Archive for Vyvanse

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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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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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

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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

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Price of ADHD Medication: A Concerning Trend

As the economy’s downturn is affecting businesses and families alike – it seems that Big Pharma has a plan to keep themselves thriving in this economy.

Quite simply: Raise prices.

A news report shares that Big Pharma are raising their prices to improve their income. Included in the example is Eli Lilly’s Strattera – a non-stimulant medication for ADHD.

I’m not sure if the same thing is happening with other ADHD medications, which are manufactured by other companies.

This is a very concerning trend – especially as people may be under-insured, or uninsured. The medication costs are often prohibitive – and if one needs the medication to survive at work and to keep one’s income, this can be quite a bind.

What has your experience been? Have the costs of your prescription gone up?

Please share your comments below.

** As further explanation – the information above refers to prices in the US. I have recently published two articles showing that the trend in Canada is that in fact the prices are coming down – particularly for Strattera and Adderall XR. You can read more details here: Strattera Price Drop in Canada, and Adderall XR Price Drop in Canada.

Best,

Dr. Kenny

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Generic Adderall XR in the US

As of April 3, 2009, generic Adderall XR is available in the United States. It is being made by Teva Pharmaceuticals. (You can review a news report about this here.)

What Does ‘Generic’ Mean?

When a medicine is first released – it is patented by the company that invested in the research to develop it. They have a certain number of years to market the medicine exclusively. After the patent runs out – the medicine can be created by other drug manufacturers – the ‘generic’ companies – generally at a significant discount.

The analogy here is ‘Kleenex’ vs. tissue.

Kleenex is a brand of tissue. It is only made by one company. However, tissue is made by many companies.
Using this analogy – Adderall XR is the ‘Kleenex’, and generic adderall XR is the ’tissue’.

Will it work the same?

The short answer is yes. Generic drug manufacturers are able to have a minor variation in how much of the medicine will be absorbed, but for most people, this will not have an impact. In my clinical experience, a small percentage of people are sensitive to the differences and may need to have the ‘brand name’ medicine only. If that is the case, the doctor needs to write a prescription for Adderall XR NO SUBSTITUTION. When the words ‘no substitution’ are there, it tells the pharmacist that only the original Adderall XR will do.

For further information on generic medicines in ADHD, please visit this article that I’ve written previously on this topic.

What Does This Mean for You?

If you have wanted to take a newer, long acting medication like Adderall XR – it just got cheaper.
If you have insurance to pay for your medication, then this is unlikely to matter much to you. If you have to pay for your medication yourself, then it may make a difference to you.
Please remember – this news just applies to the US, as Adderall XR has not gone generic in other countries – such as Canada.

Does this impact you? Share your thoughts and comments below.

Best,

Dr. Kenny

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The Dollars and Cents of ADHD

A press release just came out today – publicizing a report which is available for purchase about the nature of the pharmaceutical market in ADHD. The press release documents that the ADHD market is worth $3.85 billion per year, and will have a compound annual growth rate of 1.2% over the next 10 years. They document that the adult ADHD ‘market’ is largely untapped, and they predict that it will likely be twice as big as the pediatric ADHD market.

I have to say that I always have a mixed response when I read statistics like this.

On the negative side – this type of data makes it seems that the pharmaceutical companies are just trying to make sure that more prescriptions are written, and they see people with ADHD as just consumers of their drug and ‘dollars and cents’. Additionally, these data help to fuel the ‘ADHD nay-sayers’ to talk about how ‘over treated’ and ‘over medicated’ ADHD is. (I can hear them saying – ‘almost $4 billion dollars of drugs sold per year???’).

On the other side – this type of just report documents facts…
It’s been documented that it costs over $1 billion USD to bring a new medicine to market. The fact that there is a profit in the ADHD market – and an opportunity for companies to expand sales in the future – means that there will be more research and thus more new treatments introduced in the coming years.

