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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Mistermindmasta on June 6, 2012, at 17:52:31
I've been taking nuvigil for about 1.5 years for add/fatigue type issues and recently switched to generic methylphenidate bc of cost issues with the nuvigil w/o insurance. The methylphenidate is MUCH MUCH better for my add symptoms but I find that the effects tend to wear off quickly. Like a dose lasts 3 hrs or so. Btw my rx is 20mg 2x/ day. I've taken amphetamines many years ago and they lasted much longer. But anyway, to my point... So with the latter half of my day dragging a bit And not feeling as productive, I've decided to increase my dose to add a third pill per day. Now before I get ppl talking about this being the path to addiction or whatever, my decision was calculated and aware of risks. Anyway so I want to go to my doctor a week or so early for my refill and say 2x / day was a little weak on some days so I took a 3rd, and maybe suggest a dose increase. So my question is, is it a good idea (assuming my dr trusts me, which I'm pretty sure he does) to admit to taking a few extra bc I felt maybe a higher dose is needed? Or would it be better to wait until day 30 to go see him and THEN talk about a possible dose increase. So right now, I'm out of pills, which I knew was coming, and isn't that much of a big problem, but I really think 3 x / day is much better for me. However I suppose taking 1 extra per day on some days is a certain kind if misuse, I'm just hoping my doc would agree that the misuse was something that might have been justified. Thx for the tips in advance.
Posted by Phillipa on June 6, 2012, at 18:24:21
In reply to Good idea to request dose increase for stimulants?, posted by Mistermindmasta on June 6, 2012, at 17:52:31
I'd level with the doc. If you don't what if if he won't prescribe it for you anymore? Phillipa
Posted by emmanuel98 on June 6, 2012, at 20:30:35
In reply to Good idea to request dose increase for stimulants?, posted by Mistermindmasta on June 6, 2012, at 17:52:31
I did the same thing with adderall and my p-doc approved and wrote me a new scrip saying he was upping the dose. But the pharmacy refused to fill it because it's a schedule 2 substance. Maybe it was the insurance company, so if you don't have insurance it might be less of a problem.
Posted by Christ_empowered on June 6, 2012, at 23:39:31
In reply to Re: Good idea to request dose increase for stimulants?, posted by emmanuel98 on June 6, 2012, at 20:30:35
Instead of upping the kiddie cocaine, why not ask for a switch to straight up speed? Vyvanse, adderall, dexedrine..you've got options. Just tell the prescriber about the problems getting the stuff to last long enough. If you get an XR amphetamine, that'll also help prevent dosage escalation, I would think.
Posted by novelagent on June 7, 2012, at 9:52:49
In reply to Good idea to request dose increase for stimulants?, posted by Mistermindmasta on June 6, 2012, at 17:52:31
Don't tell me you know about the risks, I use to think I was clever and knew my sh*t. I would take my stimulant whenever I felt I needed a boost with my reading, a chore, etc.
I wound up getting schiziphreniform. A few months later, Medscape alerted doctors that the head of the National Institute of Drug Abuse was announcing research that for the first time, really, found a causal link between long-term, high-doses of amphetamines and schizophrenia.
You're at a classic point now where you are taking the medicine in what is called an "unorthodox" manner. Meaning, you lack the fear the average person has in taking a medicine without a doctor's explicit approval. The reason this is associated with addiction behavior, not to say you have addiction behavior, is because the fear of taking something without your doc's approval stops most people on stimulants from needing an early refill, and needing an early refill is a red flag.
You are also taking the mediciation with high expectstions, and this expectation is basically translating in your head to "I must have this drug 24/7 to function, it's normal to think that way, and I don't care if it means risking going without the med for a whole week if I can just have a few more hours a day of the med working." You're not weighting the risk of going without the med for a week or more against the risk of going eithout the med working at optimium capacity for just a few extra hours. That's irrational.
