ADHD Medications Require Precise Thinking
These 5 Stimulant Rules Prevent ADHD Medication Disasters:
Many thousands of individuals are treated everyday for ADHD disorders using stimulant meds that don't last 24 hr, but only last for a portion of the day. So why aren't we paying attention to those important details for every single person treated for ADHD, every medication dose adjustment, every med check – even if we don't plan to adjust the meds?
This, my friends, is a national problem of enormous proportions, as the medication adjustment simply is not sufficiently discussed or addressed. It's amazing to me that so many of these problems exist into 2011! 90% of the questions raised here at CorePsych Blog in all 2555 comments have to do with how-to-use-the-ADHD-meds-correctly. And, of those comments and questions, the predominate questions address dosage. My two most popular posts [in the thousands of views] are Intuniv Dosage Details and Vyvanse Dosage Strategies – I report that with considerable certainty as I just now checked my stats!
ADHD Med Tutorial – Video
My YouTube Video on ADHD Medication Dosage numbers over 4300 views, and when you check it out you will see even more explicit details on this remarkably overlooked subject.
Why the problem? No one has set specific dosage strategy guidelines – simple as that.
Rules: The Stimulant 5
1. Know The DOE: Start by knowing the specific expected Duration Of Effectiveness [DOE] for every stimulant medication. These are listed in detail in my book ADHD Medication Rules – Bottom line: Amphetamines [AMP] short acting = 5/6 hr DOE, AMP XR = 10 hr DOE, Methylphenidate [MPH] short acting = 4 hr DOE, MPH extended = 8 hr DOE. If the med DOE is longer than these numbers the patient is likely out the top of the Therapeutic Window.
2. Use The DOE: Dial the medication in by using only the DOE and expected increase in DOE according to each dosage increase. Vyvanse increase by 10mg = 2 hr longer DOE, Adderall XR increase by 5mg = increase of about 2 hr, MPH is more unpredictable, but an increase on Ritalin LA by 10 mg = about 2 more hr DOE. If “toxic,” out the top of the Window, then lower the dose carefully and check back. Usually the overdose level clears in ~ 3 days.
3. DOE Over Time: Adjust stimulant meds over time based upon the DOE. Each med check, every med check requires a review of the DOE as metabolic variables change, people grow, diets change – and each of these may require change over time. The standard of care in the US for med checks with stimulant meds is quarterly, about every 3 mos. Some pediatricians check biannually or even annually. My own take in this diminished frequency of med checks in practice: inadequate supervision for controlled substances. My take on monthly med checks for stimulants: not indicated, churning the system.
4. DOE Problems: Problems with the DOE arise from multiple causes, from genetic to metabolic, to drug interactions. These problems are simply too numerous to review in this brief posting, but must be addressed as they are often associated with comorbid metabolic variables, not the meds or the ADHD diagnosis itself – sleep, diet, nutrition, breakfast, etc, all covered in detail in ADHD Medication Rules.
5. DOE Reveals Comorbid Diagnosis: Problems with treatment arise from undiagnosed, misdiagnosed comorbid conditions associated with ADHD. For a significant list documented here at CorePsych Blog of the 171 [at last count] comorbid conditions that look like ADHD, may be associated with ADHD, but often don't improve as they are not purely prefrontal cortex, executive function related – from the underlying neurophysiology.
I hope this helps explain these important matters to those you counsel, to yourself or your family. Without precision the stimulant problems abound! Please pass this along to your colleagues and do leave a comment below re your take on these DOE stimulant measures.