Shorted on Adderall...

[Moon Jaguar]

I've been on Adderall since the 13th of April and was started at 10mg 8am and noon and then upped to 20mg. For some reason the shrink at the hospital prescribed me 10mg pills instead of 20mg so I had 120-count prescription to fill. My insurance (Medicare Part D) flagged it and the pharmacy would only fill half the amount. I kind of hung on for awhile because I thought I was set up with a shrink but turned out I was set up with a therapist at another organization. Which was a giant waste of gas but that's how they do it there and I did manage to get an appointment with a shrink on the 11th (the therapist did some mad arm-twisting and I thank her for that).

Only problem is I found I was going to run out of Adderall before the 11th. Some days I tried cutting the dose in half in an attempt to make the pills stretch but the head noise, agitation and concentration problems started creeping right back. I finally got ahold of the doctor who prescribed this and he said that he couldn't prescribe any more since I was no longer under his care (being out of the hospital and being set up elsewhere) but that I should be fine adderall-less for a few days.

It's making me nervous because I'm afraid of the heavy-duty agitation that ended me up in the hospital will come right back. I also feel like I'm getting slapped in a way because I'm being med-compliant and I feel that these little blue pills are helping me. I've also been seeing a therapist for two months (at another agency than the one I was directed to to see the psychiatrist). I know some of you folks here likely have to travel longer distances than 30-50 miles to get your crazymeds and crazysessions (as well as medical help too). It adds to the pain in the ass factor that resources are for shit in the cowtown county I currently live in. I know the Schedule II factor's kicking in about the meds as well, what with me not able to get a prescription.

Has anyone ever cut off Adderall cold turkey or have I not been on it long enough to have any kind of withdrawal-snapback symptoms? I do know that reducing the dose makes me feel more like I've got the commotion in my head and focus/agitation problems (though less of that and other ADHD stuff when I wasn't on the Add)

(I don't know many people who started on these kind of things at age 40 but I hadn't been on a stim since I was in grade school so I keep thinking I'm going to have problems)

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[AirMarshall]

Hi Moon Jaguar, welcome.

I don't understand what the problem is in getting a refill. You said the pharmacy gave you half the prescribed amount due to insurance restrictions. Why can't you go back to the pharmacy for the remaining half?

If you can't get started with a Pdoc in time, then have you talked with your family practitioner about getting supplemental Rx's till you can see a Pdoc?

Another alternative is to see if you can be seen temporarily at your county or state community mental health center.

Remember to take your pill bottle and any other documentation you might have to show that you have legitimately been prescribed your stimulants.

If you are stuck having to gap meds, I think that you would be far better off to split pills and go to half dose than going completely off, or even cold turkey. If you already know that half dose causes significant problems, then you can expect a very rocky time when competely off them.

Good luck!

a.m.

[Sunshine]

Unlike a lot of (or even most) crazy meds, there aren't any serious medical issues with stopping CNS stimulants cold turkey. No risk of seizure or suicide, etc. And no "withdrawal" other than a return of the symptoms for which we take those pretty blue pills.

There are many pdocs who advocate an ocassional "vacation" from stimulants as it appears that this can improve their effectiveness. I have personally found this to be true. But we're talking after being on the med for years, not a month.

Anyway... aside from a return of ADD symptoms, going without the med for a few days shouldn't cause any problems. If there are any days between now and then that would be better than others to go without (e.g., the weekend)... you might want to consider that.

I'm sorry your former pdoc isn't being more sensitive to your situation. Good luck!

~Sunshine

[Moon Jaguar]

Hi Moon Jaguar, welcome.

I don't understand what the problem is in getting a refill. You said the pharmacy gave you half the prescribed amount due to insurance restrictions. Why can't you go back to the pharmacy for the remaining half?

The pharmacy won't give me a refill. They gave me the 60 and said I'd have to contact the doctor.

If you can't get started with a Pdoc in time, then have you talked with your family practitioner about getting supplemental Rx's till you can see a Pdoc?

Another alternative is to see if you can be seen temporarily at your county or state community mental health center.

I don't have a family practitioner (there's a nurse practitioner who works at one of the cowtown clinics but she won't prescribe the stuff because she legally can't). Supposedly there's a doctor at this particular clinic but he might be a sockpuppet for all I know since the doctors from two counties away aren't going to the country clinics anymore. My neurologist won't even think of prescribing this until he sees me and I don't see him until the 31st.

