Saw the doctor today...

[mitkev]

Diagnosed for the first time today.

5+ years ago I was suspected ADD and was prescribed Dextroamphetamine (d-AMP) 10mg IR. I took it for a while but never finished my first prescription nor did I go for a follow up visit. I do remember it making a drastic improvement in my focus and concentration but I refused to believe I truly had ADD.

Today, on my first visit, I told the doctor that I was prescribed d-AMP but he said he only prescribes Adderall XR, Vyvanase, Stratera, and Focalin. When I inquired as to why he wouldn't prescribe something that already worked for me, he cited too much for potential abuse and adderall has the same thing as d-AMP. I asked about IR Adderall and he changed the topic on me stating its not as effective because the XR is much smoother.

I was prescribed 10mg Adderall XR (got the Shire brand) but feel absolutely nothing from it (I am 6'0 170lbs). I noticed no improvement in concentration or productivity. I'm assuming this is because of the 75% concentration of d-AMP in the Adderall XR which only releases 5mg at t=0 and another at t=4hrs. Thereby giving me a much lower dose than I had previously taken.

I'm not really sure what to do. I'm not too keen on calling my doctor so quickly after my visit. I know I won't notice any changes if I keep taking it everyday as it is not like a stratera which requires blood plasma concentrations of the drug to build over time.

Any input or help is greatly appreciated. Thank you!

[mitkev]

Additionally, the doctor said he must schedule regular monthly visits in order to dispense a new prescription to me each month. I asked why I couldn't have refills marked on it and he claimed because it is a class II substance its' usage must be closely monitored.

I'm curious if this is because his practice wants to collect additional income.

[ridkidLA]

Unfortunately my Pdoc does the same thing. I know in Cali, they cannot call in prescriptions that are schedule 2 such as Adderall and that I have to pick up my scripts each month at his office. In fact, the pharmacy will not even verify if they have it in stock without you coming into the store. My insurance barely covers mental health issues, so we have worked out an agreement where I come in one month for an appointment to go over the meds, progress, problems, etc. He gives me a break every other month and just has my prescriptions ready to pick up. I've seen many people on here who have cool docs that will just write them 3-4 months worth of individual scripts so that they only have to see their doc a few times year. If it's costing you a lot, your MD should be understanding.

Not sure what his issue was with the IR vs. XR. I personally like XR so much better and agree it's smoother - others like the convenience of being able to alter their dosing on an as needed basis with IR. I get booster doses of IR each month but never cash the scripts in. I don't think I really need it most of the time. Maybe up your dose to 20 mgs XR? That was the sweet spot for me.

Good luck!

[CptNemo]

Your doc is allowed by law to write 3 mo at a time.

He most likely wouldn't want to do that until you were stable and comfortable at a certain dose.

Your old dose of 10mg IR dex is equal to about 16mg adderall.

There is a still a good chance the dex would still last longer than the XR,at that equivalent dose.

If he's so concerned about the abuse potential,maybe he would go with Vyvanse.

35mg Vyvanse = 10mg dex,so you would have to go 30 mg or 50mg.

[mitkev]

Originally Posted by CptNemo

Your doc is allowed by law to write 3 mo at a time.

He most likely wouldn't want to do that until you were stable and comfortable at a certain dose.

Your old dose of 10mg IR dex is equal to about 16mg adderall.

There is a still a good chance the dex would still last longer than the XR,at that equivalent dose.

If he's so concerned about the abuse potential,maybe he would go with Vyvanse.

35mg Vyvanse = 10mg dex,so you would have to go 30 mg or 50mg.

I was under the impression that a typical adderall (racemic amphetamine mixture) was composed of 75% d-amphetamine and 25% l-amphetamine. Based on these calculations 10mg of XR adderall would be equivalent to 7.5mg d-amphetamine and 2.5 mg of l-amphetamine. Therefore the first four hours I would be getting 5mg of adderall composed of 3.75mg of d-amphetamine and 1.25mg of l-amphetamine. Much lower than my usual 10mg IR d-amphetamine.
'
So even 20mg of XR adderall would still be the equivalent of two 10mg IR adderall 4 hours apart. So 10mg of adderall = 7.5 mg d-amphetamine. Does that mean I'd need 30mg of XR adderall to get to the d-amphetamine dosage I'm accustomed to.

It just seems so much easier to just go with what worked. Instead I have to deal with my doctor's paranoia about abuse. Would it be unreasonable to say I'm dissatisfied with this paranoia and try to find another doctor?

[CptNemo]

Everything you said is true.

The exact conversion is 10mg dex= 13.73mg of adderall,because adderall,is actually 72.8% d-amp.

I went with 16mg,just to account for the l-amp.

I am using this chart:
http://www.addforums.com/forums/showthread.php?t=76106

It is the exact chart that they used for their clinical trials for Adderall XR and Vyvanse.

I really doubt your doc knows the true conversions.
Unfortunately you will likely come across as a drug seeker,if you point them out.
I did.

[indy]

you are on a baby dose, i was started at 15mg and felt nothing except a little drowsy, went up to 20mg and felt alright but not as good as i did on ritalin so i went up to 25mg and finally felt effective treatment. stimulants aren't prescribed based on weight or height but for the record i'm 4'11 and 125lbs.

