Archive for ADHD Medication Treatment

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

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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

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ADHD Medication Free Webinar Training

At the end of March 2012, I did a webinar training for ADD Resources.org, called “ADHD Medication Update”.

I’m sharing the video here, and it’s broken into 4 different video segments:

1) Introduction – this is the introduction, and let’s you know what I’ll cover during the training.

2) This is the main teaching – during this session, I cover WHY we use ADHD medications, and help you to understand that there are really only 4 types of ADHD medication – a) methylphenidate medicines, b) amphetamine medications, c) non-stimulant atomoxetine, d) non stimulant guanfacine.

We’ll cover how to make decisions around changing or adjusting medication, as well as a discussion about tolerance to ADHD medication

3) In the third video, I share some information on the ADHD Medication Shortage in the US, and strategies you can use to help yourself during this struggle.

4) In the fourth and final video, I share a summary of the ‘Ritalin Gone Wrong’ article, and share some responses to that.

I hope you enjoy the videos. Please feel free to pass them along, and type any comments in below.

Best,
Dr. Kenny

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Ritalin Gone Wrong Response

A recent article in the New York Times entitled: “Ritalin Gone Wrong” was very critical of the current treatment for ADD/ADHD. There are significant problems with the arguments forwarded in the article. I was interviewed on the News about this issue, on Thursday February 2nd, 2012. Here’s the video. I will write a more detailed response on this blog for your shortly.

To start the video, just click the button below:

For iPhone/iPad video, click here.

Please feel free to share this video with others who may want to know this information, and please share your thoughts and comments below.

Best,

Dr. Kenny

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ADHD Medication: How To Decide

When it comes to making a decision about whether to use a medication for ADD/ADHD or not, many people struggle with this… There is so much misinformation out there, that people are worried about making the wrong decision, and whether they will be judged for it…

In this short video (taken from a presentation I did), I share with you the way to decide if you will take ADD/ADHD medication or not. And this applies whether you are dealing with child/teen ADD/ADHD, or Adult ADD/ADHD.

Please watch this short video, share your comments/thoughts below (and also forward it to friends/family who may appreciate it!).

What do you think? Do you agree with the message of this video?
Best,
Dr. Kenny

p.s. To learn a whole lot more about the safe and effective use of ADD/ADHD medication – take advantage of the special discount on the Medication Mastery Course (special ends on Monday December 5th at 11:59 pm Eastern time) [hyperlink family="Helvetica,Arial,sans-serif" size="20" color="1A12FF" textshadow="1" alignment="center" weight="bold" style="normal" lineheight="110" linkurl="http://medicationmastery.com" linkwindow="_blank"]Click Here To Take Advantage Of The Special Offer[/hyperlink]

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Long Term Stimulant Use Improves School Grades

When kids or teens are diagnosed with ADD/ADHD, doctors generally recommend medication to help to control the symptoms.The most commonly used medications include the stimulant medications – namely medicines like: Concerta, Adderall, Adderall XR, Vyvanse, Metadate CD, Ritalin LA, Methylphenidate, Dextroamphetamine, and others.

While there are many studies showing that the ADHD symptoms of inattention, hyperactivity and impulsivity improve with the medicine, and cause short term academic improvements, there has been a lack of research to show long term academic benefits.

The studies summarized here clearly document that ADHD stimulant medication helps with long term academic success.

In this research, the research team followed 5700 children from birth until 18 years old. In that group, 277 boys and 93 girls were diagnosed with ADHD. Of those with the diagnosis, some decided to use medication, and some did not. When kids took ADHD medication, they generally started in elementary school, and took it for (on average) 30 months (i.e. just under 3 years).

Of the ADHD kids who were taking medication, by 13 years old, the medication children had improved reading scores compared to the kids with ADHD who had not taken medication. Children taking medication were more likely to attend school (i.e. less absenteeism), and they were 1.8 times less likely to be held back a year at school.

The lead researcher, Dr. Barbaresi was quoted as saying: “We can’t simply focus on the symptoms of ADHD,” Barbaresi said. “We really need to be focusing on the risk for poor outcomes in school and in other aspects of the child’s life,” he said. “That’s why we have to recognize these children and make sure they get appropriate treatment.”

To read more about these studies, click here.

What do you think? Has ADHD medication helped your child (or yourself) over the long term? Please share your thoughts in the comments below.

