Archive for ADHD in Canada

Methylphenidate Shortage in Canada

methylphenidate 300x200 Methylphenidate Shortage in CanadaMarch 12, 2014

There has been a recent shortage of the short acting Methylphenidate medication in Canada. This is listed on the website DrugShortages.ca (and you can visit that site to check if the shortage is still an issue).

Methylphenidate is a stimulant medication used to treat ADHD. It is the active ingredient in the following medications: Ritalin, Ritalin SR, Biphentin and Concerta. However, the only form of this medication which is impacted by the shortage is the short acting version. Specifically, the 10 mg tablets, and the 20 mg tablets.

This shortage does not impact the availability of the long acting versions of methylphenidate such as Biphentin and Concerta.

Although it’s generally recommended that the long acting medications (such as Concerta and Biphentin) should be used to treat ADHD, as they work better for individuals with ADHD, there are still occassions that doctors will use a short acting stimulant medication.

These could include:

  • Using a long acting methylphenidate medication in the morning and then taking a short acting in the evening when it has been a particularly long day (i.e. topping up the medication for night school)
  • When a teen sleeps in on the weekend and gets up too late to take a long acting medication, they may take a short acting mid-day on the weekend to have some stimulant treatment
  • There are some patients (in my experience this is very few) who don’t do as well with a long acting medication as they do with a short acting version

If you or your child is taking a short acting version of Methylphenidate, you may have a hard time refilling the prescription. The pharmacist will likely tell you that the product is ‘back ordered’. However, if the pharmacy still has stock on their shelves, then you should be able to fill the prescription.

Here’s what you can do if you are stuck and cannot refill your prescription for methylphenidate:

  1. Ask the pharmacist to call other pharmacies to see if they have stock on their shelves (i.e. they will be able to call other pharmacies in their ‘chain’ (such as Shopper’s Drug Mart) and if another pharmacy has stock, they may be able to get it for you)
  2. Phone other local pharmacies and see if they have stock on their shelves, and then take your prescription to that pharmacy (you would have to take an actual prescription, as pharmacies cannot transfer prescriptions for methylphenidate from one pharmacy to another).
  3. Check if your pharmacy can order in the 5 mg tablet of Methylphenidate. If they are able to, contact your doctor’s office and explain that you need the doctor to change the prescription to the 5 mg tablets because of the medication shortage.

If none of these strategies work, then be sure to see if you can take either of Biphentin, Concerta, or even Ritalin SR to see if they can help you. Alternatively, you may benefit from a trial of an amphetamine medication – such as Vyvanse, Adderall XR, or Dexedrine. That would be an issue you’ll have to discuss with your doctor.

Please share any experiences you’ve had – particularly if you have a strategy which could be helpful to others.

Best,

Dr. Kenny

Technorati Tags: , , , ,

How To Tell The Difference Between Concerta and Generic Concerta

In Canada, there is a generic Concerta available. It’s called: Teva-Methylphenidate ER-C (it was formerly called: Novo-Methylphenidate ER-C). Many people have had trouble with this generic, and it is widely accepted by doctors in Canada and patients that the generic doesn’t work as well as the brand name concerta.

One question which has been sent in to me a number of times is: How do I tell the difference between the brand name Concerta and the generic Teva-Methylphenidate ER-C?

When someone isn’t medically trained, it can be very confusing. I have tried to explain to people over the phone (or in blog comments!) how to tell the difference. And then I thought of the saying: “A picture is worth 1,000 words”. I was able to find an image which clearly shows the difference between the two medications. I was able to get permission from Janssen (the maker of Concerta) to share this image with you.

To tell the difference between the brand Concerta compared to the generic, notice a few features:

  • The brand Concerta has the word ‘Alza’ typed in black on its side; the Generic Teva MPH ER-C does not have this typed word on it
  • The brand Concerta looks more rounded like a little soda can, compared to the generic which is an oval pill
genericconcertacanada 801x1024 How To Tell The Difference Between Concerta and Generic Concerta

Generic Concerta vs. Brand Name Concerta in Canada

Please share any comments below. And feel free to share this with anyone who may benefit from knowing about this.

Best,

Dr. Kenny

Technorati Tags: , ,

Vyvanse Now Covered on Ontario Drug Plan

Vyvanse (lisdexamfetamine) is one of the newer medications for ADHD. It has been in Canada since February 2010. However, the provincial insurance plans did not cover it.

