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Old 12-03-11, 11:09 AM
rthomas rthomas is offline
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Unhappy Discussing Adderall Dosage with Doctor - Advice Needed!

First post. I'll start with a bit of an introduction. I'm 25 years old. I was diagnosed with ADHD when I was 9 or 10 years old and was started on Prozac. A few months later I was switched to Adderall and I've been on it since. So I've been prescribed Adderall longer than not; more than half my life. I've never really had any problems with side effects, not have I developed a noticeable tolerance even after 15 years of use. All throughout elementary and middle school, my prescription was for one daily dosage (dosage amounts changed over the years, of course, and changing between IR and XR for a brief period). During these years, I wasn't medicated during summer break, weekends, holidays, etc.; however, my father still collected and filled the prescription, so I was slowly building up a stockpile of Adderall. There were also a few years where I tried to do without medication entirely; however, each time I stopped taking it for long periods, my grades absolutely plummeted. I tried tutors, councelors, the lot, but Adderall was ever the only thing that could keep me on track, but that's a different topic.

Up until my Junior year of high school, I was still taking one adderall in the morning before school and it would start to wear off just before class was finished. This worked fine because I rarely had homework and I rarely needed to study. Junior year was when things started getting busy (full AP/Honors course load, college prep) and I usually had a steady flow of homework and studying. To stay on top of my schoolwork, I upped my dosage from 20mg once daily to 20mg twice daily - one in the morning and another around 1:00-2:00pm; however, I didn't tell my doctor about this at the time. With the stockpile I had accumulated (plus off-time during summers), I wasn't in danger of running out any time soon.

I maintained the 20mg twice daily throughout my Junior and Senior years of highschool as well as my Freshman year of college. Actually, I tried to stop taking Adderall during the first semester of my Freshman year and ended up on academic probation as a result, but again, that's a separate story.

During a 6month regular checkup with my doctor (some time between Freshman and Sophomore year), it finally occurred to me that I should probably inform him I was taking 20mg twice daily. So I told him I increased my dosage and he didn't show any signs of concern - in fact, he increased my prescription to 20mg twice daily without me even requesting.

I spent my entire Junior year studying abroad in London, England. Mechanical engineering was my degree. Not only was I adapting to life on my own in a new country, but I was absolutely determined to earn my engineering degree in four years despite studying abroad. Needless to say, my study abroad experience was a whirlwind of culture shock, studying, lectures, and trying to get out and experience the world when I had a chance. The reason I mention this is because there were a few times that I took 20mg 3 times a day simply due to the shear workload of a full class schedule (in a foreign country, nonetheless).

For my Senior year, I was back at my home university and anyone who has studied engineering knows that Senior year means Senior design project. My design project on top of a full class schedule entirely consumed every waking moment and it was then that 20mg 3 times a day became the norm. It was the only thing I could do to stay on top of homework, studying, and my design project and it's various deadlines. On top of that, my design project was part of a larger overall project on which other students were working and relying on the completion of my part of the project in order to complete the overall project. With other students depending on me, I didn't think twice about taking 20mg 3 times a day. And of course, I neglected to inform my doctor that I had increased my dosage again.

After graduating (in 4 years, nonetheless ), I was fortunate enough to be in a position where I was not in immediate need of income and I made the decision to pursue a life-long passion in professional motorsports (I've been racing nearly as long as I've been medicated!). Naturally, as a mechanical engineer, I personally do the majority of the design, engineering, and fabrication on my race car. Unfortunately, I haven't yet reached the point where I can call on a fully equipped team to assist with the car, so for now, it is just my father and myself. What this means is my ability to put in long hours and focused concentration is directly linked to my safety and my car's potential on track. In simplest terms, when taking 20mg twice daily, there is still a lot of work to be done when the second dose starts wearing off.

During a routine checkup about 12 months ago I mentioned to my doctor that I had been taking 3 pills each day. He didn't seem too concerned but he did advise me not to exceed 40mg each day.

Then, at my last checkup, about 6 months ago, I mentioned again that I was needing 3 pills each day to stay on top of my work. This time I attempted to explain my pursuit of a career in professional motorsports and how two pills just doesn't last long enough to accomplish enough in a day. Again, he advised me not to take more than 40mg per day and exceeding that amount can have negative health affects. I think part of the problem is its difficult for anyone not involved with racing to understand how it could possibly be necessary to spend 14-16 hours a day, every day, preparing a race car for the next race. I'm sure even as you read this, you think I'm full of s***. The reality is, I don't think my doctor understands the time demands of preparing a race car (not to mention by yourself) and I don't know how to portray it. Hell, sometimes at the end of a long day, even I have trouble grasping the time I've invested.

