I wanted to write to let you know that I will be on the radio this Saturday December 2, 2006 in St. Catharines, Ontario. The show airs live from 12 pm to 1 pm, on CKTB 610 AM. Listeners will be able to call in during the hour to ask questions. The show is called: ADHD: The Good News - Holiday Edition.

During this show, we will cover the basics of ADD and ADHD, and talk about how to manage ADD/ADHD during the holidays. We will also answer caller’s questions.

Now, I know that most of you do not live in the area of St. Catharines, Ontario. However, if you do live near Toronto, depending on the weather, you may be able to hear it live.

For people who live in other centres in Canada, there is a schedule below of times that the show will be rebroadcast.

If you are no where near Canada, you won’t be able to hear the show live. I will do my best to get a copy of the show for you to download later.

The show will be rebroadcast at the following times:

• Victoria - CFAX 1070 AM: Sunday December 10, 2006 - 5:30pm - 6pm
• Vancouver - CISL 650 AM : Monday December 11, 2006 - 8pm - 8:30pm
• Vancouver - CISL 650 AM : Tuesday December 11, 2006 - 8pm - 8:30pm
• Calgary - CKMX 1060 AM: Sunday December 10, 2006 - 7am - 7:30am
• Edmonton - CFCW 790 AM: Sunday December 10, 2006 - 4:30pm - 5pm
• Windsor - CKLW 800 AM: Sunday December 10, 2006 - 8am - 8:30am
• London - CJBK 1290 AM: Sunday December 10, 2006 - 8:30am - 9am
• Kitchener - CKGL 570 AM: Sunday December 10, 2006 - 9:30am - 10am
• Hamilton - CHAM 820 AM: Saturday December 9, 2006 - 11am - 11:30am
• Toronto - CHUM 1050 AM: Sunday December 10, 2006 - 7:30am - 8am
• Kingston - CKLC 1380 AM: Saturday December 9, 2006 - 11am - 11:30am
• Ottawa - CFGO 1200 AM:Saturday December 9, 2006 - 8am - 8:30am
• Ottawa - CFGO 1200 AM: Sunday December 10, 2006 - 12pm - 12:30pm
• Thunderbay - CKPR 580 AM: Sunday December 10, 2006 - 6:30pm - 7pm

If you are able to listen, please share your thoughts on the show with our readers here, by entering a comment below. I will do my best to get a copy of the show out to you as soon as I can.

Please share this post with anyone that you think would benefit from learning more about ADD or ADHD. Just click on the picture of an envelope below which says: ‘Email this post to a friend’.

If you want to learn more about ADD or ADHD, please enter your name and email address on the right.

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Despite there being many medications available to treat Attention Deficit Hyperactivity Disorder (ADD or ADHD) in the US, there are relatively few medicines in Canada. We had one new medicine added to our arsenal in Canada around September 2006 - Biphentin. This article will summarize what role Biphentin can play in treating ADD/ADHD.

What is Biphentin?

Biphentin is a new formulation of methylphenidate. Methylphenidate is the same medication that is found in Ritalin. Methylphenidate has been around for over 50 years. Despite many concerns and warnings discussed in the media, it is a safe medicine, when taken as prescribed and monitored by a physician. It also can work very well. Approximately 70-80% of people with ADD/ADHD will have significant improvement when they take this medicine.

In Canada, methylphenidate also comes as: Ritalin, Ritalin SR, and Concerta.

In the US, methylphenidate also comes as: Ritalin, Ritalin LA, Concerta, Metadate CD, Focalin XR.

Biphentin is being marketed in Canada, and is made by Purdue Pharma. It is not being marketed in the US. I was told (in a personal communication - certainly not official!) that Biphentin may eventually be marketed in Europe, but likely not in the US. Why not the US? I was told that it is very competitive in the US to market another form of Methylphenidate.

What are the characteristics of Biphentin?

Biphentin is a long acting form of methylphenidate. It lasts 8-10 hours with once daily dosing.

Biphentin is a capsule - with little beads inside. This allows the medicine to be ’sprinkled’ onto soft foods like: apple sauce, yogurt or ice cream. This can help with children who cannot swallow the pills. In Canada, this is the only medication option for methylphenidate that can be taken by children who cannot swallow pills. (As a side note, Adderall XR - which is an amphetamine, can also be opened and sprinkled.)

