I’m pleased to announce that as of June 8, 2011, Vyvanse will be covered by the Ontario Drug Plan. This means that if a family has an Ontario drug card (from being on OW, or ODSP, or a child disability, or even the Trillium Drug Plan), then Vyvanse will be covered.

The rules for Vyvanse coverage are written as follows:

Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to
other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or
psychosocial needs, and who meet the following:
1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with
inattention that interfere with learning; AND
2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner
with expertise in ADHD; AND
3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or
Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor
symptom control, side effects, administrative barriers, or societal barriers.
Administrative barriers include:
. inability of a school to dose the child at lunch;
. the school lunch hour does not coincide with the dosing schedule;
. poor compliance with noon or afternoon doses;
. the patient is unable to swallow tablets.
Societal barriers include:
. the patient or patient’s caregiver(s) has(have) a history of substance abuse or diversion of listed
immediate-release alternatives;
. the patient or patient’s caregiver(s) is/are at risk of substance abuse or diversion of listed
immediate-release alternatives.

From a practical perspective, the doctor does not have to complete a form, or get formal approval, so it will be up to your doctor to decide when he or she will begin using Vyvanse with you.

This is very good news for ADHD patients in Ontario. I know that a lot of advocacy work went on, spearheaded by CADDAC. I know that I spoke to my MPP and got him to write a letter of support, and many other doctors and patients did the same. I hope that this precedent will help to get coverage in the other provinces too.

Best,

Dr. Kenny

©2012 ADD ADHD Blog.com. All Rights Reserved.

Technorati Tags: ADHD Medication, Vyvanse

I am excited about this talk – because I’ll be talking about the strategies which I describe in my book (of the same title) – which will be coming out on June 7th, 2011.

This talk is set up to help to support the LDAO Chapters of North Peel and Mississauga.

Details:
Date: Thursday April 14th, 2011
Time: 6:30 pm registration – talk from 7-9 pm
Where: Mississauga Convention Center – 75 Derry Road West, Salon E, Mississauga, Ontario
Cost: $10 if you register in advance, $20 at the door (and free if you are a member of the LDA chapters). Please note, the money at the door goes directly to fund the programs of the LDA chapters.

Registration is Required:
To register, please phone: 905-272-4100 or email the LDA at: lda1@bellnet.ca (copy and paste this email into your email program)

To get a copy of the PDF invitation, please click here.

I know that this invitation will really only apply to those of you who live in the Toronto area. If you are interested in other events with Dr. Kenny, please be sure to join our email list, and we will let you know of future events.

(also, please remember that if you post a comment on this blog, or email us, we cannot register you for the event, you need to contact the LDA through the info above).

I hope you see you there!
Best,

Dr. Kenny

©2012 ADD ADHD Blog.com. All Rights Reserved.

Technorati Tags: Attention Difference Disorder

There have been several articles about generic medicines on this blog – many of which have generated significant discussion amongst this blog’s readers. All of the previous articles have been about generic stimulant medicine.
This is the first article about a generic non-stimulant – i.e. Strattera.

In Canada, there was a court decision made in mid October 2010 which paved the way for a generic Strattera (atomoxetine) to be made. A Canadian court invalidated the Eli Lilly patent on the medication atomoxetine for ADHD. This decision has given the generic company Teva-Novopharm the ability to create a generic Strattera in Canada. If you are interested in the details of the legal decision – you can read a summary of it here.

As of the time of this post – i.e. early January 2011 – a generic strattera has not yet come to market in Canada. I can only speculate as to why it has taken so long, as generally a company has the generic product available approximately 6 weeks after a legal decision. Maybe there are manufacturing issues which are causing delays… or maybe there are other factors that I am not even considering.

What does this mean?

At this time (February 2011) there is still no generic Strattera available in Canada. Eli Lilly is still providing samples of its product Strattera to doctor’s offices. They have some sales people and support staff still supporting ADHD/Strattera.  There is still a compassionate program (for people who couldn’t afford the medication), though I’m told that it is currently full – but your doctor could apply for you anyway.

Will the generic work well?

This is a question that I don’t know the answer to. We will have to wait and see. Strattera does not have a time release mechanism in it (like Concerta does) which may mean that the generic will be OK. But it is too early to tell.