Best,

Dr. Kenny

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Harvard Psychiatrists: Disciplined Over Pharma Payments

Three prominent Harvard Psychiatrists – who are well known researchers in the field of ADHD have been disciplined over a failure to disclose their drug company ties. In reading a news article here, it is described that these physicians did not adequately disclose payments they received from pharma companies to: Harvard, MGH (Mass. General Hospital) and the federal government. Apparently new requirements came into effect in 2010 with the federal Physicians Payment Sunshine Act of 2010.

These three doctors: Dr. Biederman, Dr. Wilens and Dr. Spencer are very well published, very intelligent, and they make huge scientific contributions to the field of ADHD, as well as children’s mental health as a whole. I have personally attended several continuing medical education events where they have spoken, and I have found their material to have been of top quality and very helpful. Was it biased? In my experience – no. I found these doctors presented the science (which included their own research, as well as summarizing the research of many other doctors as well) in a balanced and useful way.

Apparently, the doctors wrote a ‘dear colleagues’ letter. It is quoted as saying:

“Our mistakes were honest ones. We always believed that we were complying in good faith with institutional policies. We now recognize that we should have devoted more time and attention to the detailed requirements of these policies and to their underlying objectives.”

While this is an unfortunate series of events – I still do hold these doctors in high esteem. They have contributed a lot of science to the field. The reality at this time is that the pharmaceutical companies fund research, and they support educational events. Although some may aspire to not have them support these events (to avoid biases), there are many ‘checks and balances’ in place, and the reality is that there are few other sources of funding to support major conferences and educational events.

Will I disregard the doctors’ research because of this?

Absolutely not.

Their research stands on its own merit. These doctors were not disciplined on any academic issues – rather on reporting funding.

I am sorry to hear that Drs. Biederman, Spencer and Wilens have had this trouble. I wish them well, and I look forward to reading their future research.

Are you concerned with pharma company’s influence on doctors, research and healthcare as a whole?

Please comment below.

Dr. Kenny

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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

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Death From ADHD Medication?

A recent study was published in the Journal: Pediatrics, which shows that there is not an increase in cardiovascular death when kids or teens take ADD/ADHD medications.

This was a large study – observing 214,417 ADHD patients taking medication, and 965,668 control kids – not taking ADHD medications. They were observed over a period of 135 days for ADHD medication users, and 609 days in non-users. The specific outcomes which were being observed included sudden cardiac death, myocardial infarction (a ‘heart attack’), stroke, and cardiac arrhythmias (i.e. irregular heartbeats).

During the observational period – the rate of these events were very low in both groups.

In the group taking ADHD medication, there were 28 deaths (incidence 1.79 per 10,000 person-years) and 607 deaths in the control group (incidence 3.00 per 10,000 person-years). There were no validated cases of MI (heart attack) or stroke in the medication group and 11 cases in the group which wasn’t on medication.

This research supports previous studies which showed that kids and teens taking ADHD medications are not at increased risk for cardiac death. The sad reality is that there will be a small number of kids/teens who pass away from cardiac issues (i.e. a heart problem that no one knew about), and ADHD medications don’t seem to worsen that rate.

There is still a warning on ADHD medications – for individuals with structural heart abnormalities (i.e. ‘holes’ in the heart like an ASD or VSD), arrhythmias, or adults with unstable coronary artery disease. If you are concerned about this – by all means talk to the doctor, and a specialist if needed as well (like a cardiologist, or pediatric cardiologist).

Hopefully this study helps to reassure some people with ADD/ADHD who are concerned about this very serious side effect.

Best,

Dr. Kenny

p.s. this study applies to ALL ADHD medications – including: Adderall, Vyvanse, Concerta, Ritalin, Metadate, Biphentin, Strattera, Daytrana, etc.

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Strattera Doesn’t Work for 5 and 6 Year Olds

A recent study was published looking at whether Atomoxetine (Strattera) was helpful for 5 and 6 year olds with ADHD. The researchers found, after an 8 week double blind placebo controlled randomized trial that although there was some benefit, most patients still had clinically relevant symptoms of ADHD, even if they were on Strattera.

You can read a summary of the study here.

This suggests that in this age range, Strattera is not a great treatment for ADHD.

That said, if your child is 5 or 6, talk to your doctor about the treatment options which may help.

Best,

Dr. Kenny

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