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ADHD medication

Reliable ADHD information

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If you’re reading this blog, you are one of the millions of people who now use the Internet to gain information on medical issues. In a recent survey of consumers, this is where people are looking for medical information.
Most accessed online resources:
53% web M.D.
22% Wikipedia
19% health magazines and websites
16% advocacy group websites
12% YouTube
10% Facebook
10% blocks
9% Pharma company websites
(results from third annual national consumer survey by Makovsky Health and Kelton, 2014)

I would like to take this opportunity to direct your attention to the attitude magazine website that has a large number of webinars from noted academic and professional experts in ADHD. For many with ADHD it’s often easier to watch a video on a specific ADHD topic then to read a book. While many with ADHD can sit and read for extended periods of time, it always struck me as odd that clinicians referred patients to books knowing their ability to sustain attention would be limited, especially in the evening when it medication affect us dwindled.

Explore the webinars on this site as a can be extremely helpful. On this blog site, I will continue to direct my patients in readers to reliable sources of information and clinical insights from my practice not available elsewhere.

ADD stimulant substitution by insurance prohibited in Maryland

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Step therapy is the requirement that a patient first try less costly medication before being prescribed medication a doctor thinks is best for the individual patient and specific symptoms/history. In the recent past, insurance companies had requested that adults with ADHD first be treated with a short-acting stimulant despite the fact that no short-acting stimulant is FDA approved for the treatment of adult ADHD. More recently, many insurance companies request “prior authorization”. This is a paperwork process to see if the patient can be directed to less costly medication despite the fact that the “recommended alternative” may not last long enough during the day. I’m relieved now with the passage of a new law in Maryland that will prohibit this practice. The following text appeared in the Maryland Psychiatric Society newsletter May 29, 2014. MedChi is the state of Maryland medical association.

MedChi applauds the enactment of SB 622/HB 1233, a bill that addresses a dangerous health insurance practice known as “step therapy.” Step therapy (or “fail first” policy) jeopardizes patient health by requiring them to try and fail on up to five older, less effective treatments before the insurer will cover the treatment originally prescribed. This law protects patients and keeps treatment decisions in the hands of doctors. The Maryland Health Care Commission recently studied step therapy, and Senator Middleton and Delegate Bromwell introduced this bill to codify some of its recommendations. The Middleton/Bromwell legislation, which takes effect on July 1, prevents insurers from forcing patients who are already being effectively treated on a medication to undergo the step therapy process, and also prohibits insurers from forcing patients to try medicine the FDA has not approved for treatment of a specific condition. Maryland is the first state in the country to enact the latter provision. Evidence suggests that step therapy may increase overall health care costs. Patients forced to manage multiple insurer “steps” often endure additional trips to the doctor or pharmacy, with additional time off from work or child care. When patient treatment is unnecessarily delayed, manageable conditions can devolve into more difficult to manage diseases. From May 5 MedChi News 

I encourage my patients, their family and all those for who this applies to actively pursue and receive the most effective treatment and medication that works for them. And then let your insurance company know that you are an informed patient who will advocate for your legal right to individualized treatment.

Hope this is useful to you.

 

FDA looking into generic long-acting methylphenidates and variable effect

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The following post from the FDA appeared today about complaints that generic long-acting methylphenidates (brand name-Concerta) may not work equally well.

“In the case of the ADHD drug — certain generic versions of methylphenidate hydrochloride  (Concerta, Janssen Pharmaceuticals) — the issue is a possible lack of therapeutic effect, which may be linked to product quality issues, according to the FDA.

A drug’s appearance on the list, which grows quarter by quarter, does not mean the FDA has concluded that the drug actually poses the health risk reported through FAERS. Instead, the agency is studying whether there is indeed a causal link. If it establishes one, the FDA then would consider a regulatory response such as gathering more information to better describe the risk, changing the drug’s label, or mandating a risk evaluation and mitigation strategy.”

If you have followed my blogs, I wrote about this in January 2014, as patients were mentioning that “my medicine isn’t working any more.” So, what to do?

Turns out that Watson Pharmaceutical makes generic Concerta with the original OROS technology that delivers methylphenidate in a very specific fashion. Mallinkrodt Pharmaceutical makes the generic Concerta without the OROS technology. The reason the FDA originally approved this generic was that it shown to be “bioequivalent” on a pharmacokinetic chart. How can you tell the difference? The OROS pill is barrel shaped, Mallinkrodt is a “flatten oblong” pill. IF you receive your medication from mail order, this will help you identify what pill you’re getting. If in doubt, call the mail order pharmacy and ask specifically about brand of generic.

What to do? I have been advising my patients on generic Concerta who are complaining about diminish effect to change to the Watson brand. This change may not be needed if the Mallinkrodt brand works for you. If not, the your doctor needs to write Watson brand specifically on your prescription.

But where to find it? As of this posting, Walgreen’s dispenses the Watson brand and Target and CVS dispense the Mallinkrodt brand. This is because they have different medication distributors. Who would have know?

So, what to do? If your medication is working, the brand of generic Concerta doesn’t matter. If your generic Concerta was working and has “lost its effect”, check the manufacture. If you were changed to Mallinkrodt, and you were better with the “barrel” shape pill, go back to Watson brand. Don’t simply conclude that generic Concerta doesn’t work. Unfortunately that is likely to happen to new patients started on generic Concerta who get the Mallinkrodt brand.