Once I hear that the generic Strattera is out – I will be sure to update this blog post, and I welcome any comments from your experiences with generic Strattera.

Best,

Dr. Kenny

©2012 ADD ADHD Blog.com. All Rights Reserved.

Technorati Tags: Atomoxetine, Eli Lilly, Generic Medicine, Novopharm, Strattera, Teva

Vyvanse was officially launched in Canada on February 1, 2010.
When it was first launched – it was only officially approved for use in children – aged 6-12 years old. As of November 2010, Vyvanse is now officially indicated for use in ADHD in children (6-12 years old), teenagers (13-18 years old), and adults (18-65 years old). This means that Vyvanse is now officially indicated in Canada for use in ADHD ‘across the lifespan’ – i.e. from childhood to adulthood.

Dosage of Vyvanse in Canada:
Vyvanse is available in these dosage strengths in Canada: 20 mg, 30 mg, 40 mg, 50 mg, and 60 mg.
In the US, there is also a 70 mg capsule – but Health Canada wasn’t convinced that it was needed – so for now, the highest dose capsule that we have in Canada is the 60 mg.

Doctors will generally start with a lower dose (often 30 mg) and then increase to a higher dose (often 50 mg). Of course, your doctor will tailor the treatment to your needs.

Vyvanse is a the first prodrug for ADHD. This means that the medication is inactive until an enzyme in the body works to activate it. To read more about how it works, visit this blog post on Vyvanse.

To read the press release on Vyvanse being released in Canada, please view it here.

This blog has several articles on Vyvanse, but my favorite is the one where my readers have shared their experiences with Vyvanse (over 800 comments at this time) about whether Vyvanse works.
You can find more articles by looking at the ‘related posts’ below this article.

Please share any comments or issues with Vyvanse being in Canada below.

Best,

Dr. Kenny

©2012 ADD ADHD Blog.com. All Rights Reserved.

Technorati Tags: ADD, ADHD Medication, Canada, Vyvanse

Dr. Atila Turgay had recently created the ‘Toronto ADHD Clinic’, where he was seeing a large number of children, teens and adults for ADHD. This was a service which was desperately needed, and it was particularly helpful that Dr. Turgay brought such expertise to this clinic. I am hopeful that after Dr. Turgay’s passing, that some of the other doctors who had started to help with this clinic will in fact carry on the important work that was started by Dr. Turgay.

Dr. Turgay participated in many research studies, and published extensively. You can see a summary of his research publications on Pubmed here.

Dr. Turgay also regularly spoke to members of the community – educating parents, kids/teens and adults with ADHD, educators, as well as other doctors. He was always able to provide up to date, scientifically backed information in a helpful and instructive way.

Dr. Turgay actually helped to start me in the direction of Child Psychiatry and ADHD. When I was in my fourth year medical school, I had a 2 week placement in family medicine at the Scarborough General Hospital. When I was speaking with my Family Medicine teachers, and mentioned that I was interested in Psychiatry, they encouraged me to spend some time with Dr. Turgay. When I met Dr. Turgay, I was impressed by his knowledge, his teaching ability and his interest in me as a student. I subsequently arranged to spend one month with him, during my internship. This month was an exposure to Child Psychiatry and ADHD, which helped to form my interest in this field.

Dr. Turgay’s influence was far reaching. When I was at his memorial service, I met several doctors – pediatricians, psychiatrists and family doctors who were working in the field of ADHD because Dr. Turgay had provided the teaching and mentorship to encourage them to go into this challenging and rewarding field of medicine.

In recent years, I would see Dr. Turgay as a colleague in many national ADHD meetings. He always contributed so much to the meetings. Out of respect for him as a teacher, I always called him ‘Dr. Turgay’, and he was trying to convince me to call him ‘Atila’ as we were colleagues now.

Dr. Turgay will be sorely missed. His impact as a doctor, teacher, researcher and speaker will be missed both in Canada and around the world. My condolences go to his family, friends and patients for having lost such a great man. I am grateful that I got to learn from him, and  know him – and I hope that the work I do contributes to his legacy.

You can view his obituary here.