There is no county or state mental health center in this county, nearest one is 50 miles away and it is a total hellhole. I won't go there because it is a chronic factory. I thought the state mental facility where I used to live was a cuckoo's nest, this one beats it.

Nearest actual clinic to me that has psychiatrists is in Iowa and because of insurance/caseload reasons, they don't take Illinois patients. Odd... I've known people who lived in border towns of Illinois and Wisconsin and they were able to cross state lines for treatment. Guess Iowa's a whole different animal.

[Catnapper]

(I don't know many people who started on these kind of things at age 40 but I hadn't been on a stim since I was in grade school so I keep thinking I'm going to have problems)

For what it's worth, I was prescribed my first stimulant last summer at the tender age of 46 as an adjunct to other anti-depressants I take. I have recurrent unipolar depression and dysthymia.

My pdoc said that it wasn't a problem to miss a few days and there was no need to worry about half lives/titration like with all the other head drugs. The reason we were discussing it was because I was having a hard time getting on a regular sleep schedule so was reluctant to take Adderall unless I could do it fairly early in the morning, preferably after some sleep.

Air Marshall has some good ideas re getting your refill till your next appointment. I'm in a similar situation while changing pdocs to one more local to me. It sounds like you feel much better with it so I hope someone will treat you like a responsible adult. I don't know about you, but I always feel like anytime I get a "controlled substance" like Adderall or the pain meds I occasionally take that everyone involved suddenly starts to look at me like I'm going to start selling the damn things down by the high school as soon as I leave the drug store! Good luck getting it all sorted out.

[null0trooper]

Hi Moon Jaguar, welcome.

I don't understand what the problem is in getting a refill. You said the pharmacy gave you half the prescribed amount due to insurance restrictions. Why can't you go back to the pharmacy for the remaining half?

Nope.

If the insurance won't approve it, you have precisely two legal options:

1. pay for the full amount out-of-pocket

2. deal with it and pay the same co-pay as if you'd received the full amount

Going to another doctor for a script for the remainder means paying for the

second script completely out-of-pocket. However, you can "refill" as close

as 23 days from the previous pickup.

As to the original problem - as far as the ins. companies are concerned,

extended release means one per day, period. The formulations are ALWAYS

good for 24 full hours

instant release/standard formulations are allowed 2/day or 3/day with

stimulants - so legit pill counts can only be 30,60, or 90. It gets coded

into the formulary-checking software and can only be overrided

by having the doctor working monthly with the company (ain't going to happen)

*I* ran into all this over a antidepressant, not even a scheduled med

Luckily, adderall has a fairly short half-life (which is why the ins. companies are used

to kids having to take it 3/day), so the horrendous discontinuation syndromes associated

with many other meds won't be a problem. Skipping weekends should be no problem.

Me, I'd shoot for covering my morning commute or whichever part of the day is most

critical.

For the future, maybe consider having the med prescribed ONCE at 20 mg at 3/day and then

backing it back to the 20 mg at 2/day. That gives you a buffer for those times when

you can't get straight in to the doctor for the script in the 23-30 day window (doctors

take vacations too once in a while).

[DysfunctionJunction]

I've stopped cold turkey before a few times and the only problem other than lack of concentration etc is that I was really tired for the first 2-3 days and then I was fine. I took phentermine on those days to give me the energy to get things done.

[ldo]

Cold turkey is no big deal. If you're like me, you might be a little tired. And the symptoms you're treating with it will come back. Maybe a bit worse for a little while.

However, you can try taking the lower dose on an empty stomach with an antacid. But be careful with the antacid thing, because it does crank up the med some, and you want to be know how much before you overdo it. Avoid anything acidic like orange juice or cola for an hour or two after taking the Adderall.

I dropped back to 10mg last weekend because I wanted to be a bit more relaxed with my s.o., and it worked. 20mg is actually a bit much, I usually take 15.

These insurance companies who figure out exactly how much you ought to take are writing fiction.

If you run out and you have a critical day, you may find Sudafed helps. But nowadays they watch Sudafed very carefully. So don't lose your box and keep going back for more. You want the original formula, which I think is pseudoephedrine hcl and nothing else. Maybe something else would work, but I don't know. And I seriously doubt taking Sudafed for more than a few days is a good idea. Plus, if you haven't taken it before, try it on a non-critical day first.

BTW, I find a very small amount of Adderall, say 2.5 mg (a quarter pill) helps me get to sleep if I'm a bit agitated. I got a little more sleep this morning that way.