tolerance def occurs with stims. However, like stated above, after awhile you won't get the same feeling you got when you 1st took it. It is a trap if you think that's how this med works. Don't chase that feeling. You also have to eat to replenish your neurotransmitters, or else you'll be running on "fumes" but it's tricky. What you eat will determine the drugs efficiency. Acidic foods will dampen, alkaline will enhance. Eating is also a chore. A side note, constantly thinking about a solution for your illness is mentally taxing, adding to loss of focus and motivation. Do some fun activities that gets your mind off this and it will feel like a ton of weight has been lifted off you.

Pilgrim
02-13-16, 09:37 AM
Also plenty, plenty of water. Good blood thinner.

AED1955
02-13-16, 03:06 PM
Many thanks to all who replied. I believe with some dosage tweaking the D Amp is going to be my best option at this point. I am going to call him on Monday and advise how it's going. He has been quite flexible in the past about trying different meds and adjusting dosages to try and get things working right. I will let you know how it goes.

Snake-Eater
02-14-16, 06:55 AM
Forgot to mention this, DO NOT get Barr generic. Absolutely terrible. Wish the best for you!

sarahsweets
02-15-16, 08:37 PM
You also have to eat to replenish your neurotransmitters, or else you'll be running on "fumes" but it's tricky.
What scientific evidence can you provide to back this up?

Snake-Eater
02-15-16, 10:03 PM
Adderall's Effect On Your Brain: Whatever Obscure Benefits There Are, It's Not Worth It (http://www.printfriendly.com/print/?source=homepage&url=http%3A%2F%2Fwww.medicaldaily.com%2Fadderalls-effect-your-brain-whatever-obscure-benefits-there-are-its-not-worth-it-313862)
Adderall Side Effects and Nutritional Deficiencies (http://www.printfriendly.com/print/?source=homepage&url=http%3A%2F%2Fwww.naturalnews.com%2FDrugWatch_A dderall.html)

sarahsweets
02-16-16, 05:05 AM
What you provided are good articles but not much science backing them up. There are no works cited that I could find to read how the author came to his/her conclusions.

Snake-Eater
02-16-16, 05:56 AM
What you provided are good articles but not much science backing them up. There are no works cited that I could find to read how the author came to his/her conclusions.

The second link has the references at the bottom. I also speak from experience. I've taken dexedrine and it completely destroyed my appetite. When I Would take another dose it wouldn't do much. I would take a Few days off, eat a lot and the effects were much more pronounced. Strangely, adderall increased my appetite but also my blood pressure. When the amphetamines worked, they helped tremendously, but side effects and having to watch what you eat made it not user friendly. Focalin is the better option for me.

Snake-Eater
02-16-16, 05:58 AM
namazu, Sorry about the links.

sarahsweets
02-16-16, 06:42 AM
The second link has the references at the bottom. I also speak from experience. I've taken dexedrine and it completely destroyed my appetite. When I Would take another dose it wouldn't do much. I would take a Few days off, eat a lot and the effects were much more pronounced. Strangely, adderall increased my appetite but also my blood pressure. When the amphetamines worked, they helped tremendously, but side effects and having to watch what you eat made it not user friendly. Focalin is the better option for me.
I hear what youre saying i didnt mean to discount the links you shared. And I can see how the side effects could be difficult to manage for some people.

Snake-Eater
02-19-16, 06:25 PM
I hear what youre saying i didnt mean to discount the links you shared. And I can see how the side effects could be difficult to manage for some people.

Yea, even worse when you spend so much money just to figure out what works

AED1955
02-23-16, 02:25 PM
Sorry it took so long to respond back to my OP. My Dr was out of town and I just got a hold of him yesterday. He does not want to up my dose of 5 mg at this time because he said judging the effectiveness of Dexedrine after just a 15 day trial would not be appropriate, so he wrote me a script for a 30 day supply this time to see how the next month goes.

When I went today to pickup the script from his office and get it filled I ran into some problems finding a pharmacy that could fill it. I was able to get the previous 15 day supply without any problem at a Walgreens close by, but this time the same pharmacy could not fill it because they did not have enough on hand to fill the full 90 pill script. I did not know this but pharmacies cannot partially fill schedule II drugs, they have to give you the full amount called for on the script or nothing.

Since there were 2 other Walgreens close by they called them for me and luckily one of them did have enough to fill the script. Since my insurance will not cover Dexedrine I had to pay out of pocket. It struck me as strange that they did cover my previous scripts of Ritalin and Adderall but not the Dexedrine. The pharmacy tech said that many insurers do not cover Dexedrine and many doctors will not prescribe it because it is considered to be more abuse-able then most of the other scheduled stimulants. I don't know if there is any truth to this but I do know that my doctor has no problem prescribing it as long as his patients have tried Ritalin and Adderall first and had issues with them. Anyway, in the end, it only cost me about $40 so I had no real complaint.

sarahsweets
02-24-16, 10:44 AM
You pharmacy tech is full of it. ALL stimulants are easily abused.

AED1955
02-24-16, 02:25 PM
You pharmacy tech is full of it. ALL stimulants are easily abused.

Yeah, I pretty much took what he said with a grain of salt. A lot these so called "techs" are just wanna be pharmacists.

Greyhound1
02-24-16, 06:38 PM
Dexedrine usually gets a bad rap because it was originally a diet pill in the 50's and people took them like candy. It had a negative connotation well before it was marketed and used to treat ADHD.