I’m pleased to announce that as of June 8, 2011, Vyvanse will be covered by the Ontario Drug Plan. This means that if a family has an Ontario drug card (from being on OW, or ODSP, or a child disability, or even the Trillium Drug Plan), then Vyvanse will be covered.

The rules for Vyvanse coverage are written as follows:

Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to
other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or
psychosocial needs, and who meet the following:
1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with
inattention that interfere with learning; AND
2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner
with expertise in ADHD; AND
3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or
Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor
symptom control, side effects, administrative barriers, or societal barriers.
Administrative barriers include:
. inability of a school to dose the child at lunch;
. the school lunch hour does not coincide with the dosing schedule;
. poor compliance with noon or afternoon doses;
. the patient is unable to swallow tablets.
Societal barriers include:
. the patient or patient’s caregiver(s) has(have) a history of substance abuse or diversion of listed
immediate-release alternatives;
. the patient or patient’s caregiver(s) is/are at risk of substance abuse or diversion of listed
immediate-release alternatives.

From a practical perspective, the doctor does not have to complete a form, or get formal approval, so it will be up to your doctor to decide when he or she will begin using Vyvanse with you.

This is very good news for ADHD patients in Ontario. I know that a lot of advocacy work went on, spearheaded by CADDAC. I know that I spoke to my MPP and got him to write a letter of support, and many other doctors and patients did the same. I hope that this precedent will help to get coverage in the other provinces too.

Best,

Dr. Kenny

Technorati Tags: ,

ADHD Live Event: Come See Me Live (April 14)

I’m writing this post to let you know that I will be speaking live for the Learning Disability Association of Mississauga on Thursday April 14th from 7-9 pm. Registration is at 6:30 pm.
The title of this talk: Attention Difference Disorder: How to Turn Your ADHD Child or Teen’s Differences into Strengths in 7 Simple Steps.

I am excited about this talk – because I’ll be talking about the strategies which I describe in my book (of the same title) – which will be coming out on June 7th, 2011.

This talk is set up to help to support the LDAO Chapters of North Peel and Mississauga.

Details:
Date: Thursday April 14th, 2011
Time: 6:30 pm registration – talk from 7-9 pm
Where: Mississauga Convention Center – 75 Derry Road West, Salon E, Mississauga, Ontario
Cost: $10 if you register in advance, $20 at the door (and free if you are a member of the LDA chapters). Please note, the money at the door goes directly to fund the programs of the LDA chapters.

Registration is Required:

To register, please phone: 905-272-4100 or email the LDA at: lda1@bellnet.ca (copy and paste this email into your email program)

To get a copy of the PDF invitation, please click here.

I know that this invitation will really only apply to those of you who live in the Toronto area. If you are interested in other events with Dr. Kenny, please be sure to join our email list, and we will let you know of future events.

(also, please remember that if you post a comment on this blog, or email us, we cannot register you for the event, you need to contact the LDA through the info above).

I hope you see you there!
Best,

Dr. Kenny

Technorati Tags:

Generic Strattera in Canada

Updated February 2, 2011

There have been several articles about generic medicines on this blog – many of which have generated significant discussion amongst this blog’s readers. All of the previous articles have been about generic stimulant medicine.
This is the first article about a generic non-stimulant – i.e. Strattera.

In Canada, there was a court decision made in mid October 2010 which paved the way for a generic Strattera (atomoxetine) to be made. A Canadian court invalidated the Eli Lilly patent on the medication atomoxetine for ADHD. This decision has given the generic company Teva-Novopharm the ability to create a generic Strattera in Canada. If you are interested in the details of the legal decision – you can read a summary of it here.

As of the time of this post – i.e. early January 2011 – a generic strattera has not yet come to market in Canada. I can only speculate as to why it has taken so long, as generally a company has the generic product available approximately 6 weeks after a legal decision. Maybe there are manufacturing issues which are causing delays… or maybe there are other factors that I am not even considering.

What does this mean?

At this time (February 2011) there is still no generic Strattera available in Canada. Eli Lilly is still providing samples of its product Strattera to doctor’s offices. They have some sales people and support staff still supporting ADHD/Strattera.  There is still a compassionate program (for people who couldn’t afford the medication), though I’m told that it is currently full – but your doctor could apply for you anyway.

Will the generic work well?

This is a question that I don’t know the answer to. We will have to wait and see. Strattera does not have a time release mechanism in it (like Concerta does) which may mean that the generic will be OK. But it is too early to tell.

