Awkward title, sorry. Doc just prescribed Focalin XR for our youngest, for treatment of ADHD-like behaviors.
Does anyone have experience with this drug? Anything I should watch for? I have the pharmacy’s guidelines, but I’m curious about the REAL Straight Dope! 
PS- why is it that I could pick up a federally controlled substance (CII) at the pharmacy without as much as showing my drivers license, but I can’t get Sudafed without a cavity search and background check? 
One bump- kid starts taking it this morning.
And another question- the doc seemed to be in favor of slipping it into soft food without telling the kid, but my PhD SIL thinks we should tell him, as some possible side effects will not be observable, only self-reportable (vision abnormalities, etc). Anbody make that choice?
Oh, yes. My oldest son was on it for several months (10 mg), and now is on the regular, non-XR version (10 mg 2x per day). (He’s 7 1/2 now, and started on it when he was about 5 1/2.) His appetite decreased for about a week, and then bounced right back.
I just gave him the capsule and taught him how to swallow it with milk or water. He’s still mostly non-verbal, so pretty much unable to report any side effects himself; I just kept a close eye on his behavior, weight, eating and sleeping.
Now that he’s on the regular Focalin, which costs about a fourth of what the XR cost, we have a constant battle with his insurance because they want to pay for the generic (a whopping $7 less than the name brand), but no pharmacy in town can get the generic. Grrr… there’s no generic for the XR, so it was never a fight with it.
Yeah, mine is starting on 5mg once per day for the first week, then 0 for the second week, then 1 or 2 5mg once per day in week three (we are tracking initial progress to see if we will continue). We are asking him a fair number of questions about how he feels, hopefully he’ll tel us.
I opened the cap and mixed the pill-lets into some yogurt this am- mine has never swallowed pills. We decided not to tell him he’s on “a vitamin to help him concentrate” just yet, in case we don’t stick with it.
And WTF is it with the cost?!? 30 pills cost me $115 and change, and that was after the insurance company paid their whopping $15 portion… :rolleyes:
We started on the 5 mg per day, and it made no difference, so the neurologist upped it to 10, and wow! I was amazed. But even the XR wore off too quickly, and that’s why he switched to the regular, to add a second dose.
I was very nervous about starting my son on any medication at all, but I must say, it worked. He does better in school, and he functions better all around. (He has autism, ADHD, and sensory integration disorder, and now, at 7 1/2, he’s starting to speak a little bit, make a little eye contact, and almost noticing that other people exist.)
I was diagnosed with ADHD back in the third grade (1988 or thereabouts). Currently I’m on Concerta and haven’t had any experience with Focalin.
I vote for telling him. If he really does have ADHD, he’ll have noticed the problems he’s having and the difference between him and other children. Telling him and letting him take the pill makes him part of the fight for success. Slipping him a pill means you don’t trust him to even know about his own problem.
I don’t have any experience with taking these drugs, but in regards to the cost - Ritalin LA has a generic available, and without getting into too much boring pharmacy-speak, should be practically identical in effect. Focalin is to Ritalin what Nexium is to Prilosec, and Clarinex is to Claritin, etc… a purified version of a drug that is going off patent to preserve profits. Or, like mentioned above, there is a generic available to the non extended-release version of Focalin.
Although having said all that, you may be working on a deductible for your prescription costs anyway, and your copay may go down.
My son has been on Focalin XR for three years now. It has been a godsend. He was diagnosed with Asperger’s when he was four years old, and with ADD at age 9.
It has completely turned around his life. He was never able to consistently pay attention in school, and was constantly having to interrupt the teacher to have things repeated to him. After starting the medicine, he was able to concentrate and pay attention in school for the first time, and now gets straight A’s.
We did tell him when we started him on it (at age 9).
We did have a brief problem with loss of appetite when he first started it. He actually started losing weight. We supplemented him with pediatric Ensure for a few months. As he continued to grow, his appetite came back enough that he regained normal weight and actually, he’s gone a little too far the other way now. This may because he got into the bad habit of thinking he could eat as much junk food as he wanted (when his weight was low).
As it was explained to me, Focalin is actually a bit different than Ritalin. The molecule that is the active ingredient in Ritalin comes in two different mirror image forms (i.e. different chiralty). Only one of these forms has a therapeutic effect, but both forms contribute to the side effects (like loss of appetite). Focalin consists of only the mirror image that has the therapeutic effect. So to get the same therapeutic effect with Focalin, you need only use half the corresponding dose as would be necessary with Ritalin.
Because the pharmacy (and your insurance company usually) keeps track of all the information they need with regards to your CII prescription for ten years, which is much longer than with your Combat Meth Act medications. And there’s a decent chance your pharmacy knows you well enough to not have to ask for your ID with your Rxs but is required to ask for and record it for pseudoephedrine.
Which is equivalent to the situation with Celexa (citalopram) and Lexapro (escitalopram) and Prilosec (omeprazole) and Nexium (esomeprazole). In each instance, as the patent neared expiration, the manufacturer filed a new patent in which a formulation containing only the active isomer was registered. Hence cheap, generic (and now OTC) Prilosec has been replaced with expensive and (more or less) functionally identical Nexium which has a brand new lease on life until its patent runs out.
5 mg doesn’t seem to be having much of a therapeutic effect, but no noticeable side effects yet either. So far, so good- we move to 10 mg in a week or so.
We have told him that he is getting a vitamin that his doctor said might help him focus. He’s cool with it.
Both of you seem to be portraying this in terms of the “big, bad, pharmaceutical company.”
Nothing is preventing patients from using the older medicine whose patent has expired and is available in generic form, right?
Bambi, you state that “Prilosec has been replaced with expensive and (more or less) functionally identical Nexium.” Nothing of the sort has happened. Both are available, and the first is available in generic form as well.
With respect to Ritalin/Focalin, I far prefer the latter for my son, because he gets all of the therapeutic effect with half the side effects.
P.S. All that being said, I’m sure the timing of the patent filings has a lot to do with the pharma company maximizing its profits.
I’m not trying to portray it as big, bad Pharma. My degree is in accounting, and I understand entirely their trying to maximize the amount of profit off of a chemical.
My frustration is with insurance companies and their refusal to pay for certain things like Nexium when other equivalent therapies are available on the market. It leads to a lot of paperwork for us, the doctor, and the insurance company, and it often doesn’t ever go through. I understand entirely why they don’t want to pay for it when the patient has not tried other therapies first.
Yes, the older generic is still available. BUT it’s not marketed like the new brand – which is completely understandable – so it’s not on the doctors’ or patients’ minds during a consultation. So the patient brings their prescription to the pharmacy, and in their minds, I am the one saying they can’t have it – and then I get yelled at.
I’m not mad at the pharmaceutical industry, and I’m not mad at the doctors, and I’m not mad at the insurance companies. I’m just frustrated when I get a prescription for something crazy expensive when I know the patient hasn’t even tried something that will work just as well and cost much, much less.
Also, my frustration doesn’t extend to things like Ritalin vs Focalin and Celexa vs Lexapro – medications that affect brain function can have life-changing effects and side effects and eliminating the non-functioning isomer is something that can really affect a patient’s acceptance of a drug.