AFFORDABLE/CHEAP SUBSTITUTES FOR VYVANSE, ADDERALL XR, CONCERTA, FOCALIN XR, AND DEXEDRINE SPANSULES FOR ADULT ADHD.
Dramatic savings can be achieved with this strategy if you're willing to accept some inconvenience and a period of adjustment. Vyvanse, Adderall XR, Concerta, Focalin XR, and Dexedrine Spansules cost at least $125 per month if you are on one pill a day because they cost about four dollars per pill. If you need 2 or 3 pills per day, that costs $250 or $375 per month. Generic Adderall costs $.35 per pill at Costco. If you take 2 or 3 Adderalls per day, that's $.70 to $1 per day or about $20 to $30 per month. Here's how I implement this strategy for the most consistent focusing all day.
I have my patients set a daily alert in their cell phone to go off at a time in the morning soon after they arise each day. They promptly take their first dose of generic Adderall, Ritalin, Dexedrine, or Focalin for the day. Then they note how long it is until the benefit of the first dose starts to decline. The next day they set their second daily alert for each day at a time that is 30 minutes before their focus begins to decline. This way they take the next dose to be replacing the falling brain concentrations of the previous dose. This prevents a dip in focus between doses. Alerts are then set for the third and fourth doses of the day, as necessary, with the same interval between alerts as between the first and second alerts. My patients are reporting significant improvement in their work and school performance, more consistent and improved mood, and avoiding daytime crashes between doses. Crashes are the periods of tiredness, sleepiness, irritability, or easy crying from a rapid drop-off in ADHD medication brain concentrations.
When switching my patients from a more expensive, longer acting ADHD medication to the cheap, shorter acting, generic substitute, we start out on very low doses and then move up the doses gradually. This way we avoid side effects, find the most effective dose, adjust the period between doses, and adjust the size and time of the last dose of the day to prevent difficulty falling asleep.
For more information on how to save money on psychiatric medications, see my blog about affordable psychiatric medications http://www.eveningpsychiatrist.blogspot.com To make an appointment with Dr. Hege for evaluation and treatment for adult ADHD,
Call 770-458-0007.
Showing posts with label Adderall XR. Show all posts
Showing posts with label Adderall XR. Show all posts
Monday, September 29, 2008
Thursday, April 24, 2008
Vyvanse Approved For Adults
Shire PLC announced today that Vyvanse has won US approval to treat adults. I have prescribed it for 275 patient since the FDA approved it for children and adolescents in August of 2007. 95% of these patients are adults. Only a few of my patients were afraid to take it because it was not FDA approved for adults.
This information was reported in the Wall Street Journal today, April 24, 2008, in an article on page D4, titled "ADHD Drug Is Approved for Adult Use".
Included in the article was this statement that Adderall XR will not lose patent protection until April 2009. I had been informed and was telling my patients that Adderall XR went off patent this year.
Additional information about Vyvanse may be found in three prior blogs on this blog site.
Additional information about Adult ADHD and women with adult ADHD may be found on my web pages, http://www.eveningpsychiatrist.com/aadd.htm , http://www.eveningpsychiatrist.com/aaddforwomen.htm .
http://www.eveningpsychiatrist.com/index.html
Monday, February 4, 2008
Vyvanse: How it works_Adult ADHD medication treatment specialist psychiatrist Dr. in Atlanta on the new Adderall named Vyvanse.
VYVANSE_HOW IT WORKS
Adult ADHD medication treatment specialist psychiatrist doctor in Atlanta on the new Adderall named Vyvanse.
Vyvanse has several advantages over Adderall XR, Adderall, dexedrine and other amphetamine preparations. It provides more consistent concentration assistance throughout the day, lasts longer, i.e., from morning till bedtime, all in a convenient, single morning dose, and less likely to reach abusive or overdose brain levels because of an enzyme regulatory action.
Here’s how it works. In the lab they took the dextroamphetamine molecule and stuck it onto a protein molecule. You swallow the capsule with the compound inside and it is absorbed from your intestine into your bloodstream and goes to your brain. However, the amphetamine molecule can’t get into your brain cells to help your concentration because the protein molecule is too big to get through the door into your brain cells. Enzymes in the body cleave the amphetamine from the protein. I use the following analogy to help my patients understand. The situation is like a waiting line outside a nightclub. The Vyvanse compounds of dextroamphetamine and attached protein molecules are like people with large backpacks that are too big for the small doors into the club. The people need the assistance of the bouncers at the door to help remove their backpacks and grant permission to enter the club. The bouncers activity is similar to the enzyme’s action. They allow the patrons to enter at a regulated rate. The longer the line of patrons, or Vyvanse, the later in the day the last amphetamine enters the brain cells. There is a limited number of these enzymes in your body so they put a ceiling on the rate of entry and the concentration level of amphetamine in your brain cells. Hence, you are less likely to overdose or abuse the amphetamine to get high concentrations of amphetamine into your brain. This also prevents spikes of high concentrations that cause jitteriness, edginess, nervousness,or anxiety that are often experienced in the early minutes or hours after taking the immediate release form or the extended release Adderall. Now this steady action of these enzymes on the Vyvanse compound also provides protection from the dips in concentration that are experienced with the other amphetamine preparations.