Once I hear that the generic Strattera is out – I will be sure to update this blog post, and I welcome any comments from your experiences with generic Strattera.

Best,

Dr. Kenny

Technorati Tags: , , , , ,

Vyvanse in Canada

Updated January 3, 2011:

Vyvanse was officially launched in Canada on February 1, 2010.
When it was first launched – it was only officially approved for use in children – aged 6-12 years old. As of November 2010, Vyvanse is now officially indicated for use in ADHD in children (6-12 years old), teenagers (13-18 years old), and adults (18-65 years old). This means that Vyvanse is now officially indicated in Canada for use in ADHD ‘across the lifespan’ – i.e. from childhood to adulthood.

Dosage of Vyvanse in Canada:
Vyvanse is available in these dosage strengths in Canada: 20 mg, 30 mg, 40 mg, 50 mg, and 60 mg.
In the US, there is also a 70 mg capsule – but Health Canada wasn’t convinced that it was needed – so for now, the highest dose capsule that we have in Canada is the 60 mg.

Doctors will generally start with a lower dose (often 30 mg) and then increase to a higher dose (often 50 mg). Of course, your doctor will tailor the treatment to your needs.

Vyvanse is a the first prodrug for ADHD. This means that the medication is inactive until an enzyme in the body works to activate it. To read more about how it works, visit this blog post on Vyvanse.

To read the press release on Vyvanse being released in Canada, please view it here.

This blog has several articles on Vyvanse, but my favorite is the one where my readers have shared their experiences with Vyvanse (over 800 comments at this time) about whether Vyvanse works.
You can find more articles by looking at the ‘related posts’ below this article.

Please share any comments or issues with Vyvanse being in Canada below.

Best,

Dr. Kenny

Technorati Tags: , , ,

Dr. Atila Turgay

It is with sadness that I report that a doctor who was a true leader in ADHD in Canada and internationally passed away on April 8, 2010.

Dr. Atila Turgay had recently created the ‘Toronto ADHD Clinic’, where he was seeing a large number of children, teens and adults for ADHD. This was a service which was desperately needed, and it was particularly helpful that Dr. Turgay brought such expertise to this clinic. I am hopeful that after Dr. Turgay’s passing, that some of the other doctors who had started to help with this clinic will in fact carry on the important work that was started by Dr. Turgay.

Dr. Turgay participated in many research studies, and published extensively. You can see a summary of his research publications on Pubmed here.

Dr. Turgay also regularly spoke to members of the community – educating parents, kids/teens and adults with ADHD, educators, as well as other doctors. He was always able to provide up to date, scientifically backed information in a helpful and instructive way.

Dr. Turgay actually helped to start me in the direction of Child Psychiatry and ADHD. When I was in my fourth year medical school, I had a 2 week placement in family medicine at the Scarborough General Hospital. When I was speaking with my Family Medicine teachers, and mentioned that I was interested in Psychiatry, they encouraged me to spend some time with Dr. Turgay. When I met Dr. Turgay, I was impressed by his knowledge, his teaching ability and his interest in me as a student. I subsequently arranged to spend one month with him, during my internship. This month was an exposure to Child Psychiatry and ADHD, which helped to form my interest in this field.

Dr. Turgay’s influence was far reaching. When I was at his memorial service, I met several doctors – pediatricians, psychiatrists and family doctors who were working in the field of ADHD because Dr. Turgay had provided the teaching and mentorship to encourage them to go into this challenging and rewarding field of medicine.

In recent years, I would see Dr. Turgay as a colleague in many national ADHD meetings. He always contributed so much to the meetings. Out of respect for him as a teacher, I always called him ‘Dr. Turgay’, and he was trying to convince me to call him ‘Atila’ as we were colleagues now.

Dr. Turgay will be sorely missed. His impact as a doctor, teacher, researcher and speaker will be missed both in Canada and around the world. My condolences go to his family, friends and patients for having lost such a great man. I am grateful that I got to learn from him, and  know him – and I hope that the work I do contributes to his legacy.

You can view his obituary here.

Best,

Dr. Kenny

Technorati Tags: , , ,

Generic Concerta: Health Canada to Review

Generic Concerta was introduced into Canada around February 2010. As I’ve written in my full article about Generic Concerta – I’m quite concerned about the fact that the new generic medicine does not have the same properties as brand name Concerta – and this may lead to problems for patients who are automatically switched from brand name Concerta to Novo-Methylphenidate ER C.

You may wonder – am I against generic medicines?

Not at all.

