Final Thoughts on ADHD Medicines

My last post was how to start and titrate ADHD medicines. Today I'd like to discuss more of the fine-tuning issues, such as what happens if medicine isn't taken every day, how to remember it, what to do if parents disagree about medicine, and even how to plan for travel.

Time Off ADHD Medicines

Once a good dose is found, parents often ask if medicines need to be taken every day. 

Stimulants work when they work, but they don't build up in the body or require consistent use. (This is not true for the non-stimulants, which are often not safe to suddenly start and stop.)

Some kids fail to gain weight adequately due to appetite suppression on stimulants, so parents will take drug holidays to allow better eating.

Days off the medicine also seems help to slow down the need for repeated increases in dosing for people who are rapid metabolizers.

Drug holidays off stimulants were once universally recommended to help kids eat better and grow on days off school. Studies ultimately did not show a benefit to this, so it is not necessary. Some kids suffer if they are not on medications. Behavior issues, including safety issues while playing (or driving for older kids) can be a significant problem when not medicated. Self esteem can also suffer when kids are not medicated. Despite the fact that some kids need daily medicine, others don't. When kids can manage their safety and behavior adequately, it isn't wrong to take days off. Many kids want to gain better weight, and taking a drug holiday can help with appetite.

Talk to your child's doctor if you plan on not giving your child the medicine daily to be sure that is the right choice for your child.

Remembering the medicine

It's difficult to get into the habit of giving medicine to a child every day.  Tomorrow's post will be about how to remember medicines. 

My favorite tip is to put the pills in a weekly pill sorter at the beginning of each week. This allows you to see if you're running low before you run out and allows you to see if it was given today or not. These medicines should not be kept where kids who are too young to understand the responsibility of taking the medicine have access.

Controlled substances

Controlled substances, such as stimulants, cannot be called in or faxed to a pharmacy. Many physicians now have the ability to e-prescribe these.

Controlled substance prescriptions cannot have refills, but a prescriber can write for either three 30 day prescriptions or one 90 day prescription when they feel a patient is stable on a dose.

Stimulants are not controlled substances because of increased risks and side effects. Some of the more significant side effects of ADHD medicines are seen in non-stimulant medicines. 

They are controlled substances because they have a street value. Teens often buy them from other teens as study drugs. This can be very dangerous since it isn't supervised by a physician and the dose might not be safe for the purchaser. It is of course illegal to sell these medicines.

The DEA does monitor these prescriptions more closely than others. If the prescription is over 90 days old, many pharmacists cannot fill it (this will vary by state), so do not attempt to hold prescriptions to use at a later time.

Acids and Stimulants

It has been recommended that you shouldn't take ascorbic acid or vitamin C (such as with a glass of orange juice) an hour before and after you take medication.

The theory is that ADHD stimulants are strongly alkaline and cannot be absorbed into the bloodstream if these organic acids are present at the same time.

High doses of vitamin C (1000 mg) in pill or juice form, can also accelerate the excretion of amphetamine in the urine and act like an "off" switch on the med.

In reality  have never seen this to be an issue.

If anyone has noticed a difference in onset of action or effectiveness of their medicine if they take it with ascorbic acid or vitamin C, please post your comment below.

When Mom and Dad disagree

It is not uncommon that one parent wants to start a medication for their child, but the other parent does not.

It's important to agree on a plan, whatever the plan is.

Have a time frame for each step of the plan before a scheduled re-evaluation.

If the plan isn't working, then change directions.

Be cautious of how you talk about this with your child. If kids know it is a disagreement, they might fear the medicine or think that needing it makes them inferior or bad.

Do not talk about the diagnosis as if it's something the child can control. They can't.

Don't make the child feel guilty for having this disorder. It isn't fair to the child and it only makes the situation worse.

Having the medicine when you need it

Refills 

There is nothing more frustrating for a parent and child than to realize that there's a big test tomorrow and you have no medicine left and you're out of refills.

Technically none of the stimulant medicines can have refills, but a prescription covering 90 days at a time can be given. This can be done with a 90 day prescription or three 30 day prescriptions.

The technicality of this is sometimes difficult. You cannot call your pharmacy to request a refill. You must ask to have the next prescription filled if your physician provided 3 prescriptions for 3 months.

Be sure to know the procedure for refills at your doctor's office.

Travel

It's very important to plan ahead prior to travel if your travel involves the timeframe of needing new medication.

You must plan ahead so that if a refill will be needed during the trip you will either be able to fill a prescription you have on vacation or you will need to fill the prescription in advance.

Most people can get a prescription 7 days prior to the 30 day supply running out but not sooner, so you might need to fill a couple prescriptions a few days earlier in the month each to have enough on hand to make it through your vacation. It takes planning!

Sometimes you can work with your physician and pharmacist to get medicines early prior to travel. Talk to your pharmacist to see if they can help arrange this.

If you are out of town and you realize you forgot your child's non-stimulant, call your doctor to see if they can e-prescribe it. Many of the non-stimulants are not safe to suddenly stop, so they are likely to send in a prescription. Insurance is not likely to pay for these extra pills if it was recently filled.

International travel will require that you find the laws in the other country to find out if you can bring controlled substances into the country. If you will need additional medicine while you are in that country, you will need to find a way to get the medicine.

Mail order

Some insurance companies will allow mail order 90 day prescriptions.

There are insurance companies that not only allow, but require them on daily medicines.

Others do not allow it.

In general I advise against a 90 day prescription if the dose is not established or if there are any concerns that it might not be the perfect dose. If there is any concern that it might need to be changed, a 30 day prescription is a better option.

If you will need to do a mail order, be sure you schedule your appointment to get the prescription early enough to account for the lost time mailing.

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference - April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.