Let me put this another way: let's say you have acid reflux. Let's say the acid reflux med your doctor recently prescribed is only working until 9 PM, giving you acid reflux for the remaining few hours. Would you take another dose of the medicine at 8 PM, knowing you'll be out of the medicine a week early if you do, or do you wait a couple of weeks to speak to your doctor about adjusting your dose? There's a reason why your judgment is different on Ritalin. Prilosec doesn't change your ability to make decisions about taking Prilosec.
Also, you likely only need, it sounds, a very moderate, modest dose change. That's not what I'm worried about. What I'm worried about is this becoming a pattern, and the next time you have some very boring task at work, or the next time you sleep for 5 hours instead of 7, instead of grinning and bearing it, you turn to the medicine, and dose on an as-needed basis. And Gosh forbid you don't have the medicine working at its peak dose for 2 or 3 or even 4 hours.
See what I'm getting at? Don't be like me, I started off thinking I was smarter than my doc, and now I have to get an antipsychotic injection every month,
> I've been taking nuvigil for about 1.5 years for add/fatigue type issues and recently switched to generic methylphenidate bc of cost issues with the nuvigil w/o insurance. The methylphenidate is MUCH MUCH better for my add symptoms but I find that the effects tend to wear off quickly. Like a dose lasts 3 hrs or so. Btw my rx is 20mg 2x/ day. I've taken amphetamines many years ago and they lasted much longer. But anyway, to my point... So with the latter half of my day dragging a bit And not feeling as productive, I've decided to increase my dose to add a third pill per day. Now before I get ppl talking about this being the path to addiction or whatever, my decision was calculated and aware of risks. Anyway so I want to go to my doctor a week or so early for my refill and say 2x / day was a little weak on some days so I took a 3rd, and maybe suggest a dose increase. So my question is, is it a good idea (assuming my dr trusts me, which I'm pretty sure he does) to admit to taking a few extra bc I felt maybe a higher dose is needed? Or would it be better to wait until day 30 to go see him and THEN talk about a possible dose increase. So right now, I'm out of pills, which I knew was coming, and isn't that much of a big problem, but I really think 3 x / day is much better for me. However I suppose taking 1 extra per day on some days is a certain kind if misuse, I'm just hoping my doc would agree that the misuse was something that might have been justified. Thx for the tips in advance.
Posted by novelagent on June 7, 2012, at 10:14:12
In reply to Good idea to request dose increase for stimulants?, posted by Mistermindmasta on June 6, 2012, at 17:52:31
So um I don't think your request to EVENTUaLLY get 3x/day is unreasonable-- Especially given the fact the half life for Ritalin is 4 hours or something, But you're not going to get it early.What I would do is stop taking more than prescribed, and then you're going to have to grin and bear it while you're without the medicine. I would also take only one dose a day, to make up for using so much, and doing your better work while with that dose.
But no, your doc, is not going to be able to give you a higher dose early on the grounds of you feeling like taking more than prescribed. Doctors have these things, they're called medical records. DEA agents routinely audit medical reports, looking for cases just like these, where patterns of what are called, eithout passing judgment, abuse. You're telling the doc he has a reason to not give you Ritalin ever again, and then you're asking your doc to give you not just more Ritalin, but an early refill.
Early refill is the biggest red flag doctors are suppose to look out for for signs of abuse, and adjust their prescribing habits accordingly. And I'm just talking about patients who claim they lost the medicine-- they're still responsible for mind reading patients and spotting liars, as far as the DEA is concerned, Your doc, I'm sure, serms like a nice, friendly guy, but even if he didn't think unorthodox use of Ritalin is a red flag for future abuse, you're effectively asking him to do something that would look bad on paper, or to a jury. DEA spots early refills in their drug monitoring programs. If your state requires you to present an ID to get Ritalin, then your state has a rx drug monitoring database the DEA uses to spot suspicious behavior. Prescribing early is a red flag the database would catch. Even if it were otherwise explainable, they trigger audits for far less suspicious reasons. An audit involves reading the medical record. So you're either thinking the DEA won't read your medical record ever, or you think your doc is willing to lie in your medical record, or you aren't thinking. I'm going with door number 3, with all due respect.