In fact, I have taken many generic medicines myself, and so have my family members.

The issue is that for most people, taking a generic for stomach issue, or for asthma is often completely fine. It is however different, in my opinion, to take a generic for a psychiatric condition, such as ADHD.

The other big difference is that Concerta was developed based on the principle that its pharmacokinetic profile is different. What does that mean? It means that the way the medicine is absorbed throughout the day has an impact on how the medicine works.

In other words – in this ‘next generation’ medicine – the old rules for how to create a generic shouldn’t really apply. Just assessing whether the new generic has similar medicine absorbed throughout the day misses the fact that the rate of absorption of Concerta is part of what makes it so effective.

Advocacy Works:

Thankfully, our friends at Health Canada are listening. They have at least acknowledged that there may be a difference with how they should evaluate generics when it comes to medicines like Concerta.

Health Canada has created a committee called: The Scientific Advisory Panel on Bioequivalence Requirements for Modified-Release Dosage Forms (SAP-MRDF). Their draft terms include the following wording:

“The Scientific Advisory Panel (SAP) on Bioequivalence Requirements for Modified-Release Dosage Forms (SAP-MRDF) provides advice to Health Canada on appropriate bioequivalence standards for modified-release dosage forms of pharmaceutical drugs. Of particular interest are those drugs where concerns have been raised that existing standards may not be adequate, for example, methylphenidate and nifedipine. The Panel provides Health Canada with advice and recommendations, but the decision-making responsibility remains with Health Canada.”

This committee will be meeting in Ottawa on June 11, 2010 to receive input and submissions to understand the complexity of this issue.

Hopefully, this process will bring forward the science that Novo-Methylphenidate ER-C does NOT have the science behind it to be defined as a generic form of Concerta. This would then change it to be another lower cost option for people to use for ADHD, rather than a medicine which is automatically substituted for Concerta.

I will update this blog with information as I receive it.

Best,

Dr. Kenny

Technorati Tags: , , , ,

CADDAC 2010 ADHD Conference

I am pleased to let you know that I will be speaking at the Centre for ADD/ADHD Advocacy Canada (CADDAC) conference on April 24th, 2010.

This is a weekend conference in Toronto, which will focus on many important aspects of ADD/ADHD. On the Saturday, the conference will focus mostly on child ADD/ADHD, and on the Sunday, it will focus mostly on Adolescent and Adult ADD/ADHD. The Saturday night will have a Comedy night – which will be very entertaining and help to raise funds to support advocacy for ADD/ADHD across Canada.

Speakers include: Dr. Thomas Brown – an internationally known expert in ADD/ADHD, Rick and Ava Green (actor and advocate, who started Totally ADD), Dr. Laurie Dietzel and many others (including myself). My talk will be on ADD/ADHD Medications -what’s new and how to use them safely and effectively.

The conference is on Saturday April 24 and Sunday April 25, 2010.

To learn more – please visit here.

I hope you see you there.

Dr. Kenny

p.s. if you do come specifically because of this blog post or my email list, please be sure to let me know… I’d love to meet you.

Vyvanse in Canadian Pharmacies

February 14, 2010

Vyvanse was launched in Canada officially on February 1st, 2010. Even though it was officially launched, there have been some issues with the ability of pharmacies to get Vyvanse on their shelves.

As of February 12, 2010 – the following pharmacies have access to Vyvanse (i.e. if they don’t actually have it in their pharmacy, they can order it from their wholesalers and have it in within 24 hours)

  • Shoppers Drug Mart
  • Jean Coutu
  • Main Drug Mart
  • People’s Drug Mart
  • Pharmasave
  • Total Health Pharmacies
  • Wal Mart Pharmacies

I’ve been informed that by Wednesday February 17th, 2010, 80% of pharmacies will have access to Vyvanse from their wholesaler.

And by Friday February 19th, 2010, 100% of pharmacies will have access to Vyvanse from their wholesaler.

So, if your doctor gives you a prescription for Vyvanse (and you’re in Canada), you can go to one of the pharmacies above (which already have Vyvanse), or ask your doctor if it’s OK to wait until your particular pharmacy can get the medication in.

To be clear – there is nothing wrong with the Vyvanse supply or medication. The reason for the delay has to do with the paperwork and regulatory aspects which the wholesalers have to complete to be able to store and ship a stimulant medicine. This will be resolved quickly (and hopefully easily for you!).

Best,

Dr. Kenny

Technorati Tags: , , , ,