Please notify your pharmacy at least 3 days prior to when you need your medication refilled. Weekends and holidays require extra time and mail ordered medications take even longer. Many medications can be ordered electronically through Allscripts. Children should be assessed for continued need of medication at least every 6 months. If you [your child] have not been seen in the last 6 months call for an appointment before your last refill. Within the 6 month time period your pharmacy can contact me if authorization for refills are required. Many medications should not be discontinued abruptly so please plan ahead.
Schedule II medications e.g. methylphenidate, Vyvanse, Adderall, need a written prescription. No refills are authorized. Please call for a med managment appointment to refill these medications. These prescriptions may be limited by "fill after" dates and usually expire after 90 days.
Schedule III-V medications are limited to 5 refills or 6 months from the date of issue which ever comes first and the number authorized will based on my clinical judgment. Some medications will have time frame limitation e.g 30 day supply must last 30 day.
Prescriptions many not be reordered if I have not seen you in more than a six month period so plan ahead.
It is recommended that you use the same pharmacy for all of your prescriptions.
Antidepressants and other mood stabilizing agents have increased the risk of suicidal thoughts and actions in some children, teenagers, and young adults. Patients of all ages starting treatment should be watched closely for worsening of depression, suicidal thoughts or actions, unusual changes in behavior, agitation, and irritability. Families and caregivers should watch patients daily and report these symptoms immediately.
Call immediately if you have very high fever; rigid muscles; shaking; confusion; sweating; changes in pulse, heart rate, or blood pressure; or muscle pain and weakness, or a rash after starting a medication.
Certain medications are monitored for safety and efficacy by blood work. You may be required to have labs drawn in order to continue these medications.
This is done to minimize the risks of taking medication by early detection of any changes. We also want to make sure we are not dealing with potential medical issues that may appear to have behavioral or emotional presentations. Low Vitamin D levels for example may present as low energy, fatigue and poor immune response. We would not want to confuse this with symptoms of depression.
Blood work can be used to check renal function (the kidneys), evaluate liver function and detect changes in blood chemistry. We can make sure the blood cares the right amount of the various types of blood cells. We can look at metabolism of blood sugar also called glucose. Lipid panels look at the level and type of cholesterol in your blood. We can also measure therapeutic blood levels in a variety of medications. Testing urine can reveal the body’s ability to process waste. Urine test can also be done to rule out pregnancy or to reveal metabolites for drugs of abuse.
Many medications have the potential to change the functioning of the liver. Other medications may cause changes in lipid profile which and increase the risk for cardiac disease. Still other may change the production of blood cells, which allow you to fight infection, and heal from injury or to carry oxygen.
Other tests include complete blood cell count, electrolytes, and liver functions.
None of these medications are recommended for use during pregnancy so if applicable a pregnancy test may be needed before starting these medications.
Remember in order to the test to be useful it must be done on an empty stomach and 10-12 hour after the last dose of medication.
GeneSight® testing is available in my office through Assurex Health. GeneSight® can test for MTHFR polymorphisms which results in folate deficiency; Psychotropic medications used for mood disorders, PTSD and anxiety; ADHD medications; and Pain medications.
GeneSight® testing is done by a cheek swab and billing is done directly by Assurex Health. Check with your insurance company to see if it is covered. To lean more about GeneSight® visit their website Genesight.com . They may also offer financial assistance for the test if it is not a covered procedure.