Biphentin comes in multiple strengths. This flexibility of dosing may make it easier for your doctor to find the right strength for you.

The strengths are: 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, and 60 mg.

Who is Biphentin approved for?

Health Canada has approved Biphentin for the treatment of ADD/ADHD across the lifespan. Specifically, Biphentin is approved to treat ADD/ADHD in children, adolescents and adults.

What are the side effects of Biphentin?

Biphentin’s side effects are the same as the side effects of the other methylphenidate products. The common side effects include: decreased appetite, insomnia, worsening of tics, approx. 2% risk of slowing growth. There are rare concerns of agitation, mood symptoms, etc. [N.B. This post is for educational purposes only - speak to your Doctor about side effects in detail]

How much does Biphentin cost?

Biphentin will most likely be covered under private insurance plans through your work. If it isn’t, I am happy to report that in general, it is cheaper than the newer forms of ADD/ADHD medication. The price does depend on the strenght of the pill.

The cost of Biphentin for 30 days of treatment is estimated as follows:

• Biphentin 10 mg once daily for 30 days: $29.40
• Biphentin 15 mg once daily for 30 days: $38.40
• Biphentin 20 mg once daily for 30 days: $46.80
• Biphentin 30 mg once daily for 30 days: $60.90
• Biphentin 40 mg once daily for 30 days: $75.00
• Biphentin 50 mg once daily for 30 days: $89.10
• Biphentin 60 mg once daily for 30 days: $103.50

These prices are listed in Canadian dollars. These are estimates, and the prices may vary at your pharmacy.

As a brief comparison of cost - here are estimated costs of some of the other ADD/ADHD medications in Canada:

• Concerta 18 mg once daily for 30 days: $71.70
• Concerta 36 mg once daily for 30 days: $90.90
• Concerta 54 mg once daily for 30 days: $110.40
• Adderall XR 5 mg once daily for 30 days: $96.00
• Adderall XR 30 mg once daily for 30 days: $96.00
• Strattera 10 mg once daily for 30 days: $134.97
• Strattera 60 mg once daily for 30 days: $134.97
• Ritalin SR 20 mg once daily for 30 days: $25.20
• Ritalin 10 mg once daily for 30 days: $18.30

When can Biphentin be used?

Biphentin can be used to treat ADD/ADHD at any age - it is approved for the treatment of kids, teens and adults.

Biphentin can be used as a ‘first line’ treatment - i.e. the first medicine given for someone with ADD/ADHD.

Because Biphentin is a once a day treatment - the patient doesn’t have to worry about taking a pill in the middle of the day. This is particularly helpful for children who can take their pill in the morning, and then not have to go to the office at school to get their noon medicine. This makes it easier for a child at school.

If someone has been on a different form of methylphenidate and had problems, it may be reasonable to try Biphentin to see if this long acting formulation may work better.

If your child has trouble swallowing pills, but your doctor thinks that methylphenidate is the right choice of medication, then Biphentin is the best choice.

Can Biphentin Be Abused?

One of the concerns with any stimulant medicine is the risk that it may be abused. If someone takes too much of the medicine, and tries to take it as a drug - i.e. snort it - then it can produce a ‘high’.

I am happy to report, that similar to the other long acting preparations of stimulant medicines (like Concerta and Adderall XR), Biphentin is not abusable. That means that someone couldn’t use it to get a ‘high’.

It is important for you to also know that Biphentin is not addictive.

How does Biphentin compare to Ritalin, Ritalin SR and Concerta?

All of Biphentin, Ritalin, Ritalin SR and Concerta are the same medication - i.e. methylphenidate. The difference is the preparation and how it acts in the body.

Ritalin is a short acting medicine, and is required to be taken two or three times daily for symptom control. The advantage is that it is cheap. It doesn’t work as well as the long acting forms.

Ritalin SR is a long acting preparation of methylphenidate which has been around for a long time. It doesn’t work very well for many people. Sometimes it lasts 6 hours, but often it doesn’t work well at all. The advantage is that it’s cheap.

Concerta is an excellent preparation of methylphenidate. It is a once daily, long acting medicine. It works for up to 12 hours. It is well tolerated and has been a great medicine in the treatment of ADHD for the past 3 years or so in Canada, and longer in the US.

