Dr says he cannot prescribe more than one stim.

[crescentcitygal]

My son recently switched to Metadate CD after using the Daytrana patch for several years. Daytrana wasn't helping enough with the attention anymore (even after a dose increase), and the amount of time it took for it to become effective in the morning was becoming unacceptable. We are happy so far with the Metadate, and his appetite even seems to be a little better. However, since the duration of effectiveness is much shorter than Daytrana, evening orchestra rehearsals and concerts (he plays in his school orchestra) are a problem.

I asked the dr. about prescribing a short-acting stimulant for these occasions (which only occur a few times a month). He said that he could not do that because the practice of prescribing more than one stimulant is being strongly discouraged due to abuse potential. Is this some kind of new federal regulation? Has anyone else been told this by their doctor? In the past he had prescribed a short-acting generic Ritalin to be used as a booster in the morning because of the Daytrana patch taking so long to kick in. Not sure why the sudden change just as we switch meds.

Tonight I watched my poor son struggle at his orchestra concert, and I realized he was coming down from his medication. He misplaced his instrument some time between the rehearsal and performance and needed another student to help him find it. This caused him a great deal of anxiety for the rest of the concert. It was painful for me to watch him looking so lost and stressed up there.

The doctor had said that if Metadate doesn't provide the length of coverage he needs, we would have to try a 24-hour med like Strattera. I don't WANT him to take Strattera. We tried it years ago and it just did not work. I don't understand the logic behind switching to another class of meds when this one is working well and we just need occasional evening coverage. Has anyone else run into this issue?

[SharonF]

I've not dealt with the specific issue you mentioned: a doctor who prescribes a long-acting version not willing to also provide a short-acting version of the same medicine to be taken on an as-needed basis.

However, my 22-year old dd is on Ritalin LA (long acting). She gets good coverage for about 12 to 13 hours. The doc writes the script so that she can also take an additional pill in the late afternoon/early evening if she has a long night of studying ahead.

She doesn't take the additional pill very often. But when she was in college, it was helpful.

The only problem we've run into is with medical insurance. They don't like the "take 2, sometimes 3" dosage instructions. Like your situation, their concern is about abuse. But the pharmacist has been a dream to work with and has helped the insurance company see my dd's pattern of usually taking 2, sometimes taking 3 as needed, as being responsible and the opposite of abuse.

For what it's worth, my dd started on Concerta ten years ago. As you probably know, Concerta, Metadate and Ritalin all contain the same key ingredient: methylphenidate. The difference among the three is the delivery system or how each pill is packaged to time-release the medication throughout the day.

For my dd, Concerta wore off too quickly and too suddenly. So dd tried Metadate CD and Ritalin LA. By far, she preferred Ritalin. It lasted longer and tapered off more slowly. So there was very little "rebound" in the evening.

If your son has not tried a different timed-release version of methylphenidate, it might be worth looking at something other than Metadate CD. Especially if Metadate CD is wearing off too quickly.

[Mayleng]

We don't have that problem either. Your doctor is probably starting his own trend. They have to stop looking at ADHD like it is a timing issue. It is a 24 hour issue. If he is still resistant I would suggest looking for another doctor who understand ADHD. Rather than punish your son for other people abusing it, he is not looking out for the welfare of your son he is punishing him. Painkillers have potential for abuse, is he going to just give it to his patients for only the 6 hours, and then let them suffer in pain the rest of the time?

[healthy11]

Having a long-acting and short-acting Rx wasn't a problem for us. My son's Dr. is the one who suggested that he should use a short-acting "booster" of regular Adderall on days when he needed additional coverage, beyond when his Adderall XR wore off. (My son has a fast metabolism, and even meds that are supposed to be effective for 10-12 hours seem to wear off after 8 hrs. with him. Once my son went off to college, he actually preferred to use short-acting all the time, because his schedule wasn't "classes straight through the day" and he could eat in between doses.)

[michellea]

My son is on Concerta - long acting 12 hour release. He also is prescribed 10mg short acting Ritalin for instances when he does not need the full day coverage, such as on the weekends for homework, driving or sports. Like Healthy, he chooses the short acting because it minimizes side effects such as appetite suppression. In the past, he was also prescribed a 5mg booster to help him on school days when concerta wore off and he needed to do homework. Currently, he plows his way through homework unmedicated.

I understand that patients may not choose to use a full month's prescription - leaving a few pills left over for potential abuse. However, for young kids under their parents' care, I suspect this is less of an issue. Neither my doctor or insurance company has ever said they cannot prescribe both short and long acting meds - in fact I know of many patients that get both for just the circumstances you describe. I would ask if this is your doctor's personal policy or if this is something his group or your insurance company is behind. I would also question the option of Staterra - it is not a first line med, and your son has had success with stimulants. I would get a second opinion if your doctor won't budge.

[ceratops]

My DS is also on Metadate CD at the moment. His psychiatrist volunteered the suggestion of having him take 10mg Ritalin in addition, as needed, in the afternoon to help with homework or other after school activities. She wrote the two concurrent prescriptions without any qualms at all (as I said, it was her suggestion in the first place).

DS only occasionally takes the extra Ritalin (sometimes we cut the pill in half, so he's only taking 5mg), as needed.

Haven't had any complaints from insurance so far.

All of this is very recent (in the last few months), so I would doubt there are new federal regulations, or anything of that sort.