Adderall IR 20mg TID and Adderall IR 30mg BID

[runner123]

I typically see children, but started inheriting adult patients due to a provider leaving. The majority of the inherited adult patients I see are either on Adderall IR 20mg TID or Adderall IR 30mg BID? Is that normal?

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[Jules A]

Not at my practice and in fact I'd like to personally witness the adult take 30mg TID.

 

[whopper]

The majority of the inherited adult patients I see are either on Adderall IR 20mg TID or Adderall IR 30mg BID? Is that normal?

Not enough information to tell. Several adults have ADHD and need treatment but some doctors irresponsibly prescribe. 30 mg PO Q BID is still within the FDA dosage guidelines. Unfortunately whenever I took over someone else's patient it wasn't rare that the patient was on bad meds such as being on Zolpidem for years or Adderall simply for weight loss for years.

Even if it turns out the prior physician wasn't a good one and recklessly gave out controlled substances that doesn't mean the patient wasn't on the right med. A broken clock is right twice a day. That doc inappropriately giving out Adderall to many patients will likely have at least a few that actually needed it for the right reasons.

 

[NickNaylor]

The situation gives off inappropriate prescribing/use vibes but isn't completely out of the norm.

 

[Liquid8]

60mg of any short acting stimulant is probably at the upper end of what I’d be comfortable prescribing, although if patients on dexamphetamine continue to demand increasing doses or claim that it’s ineffective I tend to intervene much earlier on by offering a transition to Vyvanse or swapping to a non-stimulant.

 

[thoffen]

Certainly within dosing guidelines. If indicated, appropriately monitored, well-tolerated, and effective then this is good treatment. I do try and do a careful job between 30mg and 60mg of Adderall for my stimulant patients as there is unlikely significant benefit difference in that range. Sometimes reaching for higher indicates a need to reset expectations, reexamine diagnostic impression/comorbidities, or consider an alternate treatment/adjunct. Personally, I see a lot more problem in under-dosing and demanding only ER formulations be used in all cases.

All that said, a high rx rate for stimulants certainly suggests you should look into whether or not they are indicated more closely on an individual basis.

 

[Merovinge]

High dose of IR Adderall as the go-to really screams warning signs for diversion/shop-a-doc. Adderall IR is by far the most abusable of any stimulant and if all of a provider's patients magically do not tolerate ER/Vyvanse/methylphenidate/non-stimulants and all need to have near max dose of IR, I would definitely be alarmed. Now if this was a sizable portion (say 50%) and others had different treatments, I might just think its someone old fashioned who hasn't had good to training to push towards less divertable/abusable options but if 80+% of their patients have that exact dosage I would be concerned.

 

[Jules A]

Personally and full disclosure I tend to be suspicious but I'd consider a fair amount possibly selling meds if this pattern is the norm. In my area these pills go for $10-$20 each x 2 x 365 says = what? ~10K