This is ultimately good for people with ADD or ADHD.
New treatment options coming out in the future is a good thing…

In summary – although this type of statistic can be shocking to some – I believe it is important to know that it means that the pharma companies will be willing to invest new monies into ADHD research and treatments.

The danger here is how this statistic can be sensationalized, and how people can get too fixed on the ‘medication only’ treatment of ADHD.

Please remember that the best approach to treatment of ADHD is multimodal – meaning including medication with non-medication approaches (including behavioral therapy, parenting supports, academic/occupational support, coaching, alternative approaches, etc.).

To read a special report that I wrote about ADHD Medication, please visit: Medication Mastery.

Please share your thoughts in the comments section below.

Dr. Kenny

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Vyvanse Dosage: How to Get the Right Dose

Vyvanse is the newest medicine for ADD or ADHD in the USA. I have written several articles on this blog on Vyvanse, and have had great feedback and comments from readers of this blog. For example – if you want to find out if vyvanse works, visit this post to read many people’s first hand experiences.
One question which many people ask is about the dosing of Vyvanse.
This article will provide you with the answers you need to get the right dosage of Vyvanse.

Research studies compared the dosing of Vyvanse with Adderall XR. What this research showed was the following:

  • Vyvanse 30 mg = Adderall XR 10 mg
  • Vyvanse 50 mg = Adderall XR 20 mg
  • Vyvanse 70 mg = Adderall XR 30 mg

The recommendations for the starting doses of Vyvanse are as follows: Doctors should start Vyvanse at 30 mg, and then gradually increase the dose to 50 mg, and then up to 70 mg if needed. Of course the doctor would monitor response to the medicine (i.e. if there is a great response and ADHD is controlled at 50 mg, then there is no need for 70 mg of Vyvanse). The doctor will also monitor for side effects – i.e. if there are too many side effects at 70 mg, then the dose may need to be dropped to 50 mg of Vyvanse.

The importance of the ‘conversion’ dosing listed above relates to those people who may switch from one stimulant medicine to Vyvanse. Using the information above, you can figure out how to change your dose of Adderall XR to Vyvanse.

When it comes to the available strenghts of Vyvanse, Vyvanse is now available in the US in the following dosage strengths:

  • 20 mg
  • 30 mg
  • 40 mg
  • 50 mg
  • 60 mg
  • 70 mg

In Canada, all of the dosage strenghts are available except for the 70 mg dose.┬áThe dosage recommendations above are the general recommendations for dosage. That said, your doctor may start lower, and may take a different approach to your dosing. When Vyvanse was first release, there were fewer strengths of the medicine available – i.e. only 30mg, 50 mg and 70 mg. Now, there are the ‘in between’ doses as well (the 20 mg, 40 mg, 60 mg). This does give doctors more flexibility in adjusting the dose to tailor it to suit you.

If you are switching from Concerta to Vyvanse, then you will need to follow these rough guidelines (and of course, talk to your doctor – who can personalize the information to suit your treatment):

  • Concerta 36 mg = approx. Vyvanse 30 mg
  • Concerta 72 mg = approx. Vyvanse 50 mg

I have to say that the dose changes from Concerta to Vyvanse are based on logic, and not on research.
Here is the logic:

  1. Concerta 36 mg works out to approx. 8 mg of regular ritalin three times daily.
  2. That is approximately 5 mg of regular adderall twice daily.
  3. That works out to approximately Adderall XR 10 mg once daily.
  4. Since Adderall XR 10 mg daily is equal to Vyvanse 30 mg, once can guess that Concerta 36 is equal to approximately Vyvanse 30 mg.

[Click here for a full review of how to calculate concerta doses.]

There are two important points to remember here:

  1. Even though I can suggest what the equal doses are, you may react differently to any one medicine. Only testing, monitoring and talking to your doctor will help to sort out what the right dose is for you.
  2. Please talk to your doctor about your individual care. Even though this blog article may help you to find the right dose of Vyvanse based on a combination of my review of the research and my opinion, your doctor is an expert in your care.

Thank you for reading, and please post any comments or your experiences with the dosing of Vyvanse in the comments below.

