OpenHealth Q&A

Navigating Prescription Dosage Adjustments

I’m a 20-year-old female diagnosed with ADHD, currently prescribed a daily dose of 37.5 mg of extended-release dextroamphetamine-amphetamine, in addition to a birth control pill that I have used for a couple of years. **Overview:** Ten days ago, I collected a refill of my prescribed stimulant, yet it appears that my tolerance has risen, or perhaps this medication is no longer effective for my needs. Unfortunately, I cannot consult my typical general practitioner since she recently relocated overseas with her military partner, and my usual clinic is two hours away, making it challenging to visit without transportation. My question is whether I can find a local GP to obtain a different prescription (likely reverting to regular amphetamine salts with an adjusted dosage) or if the pharmacy or doctor might deny this request due to my recent refill. Stimulants are crucial for managing my ADHD and contributing to my academic success. Since beginning treatment, my life quality has noticeably improved; I elevated my GPA from a 2.0 to achieving a spot on the dean's list last semester. Now, I can focus more on school without excessive stress, allowing me more time for extracurricular activities, socializing, and my part-time job. Starting stimulants in January 2025 represented a significant shift for me, offering almost no side effects aside from the expected loss of appetite (I've been losing weight healthily, down from 70 pounds overweight) and considerable tiredness as the medication wore off. I have experienced no blood pressure concerns. I do not struggle with depression or anxiety. Despite feeling extreme fatigue when not medicated, I maintain a positive outlook and lack any feelings of hopelessness or suicidal thoughts. My life feels fulfilling, and I look forward to what lies ahead. However, the upcoming weeks until I can connect with a new doctor are likely to be challenging if I cannot resolve my current situation. Although I have experienced anxiety in response to a specific trigger, which is overwhelming and debilitating, I don’t generally feel this distress when facing routine stresses. I tend to ignore my issues, preferring to proceed with my day as if they don’t exist. Currently, my prescription is failing to deliver desired results. I’m encountering the same attention and work-related challenges I faced prior to initiating medication. Five weeks into this semester, I find myself falling behind again, which affects my sleep and adds considerable stress. I recognize that continually increasing stimulant doses isn't a sustainable long-term solution and is not beneficial. I am aware that seeking a euphoric high is unhealthy; when I say it’s ‘not working,’ I refer specifically to my engagement in academic settings and during homework. When dosage levels were optimized in the previous semester, I remained engaged in class, avoiding nail-biting and restlessness, and could complete assignments well before they were due without the compulsion to check my phone. I typically felt wholly like myself under the right dosage, which remains my aim with these medications. On days I attempt to skip a dose but end up taking one, it’s not due to addiction—just pure exhaustion preventing me from functioning. I recognize when I’ve exceeded my limits, such as times I’ve taken two pills while cramming for finals. While focusing is possible, it often leaves me with painful sores inside my mouth. I fully understand the sensations associated with taking too little or too much medication, and right now, I’m definitely underdosing. I began taking dextroamphetamine because of how drowsy I became in the afternoons when the effects of my extended-release amphetamine began to wane. Since my early classes start at 8 a.m., by evening, I could barely keep my eyes open. I aim to incorporate a non-stimulant ADHD treatment beginning in October to assist on days when a break from stimulants is necessary. For now, managing extreme evening drowsiness is preferable to failing classes. With a current GPA of 2.7 and five semesters remaining, it's vital I maximize my performance in each course to get back on track. It's incredibly frustrating to find myself needing to adjust my dosage so frequently, as medications seem to lose their effectiveness far too rapidly. Although I know that taking breaks or skipping weekends can be beneficial, if I miss a single day of medication, I feel utterly depleted and ineffective, a situation that worsens with each subsequent day off. I strive to get ahead to maintain some days without medication but often find that I can’t afford to be unproductive two days a week. My workload does not seem unreasonable: I’m enrolled in 14 credit hours, work part-time as a resident advisor (3 to 7 hours weekly), commit to a 4-hour per week TA job, and participate in research, which is flexible (around 4 hours weekly). I know I am capable of managing this workload, as evidenced by consistently earning A’s and B’s when properly medicated or when I had external motivation like parental support in high school. I know I can achieve academically—the current barrier is proper medication facilitating normal focus. I’ve noticed a rapid build-up of tolerance to amphetamine salts, moving from 10 mg to 20 mg within a month and then increasing from 20 mg to 25 mg over three months, after which the 25 mg seemed ineffective after another three months. I'm uncertain whether my recent prescription is failing due to a tolerance issue (having recently shifted from 25 mg dextroamphetamine to 37.5 mg only a month ago) or if the change in medication type is at fault. Clearly, a change is necessary, but with my old office located two hours away and inaccessible due to my lack of transport—with my previous doctor having moved out of the country recently—attending an appointment proves difficult. My clinic has facilitated a different doctor to fill my prescription received ten days ago, but any adjustment requires an in-person visit, as telehealth is not offered. Even if I could see my former doctor, would the pharmacy permit me to fill a different prescription so soon after receiving my last? It's evident that my current medication isn’t effective, and I shouldn’t have to continue taking something that doesn’t meet my needs. However, stimulants cannot be refilled just a few days early. Any advice on how to navigate this would be greatly appreciated!