Biphentin is a once daily, long acting medicine. One major advantage over Concerta is that the capsule can be opened and sprinkled in apple sauce, yogurt or ice cream. This will help children with trouble swallowing. It is also approved for the treatment of adult ADHD, which Concerta is not yet (though I hear that this is coming shortly…).

One final difference between Biphentin and Concerta is that Biphentin releases approximately 40% of its medicine in the early part of the day, whereas Concerta only releases 22%. This may mean that Biphentin may work better for ADD/ADHD in the morning, whereas Concerta may last a little longer into the day.

The Bottom Line About Biphentin:

Treatment of ADD/ADHD requires many components - including psychotherapy, behavioral management, academic supports, and medication. This article has been focusing on medication for the purpose of describing a new treatment for ADHD in Canada. For more information on the other treatments of ADD/ADHD: 1) sign up for my ADD/ADHD newsletter at www.TheADHDDoctor.com, and 2) peruse this blog for more articles about ADD/ADHD.

Biphentin is a new great option for the treatment of ADD/ADHD in Canada. It has its unique features, as described above. It is welcomed, as in Canada, we have fewer medicines available than in the US. Biphentin may help in the treatment of your ADD/ADHD (or that of your loved one).

If you are considering the use of Biphentin, ask your doctor. You may want to print this article, and take a copy with you to your next doctor’s appointment.

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When a new medicine is developed, it is under patent for a number of years. When the patent expires, that medicine can be made by other manufacturers. The original medicine is called the ‘trade name’, and the later one is called the ‘generic’.

For example: “Kleenex” is the trade name of a brand, but “tissue” is the generic term.

Another example: “Tylenol” is the trade name, and “Acetaminophen” is the generic.

To use an ADHD example, Ritalin is a trade name, and Methylphenidate is the generic medicine.

Why is a medicine under patent?

The medicine is protected under patent for a number of years to allow the Research and Development Pharmaceutical Companies (i.e. the companies that develop the medicine and do all of the research and testing to bring it to market) to market that medicine exclusively, so that they can recoup the investment that they have made into the development of the drug.

It costs approximatly $900 million USD to bring a medicine to market now. That is a lot of money - and means that the company should be given time to earn income due to their extensive investment.

After the patent runs out, other companies can make the same medicine, as a generic. In the same way that many companies can make tissues, but only one can market under ‘Kleenex’.

What is the immediate benefit of a generic?

Mainly, it is the same medicine and it is cheaper.

In Canada, one can buy trade name ‘Ritalin’ (with a prescription, of course), or alternatively, one can get ‘Apo-Methylphenidate’, or ‘Novo-Methylphenidate’. The ‘brand’ of medicine which is given is often determined by the insurance that pays for the pills. Often the insurance will specify that if the generic is available, then that is what they will cover (because it is cheaper and will save them money).

Are generics the same as the trade name medicine?

The rules for generics are:

1. they have to be the exact same chemical
2. they can only have a 20% variance in the amount of active medicine getting into the blood stream.

The difference in absorption from one preparation to another has to do a lot with the ‘binders’ in the tablet, etc.

Generally, if someone is started on one generic preparation and then stays with that generic, it is not a concern.

The issue comes if someone’s pharmacy or drug plan changes the generic - there could be a swing of a maximum of 40% difference in the amount of medicine hitting the blood stream.

For example, if someone is on Methylphenidate A, and the amount that gets into the blood stream is 20% higher than Ritalin; and then the pharmacy switches the generic Methylphenidate to Methylphenidate B, and methylphenidate B is 20% lower than Ritalin, the patient could be on the same dose, and end up with a 40% change in medication in the bloodstream.

In general, the changes are much more minor with generics, and most people have little if any problem or issues with them.

However, this can be a real problem for some people who are more sensitive to medicine.

If you find that a change in the trade name or generic medicine is a problem, speak to your pharmacist and your doctor. Your doctor can write 2 words on the prescription to force the pharmacist to stick to a specific preparation of the medicine.

Those two words are: “No Substitution”. That means that the pharmacist has to dispense the exact medicine written by the doctor, and cannot substitute it for a cheaper generic form of the medication. You will need to check with your insurance, though - as they may refuse to pay for the more expensive version.

