psychiatrist put easy child on a very high dose of Focalin

[Californiablonde]

We saw psychiatrist yesterday because the Focalin easy child is taking doesn't seem to be as effective as it used to be. I could have sworn easy child was already on the highest possible dose of Focalin, which is 10 milligram pills twice a day. I thought psychiatrist would have to try something else with him, but instead he increased the dosage. He wrote out a prescription for 30 milligrams twice a day. I looked it up online today on a couple of medical websites because I didn't think that sounded right. Turns out the highest recommended dose for Focalin is 20 milligrams total daily. Well psychiatrist is trying to put him on 60! I am going to call him later when he gets in to question him about it. I haven't attempted to get the prescriiption filled yet. Has anybody heard of a dose that high? Like maybe the recommended amount is 20 mgs but you can really go higher if necessary? It just doesn't seem right to me.

 

[confuzzled]

I don't know what the maximum dose is, but mine takes 30mg/once day (the xtended one) and 10/mg as needed after school (the short acting one) and it has been very effective for her. we do have some rebound at night if we don't use the 10's, so its out of her system pretty quickly, even the XR version.

it might depend on which type has been prescribed for maximum dosage, but it makes a lot of sense to contact your doctor if it doesn't seem right....

personally, we went incrementally from 5mg to 30 until we found what worked---but we moved pretty quickly.

it was the best choice for mine.

 

[Californiablonde]

He is taking the short acting form. The extended release one is too expensive. I am too afraid to give him such a high dose, even if his doctor ok's it. Maybe he can switch him to Adderall XR. It costs only $5 and I take it for my own ADD issues.

 

[dstc_99]

That dose of Focalin is not outside the recommended dosing ranges. The trouble with the internet is that it gives you generic information. Not information that is currently being circulated by medical professionals which I believe says around 45mg of the extended release is generally the most effective dose. Of course that is a generic guideline as well and 30mg may be perfect for your son.

 

[Californiablonde]

He's not taking the extended release. He is on the regular pills. psychiatrist is going from 20 mgs daily up to 60, which seems rather drastic to me. He never did call me back yesterday, so now I need to make another phone call.

 

[Malika]

I think you are absolutely right to question it, Californiablonde.

 

[Californiablonde]

It's been crazy busy at work today due to my coworker being out, so I didn't have time to call yet. My mom called for me, and the front office nurse told her that psychiatrist is a very competent doctor and she's sure there's no possible way he made a mistake. I am not buying it. At our appointment on Wednesday he asked me if difficult child was still taking Tenex. She has never taken Tenex so I don't know what he's talking about! So yes, he can make mistakes. He is not in the office yet but the nurse is going to have him call me when he gets in. Yes, he may be perfectly competent in a lot of ways, but he is not the first psychiatrist we have dealt with that has made mistakes. I'm not buying the nurse's story.

 

[dstc_99]

Did you speak with a pharmacist? A simple call to them might give you some answers.

 

[BusynMember]

I am biased because I don't like stimulants as my daughter abused them and many kids do. Also, I tried Ritalin and I most certainly have ADHD, among other things, and it reacted like speed on my body. I was flying.

You know your kiddo best. Do not give him more than you are comfortable with and, as one who has seen medications too carelessly prescribed by doctors, I think I'd tell him that you are going to go up very slowly, maybe ten mgs. at a time. See if he can tolerate 10 mgs. more. If so, you can climb to 40 mg., etc. It could be that, like many of our kids, a high dose of stimulant (whether within in the normal range or not) is not effective. In fact, often stimulants for ADHD do act like speed and make our kids violent and crabby. Adderrall is the most coveted stimulant by those who abuse stimulants. My daughter who once used drugs told me Adderrall is $10 a pill on the streets.

Many children on the spectrum are highly sensitive to medication of all kinds. Frankly, Sonic does much better medication free and, at age twenty, is not interested in taking any medication at all. Use your own common sense regarding your child. Do you think more stimulants will help him long-term or maybe more interventions? It is your call, but I say good for you for questioning this doctor. Doctors make mistakes all the time so said my neuropsychologist who spent ten years at Mayo Clinic, one of the most elite medical centers in the country. And he meant doctors at Mayo as well as everywhere else.

 

[Liahona]

If he made a mistake or not isn't the issue. You have a question. You are the parent. And of course the psychiatrist can make a mistake. He is human. He can still be a good psychiatrist. (Well I guess that depends on how he handles mistakes afterwards.)

 

[Californiablonde]

Now psychiatrist is saying give him 20 mgs in the morning to see if there's any improvement. That's double his usual morning dose. He assured me that 20 given at one time is perfectly safe, so I gave him the new dose this morning. Hopefully he's right and he reacts well to it.

 

[busywend]

Call the pharmacy

 

[Californiablonde]

I tried to find the official Focalin page and all I found was one for Focalin XR, which is the longer acting form. The page says the highest prescribing dose is 40 mgs and easy child is starting off with 20. I know his regular Focalin isn't exactly the same as the XR form, but it's similar. I gave him the 20 milligrams yesterday and he didn't have any side effects. He still slept good last night and I didn't notice any difference in his behavior. His IEP is scheduled for this Thursday morning so I will find out what his teachers have to say about his class performance and find out if the higher dose has made any difference.