[Henri J]

10mg of XR is a pretty low dose. I started out on 20 and it worked well for about a week. I am now on 30mg XR and it works pretty well.

I don't see any reason you shouldn't find a doctor who is willing to work with you instead of against you. I think a lot of general practitioners just don't have enough experience to really guide us through this difficult process. If you don't think he can help you then he is just hindering you.

I also have to pick up a paper script at the docs office every month. No refills here.

Good luck.

H

[mitkev]

Originally Posted by Henri J

10mg of XR is a pretty low dose. I started out on 20 and it worked well for about a week. I am now on 30mg XR and it works pretty well.

I don't see any reason you shouldn't find a doctor who is willing to work with you instead of against you. I think a lot of general practitioners just don't have enough experience to really guide us through this difficult process. If you don't think he can help you then he is just hindering you.

I also have to pick up a paper script at the docs office every month. No refills here.

Good luck.

H

oops guess i forgot to mention the doctor is a Psychiatrist

[Vickie]

For controlled substances (U.S. federal law), the doc has to write separate scripts for each set of pills and no refills are allowed. If the doc wrote the script for 60 pills and your insurance only allowed 30, you would not be able to get the remaining 30 pills the following month from the same script. I currently get 60 pills in a single script because that is the max my current insurance will cover at once (my last insurance covered 90 days at once). When I will not be seeing the doc for a few months, he gives me enough scripts to make sure I have proper medication coverage for the time.

Docs also have med preferences based one their med management experiences with their patients. I can be advantageous to keep with the meds that the doc has lots of experience managing for patients, but it can become a problem when you do not get get optimal effect with the potentially limited choices the doc is comfortable with. Many docs have more frequent visits in the early dosing period so that you can get to your optimal dose and effective treatment faster, but this may be hampered by insurance that only pays for so many visits and a doc that does not want you to have any additional expenses. Some docs give a script for a low dose so you can double or triple up on that dose while reporting to him/her by phone during the dose titration process, but your doc did not give you any such instructions. I personally would take the med for several days and call the doc reporting any effects (side effects and good effects) and ask if you are to continue to the next appointment. It is hard to get the med decisions, instructions, warnings, expectations and other info in a short appointment.

As you have been discussing, first you have to get to your optimal effective and stable dose and establish trust with the doc. Then you may be able to reduce the frequency of the visits and leave with more months worth of scripts. My doc sees me more often when making a change and less often when stable, we make the decision each visit. Optimal treatment of ADHD is not just taking a set dose, but optimizing the dose and dosing schedule to your needs (which may change from time to time in your life).

[mitkev]

Just went back after my initial appointment last month. Called him two weeks in and he didn't return my call because he was on vacation. The receptionist said to either continue taking the 10mg XR or stop and wait until my appointment to see the Psychiatrist.

I took it occasionally and did not play with my dose because I was not instructed to. I was careful of my diet and any potential food interactions.

I told my psych that I did not notice any positive effects or changes in my concentration and focus only a decrease in appetite and increased urination. He said ok we'll try you on 30mg XR. I quickly asked wasn't I on 10mg XR and he went ohh right then we'll do 20mg XR.

I told him about my new schedule and how I'm studying for MCATs and would like coverage even after the "12 hour" XR window. He told me I could take 10mg XR when I wake up at 8am and then take another 10mg XR at noon.

This didn't make sense to me so I basically told him that between the hours of 8am and noon I would be very unproductive because if 10mg XR by itself did nothing it won't do anything until I take the second dose at noon. He didn't seem to understand claiming I didn't understand and argued about constant blood plasma concentrations of the drug throughout the day.

I informed him that I would like the drug to work when I take it and I'll try the 20mg XR once a day. I still inquired about having some type of coverage from around 6pm - 11pm for studying and doing class work and he said I should just take it later in the day. This went back and forth for a while of me trying to explain my schedule and me taking it later would not be effective because the earlier portion of my day would be worthless. All the while he was staring at his schedule for his next patient.

I asked if there was a way to get the XR to last not as long and he said no. I asked if there was something I could take that wouldn't last as long. He said no. I stared at him blankly and said well what am I supposed to do I don't understand how I can make my days productive without having multiple hours of down time.

He stopped looking at his schedule dropped his pen and said "It seems like you're looking for instant release amphetamines, if that’s what you want you're wasting your time with me. I do not prescribe IR amps as there is too much potential for abuse." He also claimed I don't know how the XR is going to work and its very strange that I'm looking so far ahead. I told him I was merely planning scenarios out and preparing for the future. He found that strange said his time was running short and he will see me again in February.


Any advice? Am I out of line asking for IR coverage? Should I switch to a different Psychiatrist? If so should I start fresh or have my file transferred?

Thanks for your input!

[QueensU_girl]

I don't get it. Dexedrine is WAY WAY WAY milder than Ritalin and Adderall.

These doctors need to try their own medicine.

[auntchris]

lol QueensU_girl...

______________
I am glad yo saw the doctor.

My doctor also told me I will have to come in every month

to get a prescription. The pharma sist will not fill prescription... because it is

a class II substance ... and there is a lot of abuse with it.

Let us know how you are doing on the meds.