need some med help please! generics, dosage, etc

[fellow worker]

Hola- I need some help sorting out all this med stuff. Sometimes doctors need an educated consumer to guide their actions. I've just been diagnosed, not a week ago, with AD/HD. I'm a 26 y/o male, obese though very muscular (350 lbs), work out 5-6 days/week. The therapist said to me and in his report that I am a good candidate for "pharmaceutical intervention." I'm inclined to believe- behaviorally, my wife and I have done what we have, but when it comes down to it, I can no longer affording the utter lack of on-taskness and concentration. Anyway, I'd like o try medication at least for the workday.

I have borderline high blood pressure which will be a factor in med choice that is being treated with a low dose of a weak diuretic. It's been getting better as I've got in better shape, though.

I'm curious about the following things and looking for guidance for me and my doctor when I see him on Tuesday. Lots of questions... Any and all answers are appreciated!

1. The order of preferenced meds I'm considering is:

a. dextrostat
b. adderall
c. ritalin

The dextrostat is on top because it is less stimulative on norepinephrine, which means it's better for someone with high blood pressure than adderall or ritalin are. I specifically am interested in IR not XRs because I don't want the med to last too long. I'd rather have fine control and don't plan on being medicated except during the workday, for 5 or 10 hours worth.

I'd be willing to try Strattera, but only as a last resort, after the above. If the MD is keen on it, I am considering going back to the therapist and asking for a AD/HD doc referral. The worst part is that Strattera is specific to norepinephrine, which doesn't seem effective in the first place, but is worse for blood pressure than medications which aren't.

2. What kinds of doses should I discuss with my Doc? I imagine the best thing is to start at the lowest and work up. However, because I'm generally a pretty tolerant to medications, be it to my brain or my weight or both, I assume I'll need to be moved to a higher dose of whatever I'm put on.

My question: what is an appropriate schedule for requesting a dose increase for lack of working? Maybe this point will be moot, but I want to be prepared for it. A week seems reasonable, but is that too soon?

Man, I think about this way too much. I worry about this because the therapist noted I have a history of being "open to experimentation with drugs, though reports having no problems with drug or alcohol abuse or habituation," which is the truth. But I've known folks, had close friends, who upon admiting smoking cannabis to their regular doctor were perpetually shut out as some sort of fiend, denied drugs like codeine and hydrocodone when they were the obvious choice (after surgery, etc). I said as much to the therapist, but he seemed to think my friend was unlucky and overparanoid.

3. My third area of concern is that of generics.

It seems that the world of dextrostat is a but fuzzy. That there are some generics (like BARR) which are very bad, and others which are fine. That brand-name dextrostat doesn't exist anymore. The choices for Adderall and Ritalin are obvious- I have very good insurance and would request non-generics. But what if I end up on dextrostat? Can a doc write a prescription for a certain company, etc? What's the solution to the nasty BARR dextrostat problem I've read so much about? (e.g. http://www.dr-bob.org/babble/20030619/msgs/236521.html )

OK, so, I'm sure I am overthinking all of this, but well, it's my life and body and mind. I don't want to goof it up. Doctor's don't know anything, and a lot of times they need to be filled in by patients willing to do research.

Again, thanks in advance for any and all replies!

[VisualImagery]

FW, wath the strattera if you have high bp-It can be contraindicated in people with coronary artery disease. I have a heart valve defect and low bp (different from you, I know) and hade a very bad experience on 40mg-a low dose. My heart rate was over 100 bpm for many hours and I nearly had to go to the ER-not pleasant at all.

If you want to try it-Strattera, talk with your GP first -my suggestion, make sure it is not contraindicated for you. Then if you try it, start very low and go slow, usually the way pdocs work with meds. Monitor your bp so you know what is going on. It takes time for strattera to completely leave your body, just like it takes time to reach therapeutic levels.

I take ritalin with no problems, adderall and I are sworn enemies, it is very strange how each person is affected differently by these meds.

Best to you as you find the right treatment plan!