Dr. Kenny

(Updated May 2010)

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Vyvanse – The New Medicine for ADD/ADHD

What is Vyvanse?

[Article Updated May 2010]

Vyvanse is a new ADD/ADHD drug manufactured by Shire that was approved by the FDA in February 2007 to treat ADD/ADHD symptoms in children aged 6 through 12. It is a prodrug, which means that it must be orally ingested to activate its main ingredient, lisdexamfetamine dimesylate. So the actual medication is inert – i.e. it doesn’t do anything – until an enzyme in the body converts the medicine into the active drug. Because Vyvanse is a stimulant which is not a functioning stimulant (until it is converted by an enzyme in the body), it has a much lower abuse potential than other ADHD stimulant medicines.

When Vyvanse enters the stomach and small bowel, there are enzymes which will break the medicine up. Vyvanse will become: lysine (an amino acid that has no impact on ADHD), as well as dextroamphetamine. Dextroamephetamine is a medical amphetamine (different than the ‘street drugs’) which is very helpful for ADHD. It has been used for treatment of ADHD for decades, and has been available under different names like: Dexedrine and Dextrostat. Once the active medicine is broken from the amino acid lysine, it can now begin to function to help ADHD.

Thus, if someone tries to abuse Vyvanse by snorting it, or even trying to inject it – they will not get a high because it will not be an active medicine until an enzyme in the body works on it and ‘activates’ it.

Although it is generally thought that the medicine is mainly broken down or ‘activated’ in the stomach/small bowel, it may also be ‘activated’ in the blood as well.

In clinical studies, parents reported that their children’s ADD/ADHD symptoms were consistently controlled throughout the day, even through homework time from 4 P.M. to 6 P.M. Newer research is showing that Vyvanse can work for 13 hours and maybe even longer. Additionally, children taking Vyvanse in the study were able to focus and perform better on tests; in a timed math test, a group taking Vyvanse attempted 51% more math problems than the group given placebo, and provided correct answers 54% more often than the placebo group.

An overall improvement was recorded in 95% of children that took Vyvanse for 12 months.

What are the characteristics of Vyvanse?

Vyvanse is in the same medication family as Adderall; its active ingredient is lisdexamfetamine dimesylate. It provides consistent ADD/ADHD symptom control for 13 hours. Vyvanse is a capsule that can be swallowed whole or the capsule can be opened and mixed with water (for kids who can’t swallow).

Vyvanse is taken once daily and is available in six dosage strengths (when it was first launched in the US, it was only available in three strengths, but there are more options now):

  • 20 mg
  • 30 mg
  • 40 mg
  • 50 mg
  • 60 mg
  • 70 mg

These different strengths give you and your doctor some flexibility in determining which dosage is right for you, your teen or your child. The recommended starting dose for Vyvanse is 30 mg once per day taken orally in the morning. The dosage may then be increased by up to 20 mg per day at weekly intervals, up to a maximum of 70 mg per day.

Who is Vyvanse approved for?

Currently, Vyvanse is approved for children aged 6 to 12 years, as well as adults aged 18-65 years old.

While there is not yet official approval for Vyvanse in Adolescent ADHD, many doctors are using this medicine for teens, and presumably the official indication will be coming soon.

What are the side effects of Vyvanse?

Vyvanse was very well tolerated in clinical studies with children. The most common side effects were decreased appetite, difficulty falling asleep, irritability, and stomachache. Generally, the side effects were described as mild to moderate; occurrence and severity of side effects decreased over time. As with any prescription medication, it is important to remember that your doctor has prescribed it because he/she feels that the benefits will outweigh the possibility of side effects.

How much does Vyvanse cost?

Vyvanse will cost the same as Shire’s other popular ADD/ADHD drug, Adderall XR: around $3.40 a day. The cost may even be less than Adderall XR because it is estimated that patients who switch from Adderall XR to Vyvanse might need fewer doses.
Ritalin remains the cheapest ADD/ADHD drug; Vyvanse costs considerably more than Ritalin and Ritalin SR. The cost is comparable to the 36mg and 54 mg doses of Concerta, which is around $140 per month.

