I have been on Adderall for two months now and next week I will call for my 3rd month refill. I want to ask my doc about titrating up another 5mg but I feel wary after what she said last time "Ok, you can only take this amount and I give you only a month at a time so I KNOW exactly what you are doing with it and if you take too much".

I understand the whole thing behind a month scrip at a time due to this being amphetamine and I have no problem with that. It was just kind of her tone when she said it that makes me feel like asking her for more will be taken very poorly. Am I just being hypersensitive? I know I can be sometimes. Anyone else have any advice/similar experience? I never take the medicine outside of the way it is prescribed so I'm not worried about myself dong something addictive or stupid. And I need my sleep. I took it kind of late one day and had trouble falling asleep. Will never do that again!




The background for more info if needed:

36 Yr old female
diagnosed ADD by psychologist 2 months ago
went to my nurse parctitioner for medicine (she is the one with the "tone")
I have only taken Adderall, no other meds for this.
Month 1 on adderall was 5 mg twice a day. I can tell a difference in my concentration at work but it doesn't last all day. Talk to NP and she puts me on 10mg a.m. and 5 mg in the afternoon.
A few days go by and I am still having the same problem. It works but only for about 6 hours total. So I just want to ask her if I should try 10mg twice a day.

Oh...this is IR.

Thanks. Sorry this is so long. I appreciate anyone's advice.

"Ok, you can only take this amount and I give you only a month at a time so I KNOW exactly what you are doing with it and if you take too much".

Oh fer cryin out loud. Could she have been a little more condescending if she tried? Doubtful. It really irks me when health care professionals treat patients like they're evil step-children up to no good.

It's so important for us to be able to be transparent and honest with those who are treating us. This kind of attitude really makes open communication difficult on our end, I know I start second guessing myself, and don't feel free to ask questions, etc.

The dose you're on is definitely not high at all. Could you find a psychiatrist that specializes in treating adhd? This nurse practitioner may not be the most informed person to be prescribing your meds. Nothing against nurse practitioners at all, it just doesn't sound like she has an understanding of the medications, mostly because of her controlling attitude. In fact, I didn't know that nurse practitioners were allowed to write scripts for schedule II drugs, maybe they are.

In any event, I'd be looking for a psychiatrist or doctor with adhd experience, where I'd feel free to ask questions and let them know what was going on.

In the mean time, you might ask her about adderall XR, (I'm assuming you're taking IR) although this doesn't necessarily last all day, I'm reading that some here take the XR in the morning, and an IR in the afternoon. I take 15 XR in the morning, and 15 XR in the afternoon.

Good luck, and don't be afraid to speak up for yourself. You're in charge of your health, and if it's not being effective, you need to let them know it's not, and find out what your options are.

Elmig - there are two separate issues in figuring out what regimen is going to work for you. One is the dose you take each time, and the other is how often you take a dose.

A dose of IR lasts 3 to 4 hours. So getting 6 hours from two doses, while on the low end, is pretty normal. How many doses you need depends on how much coverage you need. My life pre-meds was a mess from morning till night, so I needed full coverage. I take four doses a day, 3 1/2 to 4 hours apart.

The strength of the dose is a separate issue. You have to play around a bit, and try to find the amount that gives you the most benefit without causing bad side effects or simply being "too much of a good thing."

So what you need to do is figure out how much coverage you need (and be prepared to explain why) as well as figure out the right dosage. You know what 5mg vs. 10 mg feels like. Is 10 mg enough, or is it still not quite working right? Or is maybe a little TOO much? If so, you could try 7.5.

In any case, once you've figured out those two things, you're ready to talk to the NP. Just be honest. You started the meds in the hopes that they would help, and the only way they're really going to help is if you can take the appropriate dosage the appropriate number of times a day for your particular situation and body chemistry.

Good luck...

Elmig - there are two separate issues in figuring out what regimen is going to work for you. One is the dose you take each time, and the other is how often you take a dose.

A dose of IR lasts 3 to 4 hours. So getting 6 hours from two doses, while on the low end, is pretty normal. How many doses you need depends on how much coverage you need. My life pre-meds was a mess from morning till night, so I needed full coverage. I take four doses a day, 3 1/2 to 4 hours apart.

The strength of the dose is a separate issue. You have to play around a bit, and try to find the amount that gives you the most benefit without causing bad side effects or simply being "too much of a good thing."

So what you need to do is figure out how much coverage you need (and be prepared to explain why) as well as figure out the right dosage. You know what 5mg vs. 10 mg feels like. Is 10 mg enough, or is it still not quite working right? Or is maybe a little TOO much? If so, you could try 7.5.

In any case, once you've figured out those two things, you're ready to talk to the NP. Just be honest. You started the meds in the hopes that they would help, and the only way they're really going to help is if you can take the appropriate dosage the appropriate number of times a day for your particular situation and body chemistry.