Best,

Dr. Kenny

©2012 ADD ADHD Blog.com. All Rights Reserved.

Technorati Tags: ADD, ADHD, Canada, Dr. Atila Turgay

You may wonder – am I against generic medicines?

Not at all.

In fact, I have taken many generic medicines myself, and so have my family members.

The issue is that for most people, taking a generic for stomach issue, or for asthma is often completely fine. It is however different, in my opinion, to take a generic for a psychiatric condition, such as ADHD.

The other big difference is that Concerta was developed based on the principle that its pharmacokinetic profile is different. What does that mean? It means that the way the medicine is absorbed throughout the day has an impact on how the medicine works.

In other words – in this ‘next generation’ medicine – the old rules for how to create a generic shouldn’t really apply. Just assessing whether the new generic has similar medicine absorbed throughout the day misses the fact that the rate of absorption of Concerta is part of what makes it so effective.

Advocacy Works:

Thankfully, our friends at Health Canada are listening. They have at least acknowledged that there may be a difference with how they should evaluate generics when it comes to medicines like Concerta.

Health Canada has created a committee called: The Scientific Advisory Panel on Bioequivalence Requirements for Modified-Release Dosage Forms (SAP-MRDF). Their draft terms include the following wording:

“The Scientific Advisory Panel (SAP) on Bioequivalence Requirements for Modified-Release Dosage Forms (SAP-MRDF) provides advice to Health Canada on appropriate bioequivalence standards for modified-release dosage forms of pharmaceutical drugs. Of particular interest are those drugs where concerns have been raised that existing standards may not be adequate, for example, methylphenidate and nifedipine. The Panel provides Health Canada with advice and recommendations, but the decision-making responsibility remains with Health Canada.”

This committee will be meeting in Ottawa on June 11, 2010 to receive input and submissions to understand the complexity of this issue.

Hopefully, this process will bring forward the science that Novo-Methylphenidate ER-C does NOT have the science behind it to be defined as a generic form of Concerta. This would then change it to be another lower cost option for people to use for ADHD, rather than a medicine which is automatically substituted for Concerta.

I will update this blog with information as I receive it.

Best,

Dr. Kenny

©2012 ADD ADHD Blog.com. All Rights Reserved.

Technorati Tags: ADD, ADHD, Concerta, Generic Concerta, Health Canada

This is a weekend conference in Toronto, which will focus on many important aspects of ADD/ADHD. On the Saturday, the conference will focus mostly on child ADD/ADHD, and on the Sunday, it will focus mostly on Adolescent and Adult ADD/ADHD. The Saturday night will have a Comedy night – which will be very entertaining and help to raise funds to support advocacy for ADD/ADHD across Canada.

Speakers include: Dr. Thomas Brown – an internationally known expert in ADD/ADHD, Rick and Ava Green (actor and advocate, who started Totally ADD), Dr. Laurie Dietzel and many others (including myself). My talk will be on ADD/ADHD Medications -what’s new and how to use them safely and effectively.

The conference is on Saturday April 24 and Sunday April 25, 2010.

To learn more – please visit here.

I hope you see you there.

Dr. Kenny

p.s. if you do come specifically because of this blog post or my email list, please be sure to let me know… I’d love to meet you.

©2012 ADD ADHD Blog.com. All Rights Reserved.

Vyvanse was launched in Canada officially on February 1st, 2010. Even though it was officially launched, there have been some issues with the ability of pharmacies to get Vyvanse on their shelves.

As of February 12, 2010 – the following pharmacies have access to Vyvanse (i.e. if they don’t actually have it in their pharmacy, they can order it from their wholesalers and have it in within 24 hours)

• Shoppers Drug Mart
• Jean Coutu
• Main Drug Mart
• People’s Drug Mart
• Pharmasave
• Total Health Pharmacies
• Wal Mart Pharmacies

I’ve been informed that by Wednesday February 17th, 2010, 80% of pharmacies will have access to Vyvanse from their wholesaler.

And by Friday February 19th, 2010, 100% of pharmacies will have access to Vyvanse from their wholesaler.

So, if your doctor gives you a prescription for Vyvanse (and you’re in Canada), you can go to one of the pharmacies above (which already have Vyvanse), or ask your doctor if it’s OK to wait until your particular pharmacy can get the medication in.