The longer duration action of Vyvanse is also related to this rate limited enzyme action. If we raise the dose of Vyvanse, we lengthen the waiting line of Vyvanse-protein molecules waiting to be cleaved to enter the brain. We can adjust up the dose so that you can have consistent focus from morning to bedtime. We adjust the one time morning dose of Vyvanse in this fashion. Pull the capsule apart and dump the ingredients into a measuring cup of water. Stir the solution and the Vyvanse compound dissolves in the water. Remember that the protein is only cleaved from the amphetamine by enzymes inside the body. After you have calculated the duration of hours that a particular dose of Vyvanse lasts, you drink the amount of solution proportionate to the number of hours you want the Vyvanse concentration to last. If you want it to last longer than your capsule dose, you swallow your capsule plus the measured solution. If you are going to have a short day or forget to take your Vyvanse until later in the day, you just take the proportionate fraction of your dose in solution form. If you find out later in the day one day that you’re going to need to concentrate longer that day than what you had dosed for that morning, you can take an additional partial fraction of a capsule dose at that time. You may then save the remaining aliquot of solution in the refrigerator for ingestion the next day.
Pharmacist s often are not aware yet that you may take partial doses, but you can tell them that “It’s in the package insert”. Now they may tell you that you can’t save the balance of the solution for the next day. That is what the package insert says because it was not researched in the clinical trials. However, my colleagues and my patients rarely report any loss of benefit or other effects.
For more blogs by Dr. Hege about Vyvanse
http://eveningpsychiatrist.blogspot.com/2008/01/vyvanse-update-on-first-100-patients.html
http://eveningpsychiatrist.blogspot.com/2007/11/new-adhd-medicine.html
Darvin Hege, M.D.
February 4, 2008
Adult ADHD medication treatment specialist psychiatrist doctor in Atlanta on the new Adderall named Vyvanse.
Vyvanse has several advantages over Adderall XR, Adderall, dexedrine and other amphetamine preparations. It provides more consistent concentration assistance throughout the day, lasts longer, i.e., from morning till bedtime, all in a convenient, single morning dose, and less likely to reach abusive or overdose brain levels because of an enzyme regulatory action.
Here’s how it works. In the lab they took the dextroamphetamine molecule and stuck it onto a protein molecule. You swallow the capsule with the compound inside and it is absorbed from your intestine into your bloodstream and goes to your brain. However, the amphetamine molecule can’t get into your brain cells to help your concentration because the protein molecule is too big to get through the door into your brain cells. Enzymes in the body cleave the amphetamine from the protein. I use the following analogy to help my patients understand. The situation is like a waiting line outside a nightclub. The Vyvanse compounds of dextroamphetamine and attached protein molecules are like people with large backpacks that are too big for the small doors into the club. The people need the assistance of the bouncers at the door to help remove their backpacks and grant permission to enter the club. The bouncers activity is similar to the enzyme’s action. They allow the patrons to enter at a regulated rate. The longer the line of patrons, or Vyvanse, the later in the day the last amphetamine enters the brain cells. There is a limited number of these enzymes in your body so they put a ceiling on the rate of entry and the concentration level of amphetamine in your brain cells. Hence, you are less likely to overdose or abuse the amphetamine to get high concentrations of amphetamine into your brain. This also prevents spikes of high concentrations that cause jitteriness, edginess, nervousness,or anxiety that are often experienced in the early minutes or hours after taking the immediate release form or the extended release Adderall. Now this steady action of these enzymes on the Vyvanse compound also provides protection from the dips in concentration that are experienced with the other amphetamine preparations.
The longer duration action of Vyvanse is also related to this rate limited enzyme action. If we raise the dose of Vyvanse, we lengthen the waiting line of Vyvanse-protein molecules waiting to be cleaved to enter the brain. We can adjust up the dose so that you can have consistent focus from morning to bedtime. We adjust the one time morning dose of Vyvanse in this fashion. Pull the capsule apart and dump the ingredients into a measuring cup of water. Stir the solution and the Vyvanse compound dissolves in the water. Remember that the protein is only cleaved from the amphetamine by enzymes inside the body. After you have calculated the duration of hours that a particular dose of Vyvanse lasts, you drink the amount of solution proportionate to the number of hours you want the Vyvanse concentration to last. If you want it to last longer than your capsule dose, you swallow your capsule plus the measured solution. If you are going to have a short day or forget to take your Vyvanse until later in the day, you just take the proportionate fraction of your dose in solution form. If you find out later in the day one day that you’re going to need to concentrate longer that day than what you had dosed for that morning, you can take an additional partial fraction of a capsule dose at that time. You may then save the remaining aliquot of solution in the refrigerator for ingestion the next day.
Pharmacist s often are not aware yet that you may take partial doses, but you can tell them that “It’s in the package insert”. Now they may tell you that you can’t save the balance of the solution for the next day. That is what the package insert says because it was not researched in the clinical trials. However, my colleagues and my patients rarely report any loss of benefit or other effects.