I've been taking 3 pills per day for quite a while with no perceived ill effect on my health. I'm 5'9" and weigh 155 lbs. My weight has been a consistent 155-160 since I was 18. My heart rate and blood pressure have always been within healthy limits at my 6 month checkups. Having been on Adderall for so many years, I've developed eating and sleep habits, so I don't have problems with sleep (unless I'm not on Adderall, in which case all I do is sleep) or malnutrition. I've been vegan for 4 years, so proper nutrition is always a top priority for me.

My stockpile from years ago has recently run out and my prescription is still for 20mg twice daily. It doesn't take a scientist to realize my current routine isn't sustainable. If I take 3 pill each day, then I run out before my next prescription. On the other hand, if I limit myself to two pills per day, I start to lose concentration after 8-12 hours and end up falling behind.

My next 6 month checkup is coming up in a week or two and I'm wondering how to approach my doctor about increasing my dosage to 20mg 3 times daily. I've been taking 3 pills per day for longer than he is aware; however, I'm hesitant to tell him that because I'm afraid he'll automatically assume I'm abusing amphetamines. At the same time, I'm hesitant to even bring the topic up again for fear that mentioning it at 3 consecutive checkups will make him suspect I'm abusing it and in a worst-case-scenario, cut off my prescription. The way I see it is, I know my body better than anyone and I feel fine taking 3 pills per day. However, my doctor seems pretty adamant that exceeding 40mg daily should never happen.

I've never been good with speaking to people I don't know well, so any advice on how to bring it up in a way that isn't going to raise red flags in doctor-speak would be greatly appreciated! Would I be better off looking for a new primary car physician? I noticed the "Reference For Local Doctors" thread lists a few doctors in my area. Or is my doctor right about the health dangers and I should just forget about trying to get my dosage increased?

My apologies for such a lengthy first post! I hope someone has the attention span to read through all of it. Thanks in advance!
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Old 12-03-11, 04:48 PM
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Re: Discussing Adderall Dosage with Doctor - Advice Needed!

You need to recognize that he's already told you that he's not comfortable with the dosage you suggest. He's prescribed the max he's comfortable with.

If you simply keep framing your request in the same terms, you will not like the results.

My suggestion is to try to work within the current RX and document how your day progresses. Take your first dose as you wake, and your second 5+ hours later, but at a consistant time. When you go to the next check up, explain your schedule and your needs. Explain how effective you are over the course of the day, including the times you are doing quite well.

If all he hears is a demand for more drugs, he's likely to dig in and either refuse the increase, or worse, discontinue treatment for suspected abuse.

If he hears that you are on the go (and effective) from 7am until 6pm, but failing noticeably in your work and missing crucial details in car prep from 7pm until 11pm, he might look at this differently.

My guess is the best you can possibly hope for at first is a switch to a morning 30mg XR, and possibly two 10 mg IR boosters.
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Old 12-05-11, 07:25 AM
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Re: Discussing Adderall Dosage with Doctor - Advice Needed!

I think if you bring in prescribing info it may help . The max daily dose is 60mg a day so you're not crasy.
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Old 12-05-11, 09:26 AM
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Re: Discussing Adderall Dosage with Doctor - Advice Needed!

Wall of text makes me slit
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Old 12-05-11, 03:19 PM
rthomas rthomas is offline
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Re: Discussing Adderall Dosage with Doctor - Advice Needed!

I should also mention I've always taken Bar brand generics (since Adderall's patent ran out), but recently all I can find is the Corepharma brand. I didn't think this had anything to do with requiring more doses per day until I read on here about Corepharma being having a shorter effective span for some people. I was always under the assumption that generic adderall was generic adderall.

Is this worth mentioning to my doctor or is he likely to just tell me that all generic brands are effectively the same?
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Old 12-05-11, 06:01 PM
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Re: Discussing Adderall Dosage with Doctor - Advice Needed!

You need to find a psychiatrist, not a primary care doctor to prescribe it to you. A psychiatrist is going to have alot more experience with the drug so he/she will likely be more comfortable RX'ing it. Before I starting seeing my psychiatrist I got my adderall from a primary care doc, who would not increase my dose past 40 mg a day. At my first appointment I talked to the psychiatrist about my dose and the issues I was having and he changed my RX to 60 mg per day at the first appointment! I would definatly try a psychiatrist before giving up.
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Old 12-05-11, 07:30 PM
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Re: Discussing Adderall Dosage with Doctor - Advice Needed!

I would use DXM, magnesium and memantine (40mg) to counter-act the tolerance you've experienced.
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