To be clear – there is nothing wrong with the Vyvanse supply or medication. The reason for the delay has to do with the paperwork and regulatory aspects which the wholesalers have to complete to be able to store and ship a stimulant medicine. This will be resolved quickly (and hopefully easily for you!).

Best,

Dr. Kenny

©2012 ADD ADHD Blog.com. All Rights Reserved.

Technorati Tags: ADD, ADHD, Canada, Medication, Vyvanse

Concerta is a long acting preparation of Methylphenidate. It was launched in the US in 2000, and in Canada in 2003.

When a new medication is released, the company which produces it has a patent for a certain number of years. This allows them to market the medication exclusively until the patent runs out. This is important for the company to recoup the money invested in research and development of the new medicine, as well as to earn a profit.

I understand that it is reasonably regular that the generic pharmaceutical companies petition the courts to create a generic version of the medication BEFORE the patent runs out. Companies that create generic medicines are able to take the formula of the medication, and produce it. They then sell it at a lower price than the original medication. Often times, the generic is at a price point that is only 20-30% better than the original medication.

For background on generic medication, I want to point you to these resources:

• An Article on generic medications in ADHD – Are They The Same?
• An Article on Adderall XR going generic in the US. Take note of the comments that people share – many of them explaining the side effects and difficulties with the generic version, as well as frustrations with their pharmacies and insurance – Generic Adderall XR in the US; and Generic Adderall XR – New Formulations

Concerta Going Generic In Canada:

Concerta was brought to market in Canada by Janssen Ortho. In mid January 2010, Novopharm won a lawsuit in Canada, to be able to start to produce a ‘concerta like’ medication in Canada. The courts essentially overthrew Janssen’s patent on Concerta. Novopharm is planning to market Novo-Methylphenidate ER C, as a replacement for patients taking Concerta.

N.B. In early summer 2010, the name of the generic medicine will change from: Novo-Methylphenidate ER-C to Teva-Methylphenidate ER-C. This article will be updated when the product’s name is fully changed over.

Let’s Review the Pros and Cons of Novo-Methylphenidate ER-C:

Cons of Generic Concerta:

1) Does this medication work equally to Concerta?

Unfortunately, no one knows the answer to that. For a generic company to get approval for a new medication, they simply have to prove that their medication is absorbed within the range of 80% – 125% of the original compound. That is a huge variance.

The problem with that range? This means that the original Ritalin SR could likely meet criteria to be a generic for Concerta.

If you’ve been around long enough to remember Ritalin SR (or if you have not had insurance so it was the most cost effective medication option), you’ll know that Ritalin SR was widely found to be a very ineffective long acting medication. It often did not last longer than short acting methylphenidate in most of my patients. Most of the doctors in the field considered adding Concerta to the medications available in Canada to be a huge improvement, because we could get away from Ritalin SR and its poor efficacy.

I have been unable to get any scientific data (and neither have any of my colleagues) to demonstrate how Novo-Methylphenidate ER-C works. For all we know, it could work like Ritalin SR – which essentially means that it won’t work very well at all.

Concerta has a lot of technology in each little pill. Each pill has a laser drilled hole in it. There is short acting Methylphenidate on the outside of the pill, and then there is an osmotic capsule (meaning that water can come into the capsule from the gut). The water from the gut comes into the capsule, and expands a polymer, which then pushes the medication out of the pre-drilled laser hole – in a researched process which delivers the medication in a fashion which has been shown to work best for people.

Has Novopharm invested what is needed to develop this complex a medication delivery system?
No – they haven’t.

2) Will you be able to control which medication you get?

Let’s say a member of your family is doing very well with Concerta as a treatment for their ADHD. Now that there is a generic product – can you guarantee that you can keep this product as your monthly medication?

Not necessarily.

As of late April 2010, the Ontario government has deemed Novomethylphenidate ER-C interchangeable with Concerta.

When a medicine is deemed interchangeable, then pharmacists have an obligation to automatically substitute the generic form of the medicine for the brand name version. in other words, your pharmacist will have to substitute your Concerta with Novo-methylphenidate ER -C.