Which ADHD medication is generic?

In general, the longer a medicine has been out, the more likely it is generic.

Ritalin and Dexedrine are generic. Newer preparations like Concerta, Metadate, Adderall XR and Strattera are not generic. Neither is Focalin, Ritalin LA, etc. These will likely go generic in approximately 10-20 years.

Have you had experience with this? Maybe trouble with generics? If so, please share your experience by posting a comment on this blog.

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Technorati Tags: ADHD, Ritalin, Methylphenidate, generic medicine, Pharmaceutical Companies

In a recent post, Angie posted a comment, asking about ADHD Medication and being a commercial pilot. She says that she has a friend who believes that he has ADHD, but is scared to seek help because he is worried about keeping his job.

I wanted to add this comment as a full post - mainly because I need your help.
I have searched online and found three articles which may help to guide anyone concerned about being a pilot with ADD/ADHD. I would love to hear from anyone who has experience in this field - just go to the bottom of this post, and enter a comment to share your thoughts and experiences.

I will tell you that since there are great data showing that drivers who have ADD/ADHD are much safer when they are taking their medication, I would like to think that a pilot would be encouraged to take his/her ADHD medication as needed, for everyone’s safety.

The magazine ADDitude, answers a pilot’s question about Ritalin here. In summary, the FAA would not approve Ritalin, and it could show up in screening urine tests. This article suggests that the FAA may allow other ADHD medications in pilots.

This site reviews the medicines that the FAA allows in pilots. This site suggests that the FAA generally does not approve any of the ADD/ADHD medications - Ritalin, Adderall, Strattera (and I presume this would include the other preparations like Metadate CD, Ritalin LA, Daytrana (the Ritalin Patch), Biphentin, Focalin, Dexedrine, Dexedrine Spansules, Adderall XR). The article does say that the FAA may approve these in special circumstances.

Finally, at risk of being political here - I recall an incident of ‘friendly fire’ in Afghanistan. American pilots mistook Canadian soldiers on the ground for the enemy, and fired on them. Several Canadian soldiers died and were injured. When the investigation took place - one issue which came up was the use of ‘go pills’ by the American pilots.

“Go pills” are dexedrine - the amphetamine used to treat ADD/ADHD. Click here for a full review of go pills. This article explains that Dexedrine is given to help to prevent ‘pilot fatigue’ in the militar. The go pills are used because more pilots and planes have been lost in wars due to fatigue, rather than due to combat.

However, the article explains that civilian pilots are not allowed to have anything stronger than caffeine to battle fatigue. It doesn’t mention the use of Dexedrine to treat ADD/ADHD.

So, in the end, I am still not sure what would be allowed for a commercial pilot with ADD/ADHD to take for hes/her condition.

My hope is that this industry would be willing to be open to the recognition of and treatment of ADD/ADHD, because of the possible improvements in safety if ADD/ADHD is well treated.

However, the concern from a pilot may be that if this condition is brought forward, that he/she may lose the ability to keep flying.

This topic brings up several important questions for me, and I am going to pose them here to see if you (my readers) can help to shed some light on them:

1. Do you think that pilots may have higher rates of ADD/ADHD than the general public? I guess I wonder if the allure to flying may attract people who think quickly, and are willing to ‘push the envelope’ more - i.e. ADD/ADHD’ers.
2. If you were a passenger on a commercial airplane, would you want your pilot’s ADD/ADHD treated with medication, or not?
3. Do you have any experience with or know of someone’s experience with the FAA to get ADD/ADHD treated with medication?
4. Do you know of anyone who ‘lost his wings’ because of coming forward with a diagnosis of ADD/ADHD?

Thanks for sharing your thoughts.
Hopefully we can help to share ideas here, and support the pilots who are in the ranks of ADD/ADHD.

If you think of someone who may benefit from reading this article, please click the little envelope below, and send them an invitation to come to this site.

Wishing you safe flights,

Dr. Kenny Handelman

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Technorati Tags: ADHD Medication, commercial pilot, FAA, go pills

It can be very challenging - living with ADD/ADHD, or supporting a loved one with ADD/ADHD.

There are times that can be very frustrating.