Hope this insight is helpful.

 

 

WYPR interview on ADHD with Dr. David W. Goodman

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My discussion with Dale Archer, M.D. (psychiatrist, best-selling author) on WYPR September 27, 2014 about ADHD, over- diagnosis, and over-prescribed medications was lively. While Dr. Archer advocates “medication as a last resort” and “the goal of treatment is to get off medication” after learning new skills, I offered the research on medication benefit and a quality of life measure to evaluate medication utility. Certainly, treatment of ADHD at all ages incorporates behavioral therapy, organization skills, couple/family/individual therapies, and academic/occupational accommodations, in addition to medication, when indicated.

For those of you interested, the radio broadcast is available and runs 35 minutes. I invite you to listen and decide for yourself the merits of each position. Ultimately, this information best serves those who have ADHD and their families.

Dr. Goodman interview on Dan Rodricks show on WYPR Jan 27 at 1pm

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I have been invited as an expert on ADHD to participate in an interview on the Mid-day with Dan Rodricks show on WYPR on January 27 1-2pm. This is a live panel discussion that will include Dale Archer M.D., a psychiatrist and writer, to discuss the use of medication and treatment options for ADHD. The discussion is moderated by Dan Rodricks who is a distinguished journalist in Baltimore with a regular feature in the Baltimore Sun newspaper.

Dr. Archer wrote an article online for Forbes on January 6, 2014 on his perspective of ADHD and the overuse of medication and the over-marketing of ADHD. His article highlights and echoes the sentiments of Alan Schwatz in his New York Times article “The Selling of Attention Deficit Disorder” published December 15, 2013.

This one-hour program will give me the opportunity to highlight the national and international scientific literature and research on ADHD. I hope to highlight the well documented negative consequences over the course of one’s life with untreated ADHD as reflected in several international prospective studies following ADHD children into young adulthood.

This program promises to be a lively discussion and offers listeners the opportunity to call in with questions. I encourage you to mark your calendar. I believe the program can be accessed online. If you listen, please leave me your comments for feedback.

Latest generic Concerta may not work as well as others

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Recently, a new generic of Concerta, manufactured by Mallinckrodt, has come to market and patients may be getting this substitute for their prescription. I have  two patients who, having been on the previous generic manufactured by Watson, now say this new generic is clearly not working as well. One of my patients took the pills back to the local pharmacist who is reported to have said “I have several people who have come back complaining ‘It’s not working.’”.

Background: Brand Concerta pill contains a mechanism called “OROS” to deliver the methylphenidate over several hours at an increasing dose over time. The benefit of this specific delivery was established in sophisticated research. The Mallinckrodt generic does not and can not use this technology because of patents. This is not to say that an equivalently effective medication can’t be developed without OROS. It just appears that the Mallinckrodt formulation may not be equally effective to the Watson formulation in some patients.

I bring this to clinicians’ and peoples’ attention for two clinical reasons:

1. If you have been on other preparations of Concerta and now find the medication is not working well for you. Check the manufacturer with your pharmacist. He/she will want to know.

2. If you are prescribed Concerta for the first time, receive a generic, and you find it doesn’t work well, even at higher doses, check the manufacturer. Don’t rule out Concerta as an effective medication because of this experience. See if you can specifically request the Watson formulation from the pharmacist.

Hope this is helpful. I’ll be watchful and interested to see how this develops. Please leave comments for me. Thanks.

URGENT ALERT Counterfeit Teva Adderall 30 mg pills online

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This morning the FDA’s MedWatch posted the following alert to physicians and patients concerning counterfeit Adderall 30 mg tabs from Teva Pharmaceuticals. These “Adderall” tablets don’t contain the four amphetamine salts as it should be. These tablets contain a combination of tramadol (pain medication) and acetominphen (tylenol).  READ THE FOLLOWING ALERT AND ADVISE ANYONE OBTAINING THIS MEDICATION ONLINE.

Teva’s Adderall 30 mg Tablets: Counterfeit Product – Contains Wrong Active Ingredients

AUDIENCE: Consumer, Health Professional

ISSUE: FDA is warning consumers and health care professionals about a counterfeit version of Teva Pharmaceutical Industries’ Adderall 30 milligram tablets that is being purchased on the Internet. FDA’s preliminary laboratory tests revealed that the counterfeit version of Teva’s Adderall 30 mg tablets contained the wrong active ingredients. Adderall contains four active ingredients – dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate. Instead of these active ingredients, the counterfeit product contained tramadol and acetaminophen, which are ingredients in medicines used to treat acute pain.

BACKGROUND: Adderall, which is approved to treat attention deficit hyperactivity disorders (ADHD) and narcolepsy, is a prescription drug classified as a controlled substance – a class of drugs for which special controls are required for dispensing by pharmacists. The counterfeit Adderall tablets are round, white and do not have any type of markings, such as letters or numbers. Authentic Adderall 30 mg tablets produced by Teva are round, orange/peach, and scored tablets with “dp” embossed on one side and “30″ on the other side of the tablet.

See the Press Release for pictures of the product.

RECOMMENDATION: Anyone who believes they have the counterfeit version of Teva’s Adderall 30 mg tablets should not take or should stop taking the product. Consumers should talk to their health care professional about their condition and options for treatment.