Chris Pagnani MD PC

Psychiatrist in Philadelphia, Manhattan, Delaware & The Main Line

Chris Pagnani

Adult ADHD Treatment

ADHD Medication Shortage “Substitutions” #2 – Methylphenidates (Ritalin, Focalin, Concerta)

It is incredibly important for prescribers to discuss alternatives for a patient’s ADHD medications, when the ADHD stimulant shortage is causing disruptions in their ADHD treatment, whether they live in Philadelphia, Manhattan, Delaware or the other ares that we serve.

Providers should additionally take the time to educate themselves on the psychopharmacology of these medications, the medications within each class of stimulant that are more readily available, manufacturer promotions and coupons to make newer medications more affordable, and they should take the time to establish relationships with specialty pharmacies that can help patients to consistently fill their prescriptions.

We recommend discussing the following with your mental health provider for adult ADHD treatment, if you are doing well being prescribed Ritalin, Ritalin LA, Focalin, Focalin XR or Concerta, but the ADHD stimulant shortage in the Philadelphia, Manhattan and Delaware area is preventing you from consistently filling your prescriptions.

  1. Discuss Azstarys, which contains D-Methylphenidate (the active ingredient in Focalin and Focalin XR) and Serdexmethylphenidate (which is a “prodrug” that is metabolized into D-Methylphenidate by the body). This medication can be thought of as an extended release Focalin (providing 8-9 hours of symptom relief). It is readily available at pharmacies, and many can easily order it, if it not in stock. The manufacturer’s promotion makes it reasonably affordable for patients. Click here for information.
  2. Discuss Contempla XR-ODT, which is an extended release and dissolvable D-Methylphenidate and L-Methylphenidate medication (the same active ingredients in Ritalin and Ritalin LA). This medication can often be stocked by both chain and specialty pharmacies, and the manufacturer’s coupon can be found here.
  3. Discuss Jornay PM, which is an extended release D-Methylphenidate and L-Methylphenidate medication (the same active ingredients in Ritalin and Ritalin LA). This medication is taken AT NIGHT, and starts to become active as the patient is starting their school or work day. Many believe that the delayed effect, decreases risk of abuse for certain individuals. This medication is often available at pharmacies and specialty pharmacies, and manufacturer promotions can be found here.
  4. Discuss Daytrana, which is a patch that contains D-Methylphenidate and L-Methylphenidate, the same active ingredients in Ritalin and Ritalin LA. Daytrana is available as both a generic medication and Trade Name medication, and therefore, it can not only be readily available, but affordable for patients to fill. Some individuals prefer wearing a patch for 8-9 hours, over having the “ups and downs,” of multiple daily dosing of immediate release Ritalin.
  5. Discuss Relexxii, which is a once daily extended release D-Methylphenidate and L-Methylphenidate medication (the same active ingredients as Ritalin and Ritalin LA). Relexxii is approved for children 6 years and older, and adults up to 65 years of age. It is available in 7 different strengths, so that a patient’s symptom control and side effects can be more fine tuned, than many alternative medications. It can be ordered by pharmacies and manufacturer coupons can be found here.
  6. Discuss Quillivant XR, which is a liquid medication containing the active ingredients of Ritalin and Ritalin LA. It provides approximately 12 hours of symptom control for many patients. It can be ordered by pharmacies and the manufacture’s promotions can be found here.
  7. Discuss Methylin, which has the same active ingredients as Ritalin (D and L-Methylphenidate). This medication is in liquid form, and many providers and patients alike do not think of this as an option. Due to that fact, it is often either available in pharmacies, or pharmacies can order it within a reasonable amount of time. As it is available in both Trade name and Generic forms, patients can often fill it at a reasonable cost, utilizing Good Rx coupons.

View our Blog page, for helpful posts regarding ADHD treatment. 

Visit our Services page, for a complete list of services. 

SCHEDULE AN APPOINTMENT AT OUR PHILADELPHIA, MANHATTAN OR WILMINGTON OFFICE, OR A VIRTUAL TELEHEALTH APPOINTMENT. 

Contact Us

Scheduling@RittenhousePA.com

267-687-0655 x 1

Adult ADHD Treatment

ADHD Medication Shortage “Substitutions” for Amphetamines such as Adderall, Adderall XR & Vyvanse.

Many providers unfortunately do not take the time to discuss alternatives for a patient’s ADHD medications, when a patient is struggling to consistently fill their stimulant medication due to the ADHD Stimulant Medication Shortage, which is affecting Philadelphia, Manhattan, Delaware and the areas that we serve for ADHD Medication Management & Treatment.

We recommend discussing the following with your provider, if you are doing well with prescribed Adderall, Adderall XR, Dexedrine or Vyvanse for your adult ADHD treatment, but are unable to consistently fill your medication due to the ADHD medication shortage affecting Philadelphia, Manhattan and Delaware.

