Cheap Medicine Update April 2011


Here is an improved way to get cheap medicine. Click on this link,USA Drug Plan , to take you to a website to print out your discount card. There is also a link on this page to find out the price of the medication of your choosing in the ZIP code you choose. Most of the time in my ZIP code, 30338, the Kroger pharmacies have the cheapest prices. These prices usually compete with Costco pharmacy, which are usually the lowest price medications here in the Atlanta area.

Most of my patients prefer to go to Kroger rather than Costco because Kroger pharmacies are open longer hours and seven days per week, Kroger is usually closer geographically, it usually isn't as far from your parking space into the store and inside the store to the pharmacy, and usually you don't have to wait as long to get your prescription filled.

A couple examples of the prices at Kroger pharmacy with this discount card are generic Adderall short acting for $.35 per pill and generic Lamictal, lamotrigine, for $.40 per pill. The discounts for generic medications are usually much more dramatic than the small discounts that may be obtained on brand medications.

Call 770-458-0007 today for an appointment with Dr. Hege. Dr. Hege has a lot of experience in selecting psychiatric medications cost-consciously because 50% of his patients have no insurance. He specializes in the evaluation and medication treatment of ADHD, Suboxone and Subutex opioid replacement therapy, panic disorder and other anxiety disorders, bipolar II disorder, depression, and alcohol and other substance abuse problems.

Affordable fees for psychiatric services by Dr. Hege 
is a webpage on Dr. Hege's website.


Can chronic use of therapeutic doses of Adderall, Vyvanse, or Dexedrine (amphetamines) cause brain damage?

The bottom line is we don't know. However there is a body of research that raises some concerns but gives no strong conclusive evidence either way. A comprehensive review article was published in February of 2009 "Literature Review: Update on Amphetamine Neurotoxicity and Its Relevance to the Treatment of ADHD" and is available free (1).

A worrisome study in monkeys in 2005 by Ricaurte found some evidence suggesting dopamine nerve damage in areas of the brain involved in ADHD dysregulation and amphetamine therapeutic effects (2). Some of the monkeys were given doses that are normally given to humans. However, multiple similar studies in rodents did not find evidence of this damage in usual dosage ranges that are given to humans. In contrast to amphetamines, high dose methylphenidate (Ritalin, Concerta, Focalin, Daytrana) studies appeared to have lower risk for brain toxic effects (3, 4).

Stimulant treatment of ADHD during childhood appears to reduce the risk of substance abuse that is otherwise associated with ADHD.(5, 6) Also children with ADHD who had not been treated with stimulants have smaller brain white matter volume than children with ADHD who had been medicated or children without ADHD. Stimulant treatment in children may actually increase brain growth and development.(7) However, older rodents, when given methamphetamine in doses that are known to be toxic to younger rodents and humans, had more toxic brain reactions than younger rodents. They also had brain levels of amphetamine that was twice as high as the levels in younger rodents when given the same dose. Natural aging processes reduce dopamine production greatly. Older humans may be at greater risk of toxic effects of amphetamine 

No controlled studies have examined the adverse behavioral, cognitive, neurophysiological effects of years, much less decades, of chronic amphetamine treatment. Neuroimaging with PET and MRI techniques are becoming increasingly useful in measuring brain anatomy and function in living human beings to explore for brain damage in humans treated with amphetamine. We look forward to the coming evidence to make more informed treatment recommendations to our patients with ADHD.

1.(Free) Literature Review: Update on Amphetamine Neurotoxicity and Its Relevance to the Treatment of ADH


Dramatic savings can be achieved with this strategy if you're willing to accept some inconvenience and a period of adjustment. Vyvanse, Adderall XR, Concerta, Focalin XR, and Dexedrine Spansules cost at least $125 per month if you are on one pill a day because they cost about four dollars per pill. If you need 2 or 3 pills per day, that costs $250 or $375 per month. Generic Adderall costs $.35 per pill at Costco. If you take 2 or 3 Adderalls per day, that's $.70 to $1 per day or about $20 to $30 per month. Here's how I implement this strategy for the most consistent focusing all day.
I have my patients set a daily alert in their cell phone to go off at a time in the morning soon after they arise each day. They promptly take their first dose of generic Adderall, Ritalin, Dexedrine, or Focalin for the day. Then they note how long it is until the benefit of the first dose starts to decline. The next day they set their second daily alert for each day at a time that is 30 minutes before their focus begins to decline. This way they take the next dose to be replacing the falling brain concentrations of the previous dose. This prevents a dip in focus between doses. Alerts are then set for the third and fourth doses of the day, as necessary, with the same interval between alerts as between the first and second alerts. My patients are reporting significant improvement in their work and school performance, more consistent and improved mood, and avoiding daytime crashes between doses. Crashes are the periods of tiredness, sleepiness, irritability, or easy crying from a rapid drop-off in ADHD medication brain concentrations.
When switching my patients from a more expensive, longer acting ADHD medication to the cheap, shorter acting, generic substitute, we start out on very low doses and then move up the doses gradually. This way we avoid side effects, find the most effective dose, adjust the period between doses, and adjust the size and time of the last dose of the day to prevent difficulty falling asleep.
For more information on how to save money on psychiatric medications, see my blog about affordable psychiatric medications To make an appointment with Dr. Hege for evaluation and treatment for adult ADHD,
Call 770-458-0007.