View Full Version : Reluctance to prescribe IR?


emperorpenguin
09-12-16, 10:00 AM
Has anyone encountered resistance/refusal when trying to switch from XR to IR meds? I've broached the subject a couple of times with my psychiatrist and have been mostly unsuccessful. I've been prescribed 3x15mg spansules for the last 2 months (I usually only take 1 or 2) and while it's working well, I really like having fine-grained control over my dosage so that I can take the absolute minimum I need each day. I'm a desk jockey and it's no issue at all for me to take a pill every couple of hours if need be.

At my last appointment, I asked if I could get 8x5mg IR instead. My plan was to take 10-15mg first thing in the morning and then a couple of 5mg boosts later in the day as needed. I came armed with an e-mail response from my insurance company assuring me that this would not cause any issues; there was no quantity limit for this medication and no pre-approval was needed since I was already on it.

My psychiatrist balked and said that this was "too many pills to manage", whatever that means. It's frustrating because my reason for wanting "so many pills" is so that I can take less of the stuff--the minimum effective dose. Isn't that the goal here? 40mg/day is a midrange adult dose, period (in fact it was my starting dose). I see no reason why it should matter how that's divided up. This doctor has previously asked me if I wanted to increase my dose, and I said no. She's asked me if I wanted to talk about anti-anxiety drugs and I also declined. I though I'd established a level of trust and would be granted reasonable requests.

The compromise we arrived at was 1x15mg spansule in the morning and 2x10mg IR tabs in the afternoon. While this is at least closer to what I'd like, I feel like I shot myself in the foot a bit as I now have two copays and two opportunities for something to be out of stock. It's also a reduction in total dosage. That's not the end of the world as I wasn't taking the full dose most days to begin with, but it gives me less of a buffer (for instance, if I have to go longer than a month between appointments). I like to have a reasonable supply on hand for those kinds of scenarios.

Is it time to find a new doctor? She's been OK overall, but I'm getting frustrated trying to simply switch to a different form of the same darn drug which I know will work better for me. I feel like she's starting to get annoyed at my persistence. Has anyone else encountered something like this with their doc?

My thought was that I'd make an appointment with a different doc next time and explain the situation. If they're willing to put me on the regimen I'd like, great, and if not I could go back to the original doc as a backup. Will this somehow get me in trouble for "Doctor-shopping", or am I OK as long as I only end up with 1 prescription for the month? Any other issues I'm not aware of?

spamspambacon
09-12-16, 11:03 AM
My initial thought was "why so many pills?"

I take IR. I'm on a 40mg total daily dose, but break it down into 10mg mini-doses.

I get 20mg tablets (supposed to be taken 2x per day), but cut them in half and take a half tablet every 2 or so hours.

I was on 60mg per day, and did the same thing. I would cut the tablets in half and take 6 halves throughout the day.

So my thought is this:

Why not ask your current doc for a script of 2-20mgs or 4-10mgs daily doses and cut the tablets in halves or quarters?

aeon
09-12-16, 03:32 PM
My doctor is averse to IR for dextroamphetamine, for whatever reason, but is OK with IR for dexmethylphenidate, methylphenidate, and mixed amphetamine salts.

No bother really, 4 x 15mg Dexedrine CR spansule per day works, and works well, for me.

Plus, by this point in time, I am very aware of its dose/response characteristic, and there isn’t anything I would like to change one way or the other from what I experience now. I am “dialed-in,” so to speak.


Cheers,
Ian

sarahsweets
09-13-16, 12:12 AM
The compromise we arrived at was 1x15mg spansule in the morning and 2x10mg IR tabs in the afternoon. While this is at least closer to what I'd like, I feel like I shot myself in the foot a bit as I now have two copays and two opportunities for something to be out of stock. It's also a reduction in total dosage. That's not the end of the world as I wasn't taking the full dose most days to begin with, but it gives me less of a buffer (for instance, if I have to go longer than a month between appointments). I like to have a reasonable supply on hand for those kinds of scenarios.

Have you tried taking it like this yet?

Is it time to find a new doctor? She's been OK overall, but I'm getting frustrated trying to simply switch to a different form of the same darn drug which I know will work better for me. I feel like she's starting to get annoyed at my persistence. Has anyone else encountered something like this with their doc?

My thought was that I'd make an appointment with a different doc next time and explain the situation. If they're willing to put me on the regimen I'd like, great, and if not I could go back to the original doc as a backup. Will this somehow get me in trouble for "Doctor-shopping", or am I OK as long as I only end up with 1 prescription for the month? Any other issues I'm not aware of?

I dont know that your doc is all that horrible and of course you are allowed a second opinion, My concern would be your current doc finding out or the new one taking offense to you walking in with a demand for what you think you want to take.
Just a thought.