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Post by tryingtofocus on Oct 14, 2021 15:13:52 GMT
I've been diagnosed with ADHD a few months ago.
Currently in the titration phase my doctor put me on Medikinet XL which is a medium-release med.
Unfortunately this isn't working for me at all; my procrastination is awful, the afternoon dose ruins my sleep, and higher doses make me angry.
One month ago I had a trip to Turkey and a local psychiatrist was able to prescribe me 4x10mg/day Ritalin IR.
This made all the difference to me - I had sharp focus, I took my last dose at 2pm so my afternoons were calm and I could sleep well. Had some really productive weeks.
So at every consultation I'm suggesting my doctor that I'd like to try the IR meds because I beleive they work better, but he doesn't want, he just keeps increasing the dose of my current med (30+10mg).
(I didn't tell him about the Turkey events because not sure what are the rules, only about the sleep and procrastination.)
So I'm starting to lose my patience because there's one month between consulations and all these unproductive months take a toll on my carreer.
Is this normal? Is there some sort of NICE policy that mandates titrating XR meds before IR? Or should I just find another doctor?
PS- I don't drink alcohol at all, no drugs, I'm a professional so no risk of abuse and the doctor confirmed this.
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Post by Xxxxx on Oct 15, 2021 21:33:20 GMT
I started on generic quick release Methylphenidate 3 times a day. I switched to 1 tab Mediknet XL as I got fed up with taking medication 3 times a day and would get insomnia if I forgot a dose. I did notice a difference however got used to it quickly. I was given quick release first as I’m very sensitive to medication and was easiest way to gradually increase dose. There’s no reason you shouldn’t just have quick release if that’s what works best for you. I’d ask them again explain situation, you’ve been prescribed abroad and they worked fine. If they still say no without a good reason go elsewhere.
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Post by cassandro on Oct 18, 2021 13:16:16 GMT
BTW has anyone worked out how to get the site to display quarantined posts? I'm often seeing the reply (like Xxxxx's) and have to fiddle about to see the original.
In terms of NICE guidance, yes, there is NG87: 1.7.20 When prescribing stimulants for ADHD, think about modified-release once- daily preparations for the following reasons:
• convenience • improving adherence • reducing stigma (because there is no need to take medication at school or in the workplace) • reducing problems of storing and administering controlled drugs at school • the risk of stimulant misuse and diversion with immediate-release preparations • their pharmacokinetic profiles.
Immediate-release preparations may be suitable if more flexible dosing regimens are needed, or during initial titration to determine correct dosing levels. [2018]
1.7.21 When prescribing stimulants for ADHD, be aware that effect size, duration of effect and adverse effects vary from person to person. [2018] 1.7.22 Think about using immediate- and modified-release preparations of stimulants to optimise effect (for example, a modified-release preparation of methylphenidate in the morning and an immediate-release preparation of methylphenidate at another time of the day to extend the duration of effect). [2018]
So it's supposedly just for practical reasons. Prescribing in 1.7.22 seems to be to postpone rebound slump to end of working or social day, using IR as precision.
The OP's experience is helpful to me. I'm on 30mg immediate release and think the control is useful with IR, usually taking breakfast and lunch and mid-afternoon. I'm only just realising that although a bit of tiredness can begin only 4 hours after the dose, insomnia can continue for 8 hours, and I should take the final dose as you say about 2pm. I think I'm a relatively fast metaboliser. The IR is quite XR enough for me, thank you. I try to draw lines on the blister pack to ensure I don't exceed the dose because of forgetting whether I've taken it.
One thing to realise is that drug companies lose patents on older IR formulations and are always trying to tweak drugs pointlessly (via stereochemistry, changes to indication or formulation) to get a lucrative new patent for something they try hard to convince people is better when it's really just the same old. Is lisdexamphetamine really any different at all from... amphetamine? It has to be, because it makes more money. (The 'stigma' line in the guideline sounds a lot like PR bull has filtered through.) Not that I'm criticising anybody's choice of medication, just the stupidly inefficient and harmful system of drug development and promotion.
'get insomnia if I forgot a dose' - interesting. I wonder what the explanation is.
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Post by Rossall on Oct 21, 2021 15:14:02 GMT
BTW has anyone worked out how to get the site to display quarantined posts? I'm often seeing the reply (like Xxxxx's) and have to fiddle about to see the original. I find if you make a post on the relevant thread and then delete it then the hidden post appears.
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Post by tryingtofocus on Nov 1, 2021 10:59:22 GMT
Thanks for the responses.
If the doctor doesn't bulge what's the best way to switch doctors? Do I give him an ultimatum or shall I just not make the next appointment, and go someone else? Would I need to start everything over, including the diagnosis and titration process?
Seems like a waste of time to spend time titrating a medicine that doesn't work, I already had 3 sessions, and every time I told him that I think we should go with IR because of better control with appetite and insomnia. He keeps praising the Medikinet XL, makes me wonder why.
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