When can Vyvanse be used?

Vyvanse should be taken once daily in the morning. It provides consistent ADHD symptom control throughout the day for up to 13 hours. In clinical studies, parents reported that their children’s ADD/ADHD symptoms were controlled at approximately 10 A.M., 2 P.M., and 6 P.M., and demonstrated consistent symptom control throughout the day.

Vyvanse is a once-a-day capsule that should be taken in the morning, either with or without food as prescribed by your child’s doctor. If your child is unable or unwilling to swallow pills, Vyvanse capsules may be opened and the entire contents of the pill can be dissolved in water. The entire portion must be finished and should not be stored for later use.

New research is demonstrating that Vyvanse’s absorption and effectiveness is completely unaffected by stomach factors. So – whether Vyvanse is taken with or without food, whether someone is taking antacid medicines, or has a GI disorder (like Celiac’s for example) – it will NOT have an impact on the effectiveness and delivery of vyvanse in the body. This is different than the other medicines for ADHD – like Adderall XR and Concerta, for example.

Can Vyvanse be abused?

The abuse potential of Vyvanse is extremely low; the medication is designed to have a reduced or minimal abuse potential. Since Vyvanse requires oral ingestion to be converted to the active drug, the capsule contents are highly unlikely to be sought out for inhalation or injection.

How does Vyvanse compare to Ritalin, Ritalin SR, and Concerta?

Vyvanse is a new class of ADD/ADHD medication. It is the only medicine which is a pro-drug for ADHD.

Unlike Ritalin, Vyvanse is not an immediate release stimulant. Vyvanse has much lower abuse and addiction potential. Ritalin SR and Concerta are long-acting formulations like Vyvanse, but Vyvanse has been shown to provide more consistent symptom control over a longer period of time than Ritalin SR and Concerta.

Ritalin, or methylphenidate, must be taken two or three times a day for symptom control, whereas Vyvanse is only taken once. The effectiveness of Ritalin is often inconsistent. It is inexpensive, but abuse and addiction potential is much higher with Ritalin than with Vyvanse.

Ritalin SR is a long-acting formulation of methylphenidate with inconsistent performance reviews. It doesn’t work for everyone and usually lasts up to 6 hours. However, like short acting Ritalin, Ritalin SR is inexpensive.

Of the three, Concerta is the most comparable ADD/ADHD medication to Vyvanse. They both control symptoms for up to 12 hours and are generally well-tolerated. Concerta is not a prodrug, so the abuse potential is theoretically higher than it is for Vyvanse.

Where is Vyvanse Available?

At the time of this article update (May 2010), Vyvanse is only available in the USA and Canada. It is not yet available in other parts of the world. Please check back, as I will update this article when Vyvanse will be available in other countries such as: the UK, Australia, Europe, etc.

New Data On Duration of Action of Vyvanse in Adults with ADD/ADHD:

New research has shown that Vyvanse works in adults with ADD/ADHD for up to 14 hours. This is a real benefit for Vyvanse, as adults have many responsibilities throughout the day and into the evening. This suggests that many people can avoid taking a short acting stimulant in the early evening (i.e. Taking Adderall XR in the morning, and short acting Adderall in the late afternoon to make the medicine last), by just taking Vyvanse which will last long enough to cover the symptoms throughout the day and the early evening.

The Bottom Line About Vyvanse

Treatment and management of ADD/ADHD requires many components; this article focuses only medication. Vyvanse is a breakthrough ADD/ADHD drug and many doctors and parents will seriously consider switching from their current ADD/ADHD medication for the benefits Vyvanse offers: low abuse and addiction potential, one daily dose, and symptom control for up to 13 hours. For more information on the other treatments of ADD/ADHD: 1) sign up for my ADD/ADHD newsletter at www.TheADHDDoctor.com, and 2) peruse this blog for more articles about ADD/ADHD.

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