  1. Discuss Adzenys XR-ODT, as this is a dissolvable product containing D-Amphetamine and L-Amphetamine (the active ingredients in Adderall and Adderall XR) but in a dissolvable pill form, which is readily available at many specialty pharmacies. Click here for information on manufacturer programs, making this medication affordable for many patients with commercial insurance.
  2. Discuss Dynavel XR, as it is a extended release medication containing D-Amphetamine and L-Amphetamine (the active ingredients in Adderall and Adderall XR) but in an extended release version that often lasts up to 13 hours. This medication is often readily available at local pharmacies in Philadelphia, Manhattan, Delaware and the areas that we serve. Click here for information on manufacturer programs, making this medication affordable for many patients with commercial insurance.
  3. Discuss Xelstrym, which is a Patch containing D-Amphetamine (the active ingredient in Dexedrine, and the primary active ingredient in Adderall and Adderall XR). Many patients will state that wearing the patch for 8-9 hours through a work day, provides consistent support for their Adult ADHD, without the “ups and downs” of multiple daily dosing of immediate release Adderall or similar medications. This medication can be ordered by many pharmacies in the Philadelphia and surrounding areas, and made affordable for many patients with commercial insurance, using the manufacturer’s coupon program, found here.
  4. Discuss Mydayis ER, which is a combination of D-Amphetamine (the main active ingredient in Adderall and Adderall XR) and 3 additional amphetamine salts. This medication is both in trade name and generic versions. The beads of this product are coated in various thicknesses, providing symptom relief for many patients for up to 16 hours. Many pharmacies can order this product, and Good Rx coupons may make it relatively affordable, even if paying out of pocket.
  5. Discuss Evekeo, which is a mixture of 50% D-amphetamine and 50% L-amphetamine. It is available in both trade name and generic forms. Coupons can be found on GoodRx. 

View our Blog page, for helpful posts regarding ADHD treatment.

Visit our Services page, for a complete list of services.

Schedule an Appointment at our Philadelphia, Manhattan or Wilmington Office, or a Virtual Telehealth Appointment.

Contact Us

Scheduling@RittenhousePA.com

267-687-0655 x 1

 

 

 

Substance Use Disorder Treatment & MAT

Outpatient Treatment Options for Alcohol Abuse, Dependence, Withdrawal and Cravings.

There are several medications that can be used to help patients who struggle with Alcohol Use Disorders, such as alcohol abuse and alcohol dependence. We are able to provide these treatments for alcohol use disorders in-office in Philadelphia, Manhattan and Wilmington, DE AND virtually to the various states that we serve, including Pennsylvania, New Jersey, New York, Delaware, Maryland, Florida, California and the USVI.

Oral Naltrexone: This is a medication that is frequently used to reduce cravings for alcohol. It was first developed in 1963, and first approved as a treatment for addiction in 1984. This medication works by antagonizing (blocking) the opiate receptors in the brain (and it was first approved as a treatment for patients with opiate dependence). With that said, patients will state that it substantially reduces cravings for alcohol as well, which is likely because the opiate receptors that it blocks, are involved in the “reward pathway” of the brain. This pathway affects cravings for various substances, such as alcohol. Although this medication has been utilized for alcohol abuse and dependence for decades, unfortunately many patients do not realize that it is a readily available option for the treatment of alcohol use disorders. The medication is typically taken once daily (usually 50 mg) and it generally provides protection from alcohol cravings throughout the day. In the US it’s typically taken daily, but in Europe it is often prescribed “as needed.” Our offices will discuss the risks and benefits of not only this medication (it is generally well tolerated), and also the pros and cons of taking it daily vs. on an “as needed basis.”

Vivitrol (Injectable Naltrexone): Vivitrol is a newer branded medication that is a long acting injection of Naltrexone (described above). The injection is typically given every 4 weeks, and provides patients with protection from cravings for alcohol throughout this 4 week period. Some patients prefer knowing that they have protection from cravings for approximately a month, as opposed to needing to take a medication daily. Patients will sometimes state, “having to do the right thing and take a medication once a month, can be a lot easier than doing the right thing every day.” Patients will also often describe that Vivitrol injections seem much more effective at curbing cravings for alcohol, than a typical oral naltrexone pill. Dr. Pagnani works with a network of pharmacies throughout Pennsylvania in particular, who are able to administer this injection monthly to his patients, with his oversight as the prescriber.

Antabuse (Disulfiram): It is our opinion, that Antabuse (Disulfiram) is a very underutilized medication in psychiatry for alcohol use disorders. Antabuse works by blocking an enzyme that breaks down a metabolite of alcohol (it inhibits aldehyde dehydrogenase). When an individual takes Antabuse, if they drink they can become incredibly ill, which serves as a significant deterrent from alcohol use – for many, making it a complete non-issue, because they frankly cannot drink if they are taking this mediation. If an individual does drink with this in their system, they can become violently ill, which psychologically can change the association that the patient has between alcohol use and a pleasurable feeling. Of note, some individuals have such severe reaction to drinking if they take this medication, that it can be dangerous for their health. Patients must understand that they are committing to abstinence, if they take this medication. Of specialists in Philadelphia, Manhattan, Delaware and Virtually will review risks and benefits of Antabuse for alcohol use disorder treatment.

Campral (Acamprosate): Acamprosate can be used to decrease cravings for alcohol in individuals who suffer from Alcohol Use Disorders. It works differently than Naltrexone and Vivitrol, and for some, can be a very helpful medication. When individuals drink frequently, or are dependent on alcohol, their bodies may start to make less GABA (your major inhibitory or “calming” neurotransmitter). This is because alcohol is a “depressant,” so the body starts to think that it doesn’t need to make as much of its natural “depressant” (or calming) neurotransmitter. In fact, when an individual is dependent on alcohol, their body may start to make more glutamate (the neurotransmitter that “excites” your nerves), to make up for the depressant effects of alcohol. “Excited nerves” can cause people to feel more anxious, tremulous, and have cravings when they try to stop drinking. Campral is thought to work by re-calibrating GABA and Glutamate, when individuals stop drinking alcohol. Our offices in Philadelphia, Manhattan, Delaware and virtually, can discuss Campral as an option for alcohol use disorder treatment.

This list is by no means exhaustive, and there are several other medications used in the treatment of Alcohol Use Disorders in Philadelphia, Manhattan, Delaware and the areas that we serve.

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Schedule an Appointment with Dr. Pagnani, for Alcohol Use Disorder

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Scheduling@RittenhousePA.com

267-687-0655 x 1