For more blogs by Dr. Hege about Vyvanse
http://eveningpsychiatrist.blogspot.com/2008/01/vyvanse-update-on-first-100-patients.html
http://eveningpsychiatrist.blogspot.com/2007/11/new-adhd-medicine.html
Darvin Hege, M.D.
February 4, 2008
Saturday, January 5, 2008
Vyvanse Update On First 100 Patients Treated
I have now prescribed Vyvanse for 105 patients. My patient's responses have been better than I expected. The majority of the patients prefer or much prefer Vyvanse over Adderall XR. The chief advantage is the consistently improved concentration. The second most frequent benefit is that it lasts longer. Some patients report it lasts all day and they experience no "fade" before bedtime. Patients frequently say they just feel normal all the time. Many patients report no more of the "crash" that they experienced when their Adderall XR levels dropped later in the day.
The most frequent reason that patients want to change back to Adderall or Adderall XR is that their insurance doesn't cover it. Other patients feel it doesn't work as effectively as Adderall. As I get more experience, I am using higher doses and having fewer of these complaints. When I started prescribing Vyvanse I started at a dose similar to the total daily dose of Adderall the patient had been taking. Now I am aiming for approximately double that dose and I am getting better results.
Few patients complain of jitteriness even when I raise the dose significantly. Usually, each raise only prolongs the duration of benefit to a later point in the day. A few patients have had to stop Vyvanse because of abdominal distress, headache, or insomnia.
Call us today at 770-458-0007 for an appointment if you would like to be evaluated for Vyvanse.
Dr. Hege
January 05, 2007
For more information :
http://eveningpsychiatrist.blogspot.com/search/label/Vyvanse
and http://www.eveningpsychiatrist.com/aadd.htm
Tuesday, December 11, 2007
Dr Hege - Affordable Medications for Psychiatric Diagnoses
You’ve gone through the sometimes difficult process of being diagnosed with Adult ADHD, bipolar disorder, anxiety or depression. Now you have to figure out how to pay for the medication. Whether or not you have insurance to help with costs—you may find some of these tips helpful.
Generics are Affordable Medication
Choosing a generic over a brand medication is a great way to save money. Generic Adderall immediate release costs 90% less than brand Adderall XR. All of the antidepressants except Lexapro and Cymbalta are generic now.
A lot of prescription sleeping pills have generics including Ambien. All of the benzodiazepines are now generic, including the extended release Xanax (alprazolam ER).
However, often the newer, brand-only medications offer superior effectiveness and/or fewer side effects than the older generics. Consult your doctor or pharmacist about generic versus brand medications.
Where to Buy Affordable Medications
Patients tell me that the cheapest places to buy their psychiatric medicines are at Costco or Sam's Club. The biggest savings are in generic medication. (The spread between different stores’ prices on brand medications is not nearly as great as for generic medications.)
Patients report paying $.75 to $1.25 per pill at retail pharmacies for generic, short-acting Adderall. At Costco, they pay about $. 40 per pill. The pharmacies in Kroger and Target match prices. When you get a lower price at Costco or Sam’s Club, keep the receipt and present it at the most convenient, price-matching participating pharmacy when you fill your prescriptions the next time and ask for a matching price. An option is to go online at the Costco website and check out their price for your medication. Print it out for evidence to take to your price matching pharmacy. However, that list is not comprehensive and you may have to go to the store to get a price. Some patients have been able to call Costco to get a price, while others have been told they have to come in to the store to get a quote on their medication price.
By the way, you don't need a membership card to go to the pharmacy at Costco or Sam's Club. It is illegal for membership stores to require membership fees to access their pharmacies.
Other Tips for Affordable Medication
Another great way to save money is pill splitting. Most tablets can be split. A pill splitter costs $3-$5 and can be purchased in most pharmacies. Pill splitters are even available for $1 at the dollar stores.
The most dramatic cost savings are for patients who are on Abilify. If prescribed 2 mg per day, it is possible to split a 20 mg tablet into eighths, which is approximately 2.5 mg per day. Since Abilify has such a long half-life, the blood levels swing only a small amount from high to low each day. Patients are unlikely to experience any side effects if they get 1 mg one day and 4 mg another day.
A 30 day supply of the 2 mg size may cost around $400. By cutting the 2 milligram tablets into eighths, it only requires 4 tablets per month. At $13 per tablet, this is only $52 per month.
Other pills I frequently have patients cut are Lamictal 200 mg, Seroquel 400 mg, Trileptal 600 mg, gabapentin 600 mg, Adderall and Ritalin (both in the immediate release form), Provigil 200 mg, and Suboxone 8 mg.
Call 770-458-0007 today to schedule an appointment for an evaluation to see if you are getting the most affordable and effective medications for your psychiatric diagnoses, such as Adult ADHD, depression, anxiety or bipolar disorder.
Darvin Hege, M.D.
http://www.eveningpsychiatrist.com/
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