> I've been taking nuvigil for about 1.5 years for add/fatigue type issues and recently switched to generic methylphenidate bc of cost issues with the nuvigil w/o insurance. The methylphenidate is MUCH MUCH better for my add symptoms but I find that the effects tend to wear off quickly. Like a dose lasts 3 hrs or so. Btw my rx is 20mg 2x/ day. I've taken amphetamines many years ago and they lasted much longer. But anyway, to my point... So with the latter half of my day dragging a bit And not feeling as productive, I've decided to increase my dose to add a third pill per day. Now before I get ppl talking about this being the path to addiction or whatever, my decision was calculated and aware of risks. Anyway so I want to go to my doctor a week or so early for my refill and say 2x / day was a little weak on some days so I took a 3rd, and maybe suggest a dose increase. So my question is, is it a good idea (assuming my dr trusts me, which I'm pretty sure he does) to admit to taking a few extra bc I felt maybe a higher dose is needed? Or would it be better to wait until day 30 to go see him and THEN talk about a possible dose increase. So right now, I'm out of pills, which I knew was coming, and isn't that much of a big problem, but I really think 3 x / day is much better for me. However I suppose taking 1 extra per day on some days is a certain kind if misuse, I'm just hoping my doc would agree that the misuse was something that might have been justified. Thx for the tips in advance.
Posted by novelagent on June 7, 2012, at 10:20:42
In reply to Re: Good idea to request dose increase for stimulants?, posted by Christ_empowered on June 6, 2012, at 23:39:31
I've been on all of the stimulants, and can't say Ritalin is somehow inferior to amphetamine for any reason. They all do the same thing. Also, there's Concerta, which is very high-tech, although the sophisticatedway I've read it is manufactured, in specialty equipment made just for it, makes it sound like it's one of those meds I wouldn't want to try as a generic. But,it's now sold as a generic, I think. So is Ritallin LA, long-acting ritalin (but less sophisticated).If Ritalin is working for him, his best bet is to say it doesn't work very long, and ask to be switched to Concerta, This will avoid the need to basically ask for an early fill, since the drug monitoring database and the insurance just see it as a whole different medicine. I would also stick with what you know, instead of having to toy around and wait and reset the clock as you try out an amphetamine. Just go with Concerta.
> Instead of upping the kiddie cocaine, why not ask for a switch to straight up speed? Vyvanse, adderall, dexedrine..you've got options. Just tell the prescriber about the problems getting the stuff to last long enough. If you get an XR amphetamine, that'll also help prevent dosage escalation, I would think.
Posted by Phil on June 7, 2012, at 12:13:50
In reply to Good idea to request dose increase for stimulants?, posted by Mistermindmasta on June 6, 2012, at 17:52:31
Vyvance is a true time released med, it does last 12 hours. But you will have price issues with it.
On your current med, an option would be to take the first dose later in the morning to get through the day.
I'm always honest with my doctor but I wouldn't go in and tell him I've been customizing my dose on Ritalin. Wait 30 days and then talk an increase over. If you don't do this, you might end up with three words in your permanent record that you do not want there, drug seeking behavior.
If you have to change doctors, the only stim you'll ever see again is coffee.
Posted by Mistermindmasta on June 7, 2012, at 14:13:18
In reply to Re: Good idea to request dose increase for stimulants? » Mistermindmasta, posted by Phil on June 7, 2012, at 12:13:50
Thx for all the tips... I'll give them consideration but likely will wait closer to 30 days cuz being labeled a drug seeker is something I don't want to risk, since the ritalin has been way more effective than nuvigil, as far as motivation and focus. At this point even with the last dose wearing off quickly it's still greatly improved my life. Anyway thx peeps! You've been super helpful!
> Vyvance is a true time released med, it does last 12 hours. But you will have price issues with it.
>
> On your current med, an option would be to take the first dose later in the morning to get through the day.
>
> I'm always honest with my doctor but I wouldn't go in and tell him I've been customizing my dose on Ritalin. Wait 30 days and then talk an increase over. If you don't do this, you might end up with three words in your permanent record that you do not want there, drug seeking behavior.
>
> If you have to change doctors, the only stim you'll ever see again is coffee.
This is the end of the thread.
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