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Q: protocol for monitoring use of ridalin ( Answered,   0 Comments )
Subject: protocol for monitoring use of ridalin
Category: Health
Asked by: veryconcerned-ga
List Price: $100.00
Posted: 22 Jul 2006 05:53 PDT
Expires: 21 Aug 2006 05:53 PDT
Question ID: 748515
Is there a protocol on how often you have to see your doctor if he is
prescribing ritalin for depression? I think its a month. My wife's
Doctor has once a week. She's been on it for many years and doing much
better. Is he seeing her this often just for the money because we
can afford it?
Subject: Re: protocol for monitoring use of ridalin
Answered By: boquinha-ga on 24 Jul 2006 08:30 PDT
Hello veryconcerned-ga!

I can understand your concern with your wife?s medications. Ritalin is
a medication with many side effects and this is one of the main
reasons that its use is monitored so closely. Traditionally it is used
in treating ADHD, but has recently been used more and more in treating
depression, especially in patients that have not responded adequately
to other anti-depressants. This answer is not intended to substitute
for the opinion of a qualified health practitioner that you trust, but
is a starting point for gathering information. I found some resources
that you should find to be useful. Here it is!

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The DEA has a list of drugs it considers to have ?abuse potential.?
These are then assigned a ?schedule? depending upon how likely it is
that someone would abuse the drug. Class I drugs are those that have
high abuse potential and are illegal (such as heroin, PCP, Ecstasy,
etc.). Class II drugs also have a high abuse potential, but can be
obtained with a prescription. Methylphenidate (Ritalin) is a DEA Class
II drug.

This article gives a nice overview of the Controlled Substances Act.

The government also regulates how a schedule II drug can be prescribed.

?Unlike other prescription drugs . . . controlled substances are
subject to additional restrictions. Schedule II prescription orders
must be written and signed by the practitioner; they may not be
telephoned into the pharmacy except in an emergency. In addition, a
prescription for a Schedule II drug may not be refilled; the patient
must see the practitioner again in order to obtain more drugs.?

Because of the restrictions that Ritalin prescriptions must be written
by the practitioner, and because refills are not allowed, many
physicians require at least a monthly visit to be evaluated and pick
up these prescriptions.

My husband (a family physician) says that after a person has been
stable on a medication such as Ritalin, for a ?significant amount of
time,? some physicians may predate prescriptions so that follow up may
not be so frequent. Or sometimes they may require a patient to pick up
the prescription, but not necessarily make an appointment to be seen.
Specific protocols vary widely, as do practice styles of physicians.

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The most common reason to monitor patients on Ritalin weekly is to
make dose adjustments. This ensures that a patient tolerates the new
dose in terms of side effects, but also to see that the dose is the
correct one to control the depression.

?Ritalin should be initiated in small doses, with gradual weekly [increases].?

This site has a chart with various information about Ritalin. It
mentions weekly dosing increases and makes references to monitoring
mood, blood pressure, appetite, and weight, but not specifically how
often these things should be monitored.

The next excerpt from an article in ?The Independent? makes reference
to monitoring children with ADHD taking Ritalin, but again, there are
no specifics other than monitoring should be done regularly.

?The Department of Health added that guidelines from the National
Institute for Clinical Excellence said that children on Ritalin should
?receive regular monitoring and be taken off the drug if there was no
improvement of symptoms.??

Here is another article recommending regular follow up.

?Regular monitoring of blood pressure is generally recommended in
adults [taking Ritalin] with or without AD/HD.?

WebMD has a patient information page discussing Ritalin. Along with
mentioning its side effects, it mentions the association between
depression and suicide and encourages patients to see their doctors
regularly to be monitored.

?Though uncommon, depression itself can lead to thoughts or attempts
of suicide. If you are being treated for depression, tell your doctor
immediately if you have any suicidal thoughts, or other mental/mood
changes. Keep all medical appointments so your doctor can monitor your
progress closely.?

The National Institute of Health patient information page on Ritalin
lists the many side effects associated with its use. In the case that
a patient takes an inappropriate dose of Ritalin, his or her doctor
may do more monitoring over a short period of time.

?Your doctor will probably decrease your dose gradually and monitor
you carefully during this time. You may develop severe depression if
you suddenly stop taking methylphenidate after overusing it.?

There is no mention of a specific monitoring schedule, but the site
does refer to the prescribing restrictions placed on Ritalin.

?This prescription is not refillable. Be sure to schedule appointments
with your doctor on a regular basis so that you do not run out of

I showed this information to my husband who said that ?regular
monitoring? differs widely from doctor to doctor. Monitoring intervals
also depend a great deal upon a patient?s other medications, medical
problems, and other risk factors. Although his opinion cannot be
considered an ?official? recommendation (since he is not privy to your
wife?s health information, and he does not have the opportunity to
interview and examine her), he suggests that your wife ask her doctor
why she is being monitored so frequently and then discuss whether or
not spacing out her monitoring is appropriate. If she has been on
Ritalin for ?years,? and if her physician is not making weekly dosing
adjustments as part of treating her depression, and there aren?t any
other conditions that he or she is monitoring, then weekly monitoring
does sound a bit excessive. Again, please address these concerns
directly to your wife?s physician as he or she knows many more details
of your wife?s health.

- - - - - - - - - - - - - - - - - - - -

I hope that you find this information useful. Again, be sure to
discuss any other questions or concerns that you have with your wife?s
physician, or with another qualified health practitioner that you
trust. If you have any need of further clarification, please let me
know how I can help.


Search terms:
dea controlled substance list
?schedule II? prescription
ritalin depression treatment protocol
weekly monitor ritalin
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