Medication and prescriber advise please!

[AniSk]

I went to see a Psychiatric Nurse Practitioner to see if my anxiety issues were stemming from ADHD and if adhd meds could be helpful. After a 20-30 min interview/discussion she agreed that ADHD sounded likely and prescribed Vyvanse. We started with 20mg and went up to 30 when I followed up a month later. Initially, I was very happy with the effects. I felt less scattered and less overwhelmed - more able to transition throughout work responsibilities. I have found, however, that these effects seem to be lessening over time. The Vyvanse also seems to wear off rather quickly and I feel like I only get 3-4 hours of its full effect. The NP suggested adding an afternoon booster of Focalin, however I also recently met a few times with a psychologist (trying to get a more thorough assessment and diagnosis) and she felt that it may be more beneficial to first increase the dose, since 30mg is considered a starting dose. To complicate things, the NP won’t allow any changes to be made or prescriptions to be given without an appointment, which is currently a $100 copay. So right now I’m at a bit of a loss regarding what to do. I’d like to find a prescriber who has the knowledge of adhd and anxiety meds but is in a cheaper tier of my insurance plan but I’m not sure if that is possible. Or if not, I’d like a provider who’d be willing to make small changes or give rx without having to come in every 2 weeks to one month... My understanding is the electronic RX or issuing multiple Rx (up to 90 day supply as long as instructions indicate when to be filled) should be allowed even for controlled substance. My current prescriber essentially cut me off when I even mentioned this possibility. Anyone have similar experiences? Advice would be greatly appreciated!!

[SleeplessinMaryland]

Time to find a new provider. They are not meeting your needs and are unreasonable.

[AniSk in reply to SleeplessinMaryland]

Yes, I’m starting to realize this! I know it can vary with state laws but I’m wondering how frequently others on here, who are on stimulants, have to see their dr? And if there are doctors willing to make changes without a formal appointment.

[SleeplessinMaryland in reply to AniSk]

I see my doctor for 15 minutes every 90 days. They will not make changes in the dosage between appointments unless it was something discussed during the appointment.

[quietlylost]

I would first give your feedback directly to the provider. Let her/him know what you're looking for and see if they can accommodate.

Second, different states have different guidelines, and so do different clinics. In some cases you cannot e-prescribe controlled substances, and only those with certain DEA keys can do it anyway. So, the NP may not be able to do that. A lot of times you can only do 30 days at a time. For me, my provider writes me three paper scripts (one for each month) and I give those to the pharmacy.

It's also good to learn about the pharmacokinetics of the medication. Vyvanse is a long acting medication that "should" have an efficacy of about 10 hours. It shouldn't vary based on metabolism, weight, or other factors. It also shouldn't be dose dependent, but everyone is different so there's a chance that you're right. You may want to move up to a higher dose. But it's important to be patient. Even though you can technically make adjustments quickly, sometimes our bodies do need time to level out and adjust. It took me about five months to get from 20 mg to 70 mg of Vyvanse where I am now. I learned that I felt really good on 50 and not good on 60. I hit 70 and that seems to be a good dose, but I'm okay that I took time to get there. Granted I had to wait and still deal with symptoms, but I appreciate finding the right dose and having had time to weigh and evaluate each dose independently for those 4 weeks at a time.

I wouldn't rush to change providers. If you can work with the one you have now and give your feedback, see what they say. Mostly, I'd just encourage you to be active in noting what your symptoms are, what you want to see more of, and also giving feedback about how the medication is working or not working.

Good luck!

[AniSk]

The problem I have is that the copay is so high and the fact the the provider doesn’t really seem to listen to my concerns. If my provider had given me a thorough explanation (as you just did) I may be willing to give her another chance. I do appreciate knowing that it took you some time to get to the correct dose. I was so hopeful with the initial effects but obviously this is no “quick fix” and I’ll have to be more patient!

[spb1234]

If you aren’t eating throughout the day then that could be why. I’ve been taking Vyvanse for the last 4 years with 70mg. The cool thing about Vyvanse is that the amphetamine salt is bound to a protein that can only be broken down by an enzyme in the stomach during digestion. Therefore you need to have food in your stomach to digest throughout the day. Generally I just take care of it with trying to eat lunch and then an afternoon snack, however it’s hard to keep up with that because the amphetamine also causes loss of appetite. In addition to the vyvanse I also use a instant release of generic adderall which works really well so if your issues persist, that might be worth looking into. Hope this helps!

[johnfamilyman]

Hi, AniSk.

Your story is quite Similar to me and possibly most people that have been diagnosed and are seeking treatment.