Good luck... gotta agree with you chartreuse...trial and error...getting the appropriate dose is so important to our good health

First of all, I'm sorry you had to deal with that. As a nurse practitioner she is going to be scrutinized much more heavily by the federal government for this class of prescription. I dare say she is was trying to watch out for her own butt.
I would certainly recommend a psychiatrist. When you look for one, it is certainly appropriate to ask about how many patients they see with ADHD.
I always felt uncomfortable about asking for increases even though I have a wonderful doctor. I just didn't think that I would ever reach a good level. Each level would work for a little while --then not so good. Luckily my doctor knew this was to be expected, and it was more of a matter of me letting me know what was working. I ended up leveling off with Adderall XR 20mg twice a day.
During this time when you are trying to get your dosage straight, it is very helpful to keep a journal. Nothing formal. Just jot down what is working, when it works best, side effects, sleep patterns.
You can answer questions easier at the mds office. Also, when they ask why or what makes you feel like you need an increase, you can give them a well thought out answer.

Instead directly asking for an increase it's more helpful to explain how the medication is or isn't working for you. Try keeping some type of log during the month and bringing it with you to your appointment. It might also be helpful to get observations from other people in your life too.

I realized my snarkiness towards your NP in my post might not have been so helpful, sorry about that...

These folks have given you some really sound advice. I'm new to adhd meds also, and while the dose I'm on has been very helpful so far, I realize that things could change at any time.

The suggestion to keep a log or journal is a good one. I think I'll start doing that myself, that way if I need to talk to my dr. about a change in my meds, I can bring him specifics. I'd probably write down what I need to tell him and take that with me since I can't always rely on my memory at the times I need it the most.

It's totally appropriate for you to want to adjust things so that they're effective for you. So again, good luck.

jus do it why would u be scared? its not like he's gonna yell at you and give u a spankin lol j/k but yea jus ask. i asked an now im on 120mg of ir a day. 30mg to 120mg with one question and yea 5mg is a small small dose

I'm curious how it went when/if you did ask for an increase.
I've been blessed with a great GP who increased my meds with few questions. Even still, I get a little scared to ask for the increase. I chickened out this month.
I don't even like calling for my refills...

me:I'm calling because I need a refill on my med from Dr. xxx

receptionist: OK. You need to call your pharmacy and they can request it.

me: No. It's the kind of script I need to pick up every month.

receptionist: Did you talk to your pharmacy about the refill?

me: No. I need a new script every month.

receptionist: A change in medication? Do you need an appointment?

me: NO. I just need Dr. xxx to write a new script for me.

I hate it.

Yes, I agree with those who would not ask for a dose increase, just describe how it's working and not working. Any decent doctor would say we'll try a higher dose. That's how it was for me initially. I didn't even want a higher dose or think about it, I just said how I was feeling. The doctor then upped me and said to try that.

Asking for a higher dose may look like you are trying to get "drugs"- especially to these practitioners who are not experts in the area and are always suspicious to begin with.

Im no Dr. But I have been on adderall for over 3 years now so I can share what I do know. Your Dr started u out on a pretty low dose so asking to increase it would be a give in to me. You say you feel it last for up to 6hours? Not me, Mine last for maybe 4 hours max. I take 60mg a day. Once in the morn then mid afternoon. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
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One time I did try xr and it worked so much better and last longer, not only that but with instant release you have to be careful of what food you eat with it because it can lower the intensity. The xr is unaffected by food which I liked.<o:p></o:p>
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My prob is no insurance. XR is soooo expensive, where I can fill 60 adderall for 37 dollars apposed to the 300 dollars for xr!!!<o:p></o:p>
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Don’t be afraid to ask to up <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:place w:st="on"><st1:City w:st="on">ur</st1:City></st1:place> dose, you are just starting out and it will take a few trys to find the best fit for u. My doc is extremely conscious of habit forming and addictive personalities. But anytime I was honest about my meds she worked with me. She told me diabetics need insulin to function, and we need our meds to function as well. <o:p></o:p>
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Good luck and keep us posted! <o:p></o:p>
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Hi All,

thank you so much for feedback! It really helped me get over my fear and pick up the phone. Here is the great part...a nurse just called me back and left a message saying "sure, try 10 mg later in the day if you feel you need it. But don't forget that means you will have to call in earlier for your refill".

All this concern for nothing, I guess. But I am really glad this forum exists!:)

Thanks

=). That's a good thing.

I think usually psychiatrists tend to be like "Oh, well try two of them and see what happens." It surprised me that one would be so strict about it.

Ladybug, wow, that must be a stupid receptionist. Anything CII has to have a new paper prescription. Jesus Christ. Phone calls for CIIs are illegal (and potentially grounds for Rx fraud charges). Damn she's dumb. (I worked in a pharmacist, haha.)

Does anyone ever get worried that their doctor will just give up on trying to "fix" them and take the medication away? Or is that just a ridiculous way of thinking?