[fellow worker]

Well, I am hoping to avoid Strattera at all costs, a last resort of the other three don't jibe. It seems ineffective at best for a lot of people, and very problematic for a lot of others. Thanks for the reply!

[Edward]

Desoxyn has the least effects on blood pressure and such, maybe you should start on a low dose of that

[Edward]

Originally Posted by fellow worker

3. My third area of concern is that of generics.

It seems that the world of dextrostat is a but fuzzy. That there are some generics (like BARR) which are very bad, and others which are fine. That brand-name dextrostat doesn't exist anymore. The choices for Adderall and Ritalin are obvious- I have very good insurance and would request non-generics. But what if I end up on dextrostat? Can a doc write a prescription for a certain company, etc? What's the solution to the nasty BARR dextrostat problem I've read so much about? (e.g. http://www.dr-bob.org/babble/20030619/msgs/236521.html )

OK, so, I'm sure I am overthinking all of this, but well, it's my life and body and mind. I don't want to goof it up. Doctor's don't know anything, and a lot of times they need to be filled in by patients willing to do research.

Again, thanks in advance for any and all replies!

Yes you can ask your Dr to write Brand only.
And if you forget to ask your dr to write that you can write "per patient, BRAND ONLY, NEVER BARR" then sign it, on the presciription (mkae sure your writing doesn't overlap the dr's tho

Trust me I have done this and it works

[fellow worker]

Originally Posted by Edward

Desoxyn has the least effects on blood pressure and such, maybe you should start on a low dose of that

Yeah, but how nuts would it be to ask for that? I mean, let's be frank here. Maybe it's because the meth problem is especially bad here, I can't imagine the doc's reaction to a specific request for that. I mean, in my opinion, it is about delivery method, intent to abuse, etc not the chem in question (vs dextroamphetamine), though I've not had therapeutic or recreational dosages of any sort of stimulant other than caffeine (which does zilch).

I mean, these drugs are all schedule II, but isn't asking *specifically* for desoxyn at a first meeting a red flag or something? I mean, I am very interested in trying the medications with the least contradictions to my blood pressure, but it seems like the difference between asking a doc for heroin rather than morphine or oxycodone, just red flag raising. Heroin can be perscribed in the UK, not in the US, but analogous sitch.

I think I'm just paranoid about this stuff. I've really never negotiated the world of prescription medications, let alone ones with potential for abuse like those for AD/HD. I just want the best med for my problem. *I* personally don't see a difference between a methamphetamine tablet and a dextroamphetamine tablet, but like I said, I'm not a doc looking around for people trying to squirrel out drugs to abuse or sell. Thoughts?

[livinginchaos]

as for dose, regardless of what ADHD med you try, you should always start low. Starting low and titrating up (gradually working up to optimal dose) is the best way to find your optimal dose and it decreases side effects.

It will take your body at least a week to get used to the med. Spending at least a week or so on a dose is usually good enough to determine if it's a good dose for you or if more or less is needed.

Good luck!!

[Edward]

Originally Posted by fellow worker

Yeah, but how nuts would it be to ask for that? I mean, let's be frank here. Maybe it's because the meth problem is especially bad here, I can't imagine the doc's reaction to a specific request for that. I mean, in my opinion, it is about delivery method, intent to abuse, etc not the chem in question (vs dextroamphetamine), though I've not had therapeutic or recreational dosages of any sort of stimulant other than caffeine (which does zilch).

I mean, these drugs are all schedule II, but isn't asking *specifically* for desoxyn at a first meeting a red flag or something? I mean, I am very interested in trying the medications with the least contradictions to my blood pressure, but it seems like the difference between asking a doc for heroin rather than morphine or oxycodone, just red flag raising. Heroin can be perscribed in the UK, not in the US, but analogous sitch.

I think I'm just paranoid about this stuff. I've really never negotiated the world of prescription medications, let alone ones with potential for abuse like those for AD/HD. I just want the best med for my problem. *I* personally don't see a difference between a methamphetamine tablet and a dextroamphetamine tablet, but like I said, I'm not a doc looking around for people trying to squirrel out drugs to abuse or sell. Thoughts?