There are a couple of factors which can impact whether you get Concerta or the Generic:

• Your insurance: your third party medication insurance may decide that to save cost, they insist that you take the generic Concerta, and they may not cover the real Concerta. If the generic doesn’t work for you, you may have to either pay for it out of pocket, or just stick with the generic.
• If you are on a government provincial drug plan – they may insist on the generic version, and not cover the name brand Concerta any more (Ontario has just forced automatic substitution on their plan).
• What your pharmacy carries: some pharmacies may order in ONLY the generic version, and stop carrying the name brand Concerta. In this case, you may have to go to another pharmacy to get the medication you need.
• How your doctor writes the prescription: If your doctor just writes the prescription for ‘Concerta’, the pharmacy can substitute it automatically for the generic. If your doctor writes the words: NO SUBSTITUTION on the prescription, then the pharmacy will have to give you the name brand Concerta.

Pros of Generic Concerta:

• If this generic works well, then this means there will be a lower cost long acting medication option for people who can’t afford the more costly brand name Concerta. It seems that the price reduction is in the range of 50%.

Overall, as you might have gathered, I feel very uncomfortable with the Generic Concerta at this time (Novo-Methylphenidate ER-C). Most people that I see in my office have had a long and/or challenging road to get to the diagnosis and treatment of ADHD. Often taking a medication for ADHD is a huge decision, and arriving at a medication which works well with few side effects is beneficial and often a relief for concerned parents and family. To have that medication changed and become less effective would be very detrimental to my patients – and create a huge disruption to their lives.

Will Novo-Methylphenidate ER-C work well?

I don’t think anyone knows right now. Where is the scientific data?

I don’t know anyone who has seen it yet. And despite this, pharmacies across Canada can start stocking this and replacing it for regular Concerta (and they don’t even have to get your permission).

What do I recommend you do if you or a family member take Concerta?

• Ask your doctor to write a prescription for Concerta NO SUBSTITUTION (it doesn’t have to be capitalized – I am adding that for emphasis). Your doctor can even write: No Sub (which is faster!). It has to be in handwriting. If it is a stamp, or some other form of automated process, then the pharmacist can ignore it.
• Talk to your pharmacist about this – to check if you can still get the name brand medication
• Look closely at your prescription bottle – to see if the medication is: Concerta, or ‘Novo-Methylphenidate ER-C’
• If needed, check with your third party insurance for medication – to see if you are still able to get the name brand Concerta covered
• If you start to notice that Concerta isn’t working as well as it used to – look closely at the bottle, and realize that your prescription may have been substituted for the generic.

As this is a significant change to medication for ADHD in Canada, and one which came as a surprise – I wanted to provide you with some background. I’ll be happy to update this blog as more information comes out, and I know more about this.

One of the things that has been very helpful to many people on this blog – is that readers like you share their stories in the comments below (as you saw with the link about Adderall XR going generic in the US). So, I ask you to share your thoughts, experiences and comments below. Let’s help one another figure out how this new medication works, as well as what is going on in pharmacies, and with insurance coverage, etc. Thanks in advance for your contribution to this post.

New Updates:

Janssen Ortho Releases A Program To Help To Keep You on Brand Name Concerta:

Janssen Ortho is the company making Concerta. They have invested a lot of resources into developing Concerta, as well as educating doctors, educators, and patients and their families about ADHD and its potential impact on people’s lives.

The acceptance of the generic medicine as ‘interchangeable’ is leading to people being taken off of Concerta and being put on the generic very quickly.

Janssen has created a program which can help you to stay on the brand name product. It is called the: “Concerta Co-Pay Assist Program”.

What happens is this:

1. You get a prescription from your doctor that says: Concerta No Substitution
2. You go to the pharmacy, and give in the prescription – and insist that you get the brand name product.
3. If the pharmacy says that your insurance will only cover the generic product, and you have to pay the difference – then you give the pharmacy a ‘Concerta Co-Pay Assist Card, and then Janssen Ortho will pay the difference between the generic medicine and the brand name medicine.

In other words, when you give one of these cards to the pharmacist – you won’t have to pay any extra above the costs of the generic medicine. This applies whether you are on the Ontario Drug Benefit Card, or whether you are on private insurance (i.e. from your work), or even if you are a cash payer.

