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Monthly NewsNote
June 2005
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Take Medication as Prescribed - It's Important!
It is very important that medications be used as prescribed by the physician.
The logic of this idea is inescapable. But often that is not what occurs, and
there can be negative consequences. This issue of the Monthly NewsNote will discuss
the problem in the hope that talking about it will make patients understand the
importance of following instructions. I will be discussing ADD medications, though
the subject applies to all.
Here are a few examples. Rich is a 16 year old high school sophomore with ADD,
Inattentive Type. After trying other medications we found that RitalinLA on
school mornings was appropriate. He was given a month's supply. I didn’t
hear from him for 3 months. At that time I learned he was not doing well. I
asked about the medication and was told he “didn’t take it every
day”. Clearly, he had not used it as prescribed, and was doing very poorly
because of it.
Mike, a 12 year old boy, was having trouble sleeping. He was taking Metadate
and the dose was two capsules at 7 AM. Metadate lasts about 7 hours and I planned
to have it work during school hours. At first I assumed the sleep problem was
related to the morning medication, but then his mother told me she was giving
him one capsule at 7 and one after school because he was much easier to manage.
Obviously, a 7 hour medication given at 3 or 4 in the afternoon will keep the
patient awake well into the night. In this case, changing the dosage time changed
the result.
And one more: I received a call from the emergency room of a local hospital.
Frank, a 10 year old patient of mine <,> had been brought in shaking,
having trouble talking and feeling nauseous and ill. He had been on Concerta
for a month and had done well. Concerta is a time release capsule that lasts
10 hours. It was assumed that his condition was a reaction to his medication,
but this didn’t seem logical to me as he had been taking it without trouble.
I met with Frank and his father the next day. It turned out that he had been
having some trouble swallowing the capsule. To help him, that morning Dad had
cut the capsule into 3 pieces. This means the boy got the entire 10 hour dose
at one time. Clearly, it was a reaction to the huge dose given at one time.
I should mention that time release medication should not be cut. Dividing Concerta,
a rock hard capsule, is probably rare. But other long acting medications are
divided because the user doesn’t know that it changes the release time
and amount. This includes long acting Wellbutrin, Depakote ER, etc.
The need to change dose, time and medication is common, particularly as a treatment
program gets started. Be aware that the physician has a plan even if he/she
has not explained it clearly. If a parent or patient feels that some type of
change needs to be made, discuss it with your doctor! Change is often necessary,
but don’t risk appropriate treatment by doing it yourself.
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