Answers (1)

9/15/2025, 2:41:20 PM

OpenHealth AI

It sounds frustrating to feel that your medication for ADHD isn't providing the support it once did, especially given the positive impact it has had on your life and academic performance. Here are some main points to consider moving forward:

1. Understanding the Challenge: Tolerance to stimulants can develop quickly, leading to decreased effectiveness in managing ADHD symptoms. Changes in your medication may be necessary to regain control over your focus and productivity.

2. Temporary Solutions: While awaiting a consultation with a new physician, there are strategies you can employ to manage your symptoms.

Explanation:

Stimulant medications, like dextroamphetamine, can become less effective over time as your body adjusts to them. It's essential to approach this situation cautiously, as any changes in medication need to be managed under a doctor's guidance. However, your immediate need for medication adjustment is understandable given the impact on your school performance and overall well-being.

Next Steps:

1. Visit a Local Provider: Seek out a local healthcare provider who can see you for an evaluation. They might be able to prescribe a different stimulant or adjust your dosage if they agree on the necessity based on your history.

2. Document Your Experience: Keep a detailed record of your medication history, dosages that have worked previously, your current symptoms, and any side effects. This information will help a new physician quickly understand your situation.

3. Communicate with the Pharmacy: Speak with your current pharmacy about your challenges. While they generally cannot fill a new prescription too soon, they might be able to provide guidance or work with the new provider to reassess the situation.

4. Consider Lifestyle Adjustments: Focus on maintaining a healthy routine that includes:

   • Sleep management: Aim for consistent sleep patterns to help mitigate fatigue.
   • Nutrition: Ensure you are eating balanced meals to maintain energy levels, especially given the decreased appetite.
   • Stress management: Techniques such as mindfulness, deep breathing exercises, and physical activities can reduce overall stress and improve focus.

5. Explore Non-Stimulant Options: If possible, research non-stimulant ADHD treatments that you can discuss with your new doctor. If you plan to incorporate these in October, having a conversation and preparing beforehand may be beneficial.

6. Stay Engaged: Reach out to your academic resources, such as counseling services or ADHD support groups, that may offer strategies or support during this time.

7. Create an Action Plan: Prioritize your academic workload to manage challenges while you seek medication adjustments. Break tasks into smaller, manageable parts and set deadlines to keep yourself organized.

By taking these actions, you can begin to manage your current symptoms while working towards a better medication strategy. Remember, your well-being and academic success are achievable, and there are steps you can take to get back on track. Let me know if you need any further assistance or guidance!