Here is an image of the card:

You’ll notice that the card says: ‘Multi Use Patient Co-Pay Assist Program’.

This means that you can use the card over and over again, as long as you are taking Concerta (and as long as Janssen continues to run the program – which seems to be for the duration at this time). Logistically, you can either leave the card at your pharmacy, or take it with you – just make sure you still have it when you need to refill your prescription.

Now the big question you may have is: where do you get these cards?

These cards are being give out to doctors, as well as to pharmacies. So, ask your doctor if he or she has a card for you. If he or she doesn’t, you can either ask at your pharmacy, or ask your doctor to contact his or her representative from Janssen Ortho to get a card for you.

Hopefully, it will be easy for you to get a card to continue on the brand name Concerta.

***Please note – that at this time – these cards are only available in the following provinces: Ontario, British  Columbia and New Brunswick.

Another Update: Potential For Abuse:

One of the risks with Methylphenidate medicines is that the medicines can be abused. Kids in school yards can sell ritalin (or short acting methylphenidate medicines) for $5 per pill. Many people will take the tablet – and crush it, so that they may snort it. When they change the route of delivery to the brain (i.e. when the medicine is absorbed via the nose vs. via the stomach), it can increase the speed of the medicine getting to the brain and it can then increase the abuse potential – i.e. people can get a ‘high’ from it when they snort it.

Concerta has a polymer inside, and a hard outer capsule. When it is crushed, there is no powder which can be snorted.
However, the Novo-methylphenidate ER-C can be crushed easily.

Look at the picture below which shows two 54 mg capsules – Novo-Methylphenidate ER C on the left, and Concerta on the right.

Generic Concerta versus NovoMethylphenidate ER C

You can clearly see that the Generic medicine is easily crushed into a powder which could increase the chances of the medicine being abused.
There are studies done which show that with Concerta, there is less risk of abuse. There aren’t any studies done on Novomethylphenidate ER C yet, but, as they say – a picture is worth a thousand words. This picture shows that it can be crushed into a fine powder – thus increasing the risk of abuse.

Best,

Dr. Kenny

p.s. regarding dosing – Novo-Methylphenidate ER-C will be available in the same doses as Concerta:

• Novo-Methylphenidate ER-C 18 mg
• Novo-Methylphenidate ER-C 27 mg
• Novo-Methylphenidate ER-C 36 mg
• Novo-Methylphenidate ER-C 54 mg

p.p.s. A comment from me about this blog post: I am not being reimbursed by Janssen Ortho for this blog post. I do not own any of their stocks. I use this blog to post my opinions and to share updates to science, research and general ‘goings on’ in the field of ADHD. That is what is happening here. I happen to feel very strongly about the generic Concerta not working as well as the brand name product – and that is why I am working hard in my office to support people staying on the product, and using this blog to get the information out to a broader audience as well.

©2012 ADD ADHD Blog.com. All Rights Reserved.

Technorati Tags: ADD Medication, ADHD Medication, Canada, Concerta, Generic, Novo-Methylphenidate ER-C

One of the participants suggested that it would be helpful to have a spot for people to share their contact info and what they do.
I would be very happy to help to facilitate that with this blog post.
My invitation – if you provide an ADD/ADHD resource in the Great Toronto Area, please enter a comment below – with your contact information. I recommend a website or phone number. (If you post your email address, there’s a chance that someone could come to this site and ‘harvest it’, meaning start to spam you! NB You do have to enter your email to post a comment, but that doesn’t show up on the site)

So – if you provide ADD/ADHD resources in the Greater Toronto Area, particularly with adults, please leave a comment below describing (briefly):

• Who you are
• What you do to help with ADD/ADHD (hopefully adults)
• How people can learn more about you – i.e. website link, phone number
• How people can contact you

Please note that all comments are moderated – so they will not appear on the blog right away, and any comments deemed to be ‘spam’ will be deleted, and comments may be mildly edited if it’s deemed necessary.

I hope this helps!

Best,

Dr. Kenny

©2012 ADD ADHD Blog.com. All Rights Reserved.

Technorati Tags: Adult ADD, Adult ADHD, Greater Toronto Area, Toronto