Optimising Your ADHD Medication
We asked Beehyve GP, Dr Torrance Merkle, to explain how adults with ADHD can ensure their ADHD medication meets their needs. He outlines how the system works in New Zealand and who can help you get the right dose or formulation. He also shares specific examples of ADHD medication types and brands and their availability.
ADHD medications can be lifechanging
ADHD medications are used to treat the core symptoms of ADHD, including impulsivity, hyperactivity, inattention, and emotional regulation.
Medications are only one part of the treatment of ADHD, along with exercise, sleep, nutrition, coaching, counselling and other therapies. Nevertheless, medication can make a life-changing impact.
Only a psychiatrist can initiate a prescription for Dexamfetamine or Methylphenidate, which includes brands such as Ritalin, Rubifen, and Concerta. Lisdexamfetamine branded Vyvanse is available in New Zealand, but not currently funded .
Psychiatrists are in high demand
We don’t have enough psychiatrists in New Zealand to diagnose and initiate medications for ADHD. It means people often only get one or two visits to discuss their medications before they are discharged to their GP for ongoing prescriptions.
Not all GPs are confident in adjusting medications for ADHD. Some GPs have experience adjusting ADHD medications to help their patients make the most of them. However, others haven't yet had enough exposure to be comfortable doing this.
Medication may need to be adjusted for people to keep improving
People sometimes describe a 'honeymoon' effect of ADHD medications. With their first prescription, they are finally able to sit still, initiate and complete tasks, or stop interrupting people. Yet, at the three, six or twelve-month mark, they wonder if their medications have stopped working so well. They may wonder if they need to change their dose or if they have just gotten used to the beneficial effects of the medication.
“I commonly hear that people have had some initial success with medication and have been able to use the "pills to develop their skills". Then, they say they reach a point where they feel like they are no longer improving. They want to know how to further reduce their symptoms and improve their functioning.”
In this case, adjusting the dose, formulation, or medication itself can be an option.
GPs can adjust your dosage
Any GP can adjust your dosage of medications that have already been prescribed. For example, if you started on Rubifen SR 20mg in the morning, you could potentially add a second dose at lunchtime if it doesn't last you the whole day. If your GP has any concerns, they can access the CADDRA (Canadian ADHD) guidelines or the Australian (AADPA) guidelines.
The New Zealand Formulary also has really clear information about prescribing with suggested dosing and reminders about safety and side effects to monitor.
GPs can change the formulation
Your GP can also change you to a formulation that has a slower release or is longer acting. For example, they could change you from either an immediate-release methylphenidate formula, such as Ritalin or Rubifen or a sustained-release formula, such as Rubifen SR, Ritalin LA, to a longer-acting version. These longer-acting versions include Concerta or Methylphenidate Extended Release, Teva. This is covered by the same Pharmac Special Authority number.
Only psychiatrists can change you to a new medication
If you are currently on methylphenidate (Rubifen, Ritalin, or Concerta), and you want to switch to another medication such as dexamfetamine or Vyvanse, you will need to see a psychiatrist for review. Psychiatrists are the only prescribers that can initiate this.
To book an appointment with Dr Torrance Merkle, get in touch through our contact page. The Beehyve team would love to meet you and know you’re getting the help you deserve to hone your medication dosage and treatment.