And we can forget the most important of facts:

Even though we may get frustrated too much with the ADD/ADHD people whom we care about - we need to remember that at the core of it - we love them and want to help them.

We also need to remember to take care of ourselves.

A friend emailed me this video, and I thought it was a wonderful reminder about the importance of a good hug.

So, watch this video, and share it with a friend.

At dinner tonight, go and give your ADD/ADHD child a big hug - and make sure that he or she knows that they’re loved.

If it is you support an adult with ADD/ADHD, give them a big hug - share your love and compassion.

If you are an ADD’er yourself, be brave, and get your daily quota of 8 hugs per day.

We’ll all feel better for it.

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Technorati Tags: ADD/ADHD

To keep you up to date, I regularly search online about ADHD .

I was a little surprised when I can across the Daytrana website, at www.Daytrana.com.

Their headline reads in big letters: ‘Stick it to ADHD’.

Of course they are using the double meaning - because Daytrana is the ‘ritalin patch’ which ’sticks’ to the skin.

I want to know your opinion:

Do you like this ‘tagline’ about Daytrana?

Or does it put you off a little?

I am not trying to do ‘market research’, I just value your opinion, and wanted to hear it. I’m not sure that I like the headline, but I wanted to know what all of my readers think.

If you are willing, please go to the bottom of this page, and enter a comment to share your opinion.

Let’s see what our community comes up with. Maybe Shire (the maker of Daytrana) will take notice…

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The American Academy of Child and Adolescent Psychiatry just concluded its annual scientific meeting in San Diego.

An important study came out regarding the use of Daytrana, the methylphenidate patch - which is sometimes called the ‘ritalin patch’.

Click here to see a video on how daytrana works.

While the Daytrana patch is recommended to be used for 9 hours per day, this study showed that the patch can be used for less than that.

If a child has the patch put on later in the day - for example on the weekend - it can still be taken off at the regular time. This means that the child can have the benefit of the long acting patch even if it is applied at 11 am or later, but when it is taken off on time, there is less chance that it will cause sleep or appetite troubles.

To read a full account of this story, click here.

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I have partnered with other ADHD Bloggers - to share information on ADHD. It is called the ADD Carnival.

To see 10 articles on 10 different blogs on ADHD, visit:
ADHD Carnival #21

I have one article in there, and there are great articles on topics like: dealing with an ADD spouse, dealing with your ADHD kids, multitasking, undiagnosed ADHD in adults, etc.

Check it out!

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A new research study was just released which tested light therapy on adults with ADHD. It was done at the Centre for Addiction and Mental Health in Toronto, and is the first study to examine light therapy as an add on treatment for adult ADHD.

Light therapy involves using a bright light, developed for medical use. It is a full-spectrum fluorescent light box that filters out
ultraviolet wavelengths. In this study, the participants used the bright light for 30 minutes each morning.

Why even consider light therapy for adult ADHD?

Light therapy is a proven treatment for SAD (Seasonal Affective Disorder). SAD refers to individuals who have seasonal depression - generally in the fall and winter when the days are shorter and they are exposed to less sunlight.

While adults with ADHD tend to have higher rates of depression, many of them also have a delayed sleep/activity rhythm. This study looked at whether light therapy could help with their depression symptoms and even their ADHD symptoms.

This study showed that in ADHD adults treated with light therapy:

• 55% had less depression symptoms
• approximately 28% of had a full or partial improvement in
  attention deficit symptoms, measured with both questionnaires and actual
  laboratory-based tasks

Which ADHD symptoms improved?

The light therapy helped these core symptoms of ADHD:

• inattention
• difficulty sustaining effort
• impulsive responding to stimuli
• hypo-arousal/fatigue

Strikingly, the strongest predictor of improvement in ADHD symptoms from light therapy came from a change in circadian activity rhythms rather than decreasing
the symptoms of SAD that are often experienced by adults with ADHD.

Does this mean that if you have adult ADHD that you should start light therapy this fall or winter?
Not necessarily. While this is a promising and fascinating study, more research is needed.

This study does suggest that if you have seasonal depression with adult ADHD, you may be the perfect candidate for light therapy this winter. Talk to your doctor and review your options.

To read more details of the study, visit here.

Consider printing this article and taking it with you to the doctor to discuss.

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