Ask for Desoxyn, and tell him unless he can offer a medication that is effective and doesn't effect he blood pressure as much as desoxyn, then that's the one you want

[fellow worker]

Originally Posted by Edward

Yes you can ask your Dr to write Brand only.
And if you forget to ask your dr to write that you can write "per patient, BRAND ONLY, NEVER BARR" then sign it, on the presciription (mkae sure your writing doesn't overlap the dr's tho

Trust me I have done this and it works

Cool, good to know! But if I'm interested in trying out some dextroamphetamine formulation first, what should I ask for? I mean, there is no longer a dextrostat, correct? It is taken today to mean generic dextroamphetamine. I can see the never BARR thing working, but also opening up the possibility of having to call a dozen pharmacies to find out what generics they carry. Not that is outrageous, just trying to get a handle on this.

From what I've read dexidrine has been prescribed and met with approval, but unless the 5 mg dose they come in works as is, it'll leave me and the doc having to think of something new, because of the seemingly fog around worthwhile dextroamphetamine generics.

*sigh* I think I'm thinking about this way too bloody much. I'll add the desoxyn to the list of possibilities, at least as a mention of its effect on blood pressure.

Thanks so much again for the help!

[Edward]

Originally Posted by livinginchaos

as for dose, regardless of what ADHD med you try, you should always start low. Starting low and titrating up (gradually working up to optimal dose) is the best way to find your optimal dose and it decreases side effects.

It will take your body at least a week to get used to the med. Spending at least a week or so on a dose is usually good enough to determine if it's a good dose for you or if more or less is needed.

Good luck!!

O good point, if you do get on stimulant medicine, you should buy a sphygmomanometer and check your blood pressure often

[Edward]

Originally Posted by fellow worker

Cool, good to know! But if I'm interested in trying out some dextroamphetamine formulation first, what should I ask for? I mean, there is no longer a dextrostat, correct? It is taken today to mean generic dextroamphetamine. I can see the never BARR thing working, but also opening up the possibility of having to call a dozen pharmacies to find out what generics they carry. Not that is outrageous, just trying to get a handle on this.

From what I've read dexidrine has been prescribed and met with approval, but unless the 5 mg dose they come in works as is, it'll leave me and the doc having to think of something new, because of the seemingly fog around worthwhile dextroamphetamine generics.

*sigh* I think I'm thinking about this way too bloody much. I'll add the desoxyn to the list of possibilities, at least as a mention of its effect on blood pressure.

Thanks so much again for the help!

I take DextroStat (the brand, the ONE AND ONLY!!), it's still prescribed and avaliable... (It comes in 10mg, but with the blood pressure problems, start on 5mg) and also try desoxyn before u try dextrostat(becuase it effects the Blood pressure less)

[fellow worker]

Originally Posted by Edward

O good point, if you do get on stimulant medicine, you should buy a sphygmomanometer and check your blood pressure often

I don't own one, but I check my BP at least once a week at the gym. I work out 5-6 times a week and have seen a steady decline over the last year.

I'll think about what you said and talk it over with my doc. In the midwest where I live, the meth problem is bad. I go to a clinic that is staffed all by new doctors doing their residencies, and they tend to be very by-the-book, which is sometimes really good and other times inflexible. Mostly good, but I just have a hunch about this one. Thanks!

[fellow worker]

Originally Posted by Edward

I take DextroStat (the brand, the ONE AND ONLY!!), it's still prescribed and avaliable...

It's been brought back? I remember reading something from 2003 that said it was discontinued- who makes it?

[Edward]

Originally Posted by fellow worker

It's been brought back? I remember reading something from 2003 that said it was discontinued- who makes it?

Shire makes it and it is avaiable in 10mg (but you should start on 5mg)

[fellow worker]

Yeah, I want/intend to start on lowest doses of anything, for sure. I feel I might not end up on the lowest, but I understand the logic of it! Depending on how the chat with the doc goes (tommorow), we'll see about the desoxyn, but at least I know dextrostat is still around. Thanks!