Compliance taking a daily medication (or vitamin) can be troublesome for many. I find myself counseling parents and kids how to remember medicines often.
Here are my favorite tips:
Use a pill box for pills
Pill boxes come in various sizes and either single daily dosing or am/pm dosing, depending on your needs.
Pill boxes allow you to:
be sure you have enough for the upcoming week
remember if they were taken today
keep several types of pills for each day together if taking more than one pill
Wash the syringe after each use.
Put it where you’ll see it. Remember the medicine needs to be out of reach from kids… not necessarily the syringe!
Empty the dish drain of all contents daily so you find the syringe and remember to use it.
Or put a clean syringe in visible sight where you often look. Tape it to the milk jug. Put it in a glass next to the kitchen sink or in a glass near your coffee pot.
Grab a pen/marker and draw a “calendar” (Mon am/pm, Tues am/pm, …) on the bottle with space to check off when you’ve given the medicine each day.
Put the medicine on a shelf that is eye-level, right in front. Don’t let it get pushed to the back.
Return the bottle to the fridge before giving the medicine to lessen the chance you leave it on the counter.
Remind older children who can access the refrigerator that the bottle is off limits!
Keep it where you’ll see it – but out of hands of kids
Keep medicine next to something you do daily (coffee, toothbrush) only if your kids are old enough to respect that it’s medicine. Use associations if you can’t put the medicine itself there.
Make associations with other objects
Use a specific glass that is unique that goes from table to dishwasher to table and never is put away.
Every time you empty the dishwasher, put water in the glass and set it on the table for medicine.
Refill the medicine 1 week before you run out
This allows you flexibility in case you forget to pick it up.
It also allows recognition that there are no refills if that was missed, giving one week to see your doctor.
You can have enough for vacations if you routinely do this, since you can only fill one week earlier than the last fill… plan ahead if traveling!
Keep tabs on number of refills left
The pharmacist should let you know with each refill how many are left. If there are none, call right then to set your next appointment if you haven’t already.
Regular prescription medications goes hand in hand with regular follow up with your doctor to manage the medication dosing. This is important for many reasons, so I try to give as many refills that will be needed until the next visit.
Ask your doctor how they handle refills before the medicine runs out so there are no delays in treatment.
If you travel often, it helps to keep an empty pill box in your toiletry bag, so when packing it you see the empty box that needs to be filled.
Or you could put a sticky note in the toiletry bag reminding you to pack them.
Set your phone or watch to alarm at the times the medicine is due. Change the tone to one that is unique to remind you.
There’s an app for that! You knew there was, right? There’s an app for everything. Search your app store for a medication reminder.
Put a reminder on your calendar to call for refills and/or schedule appointments before the last minute.
Leave sticky notes around the house or in your bathroom and kitchen if you’re more old school!
If forgetting’s a problem…
Keep some medication in your purse (or at the school nurse) to take if forgotten in the morning if this might still be a problem.
Remember to not leave your purse in the car or other places the medicine will get too hot or cold or in a place your children have access to it. We don’t want them sneaking into your purse for mints and getting a medicine instead.
If the school nurse will keep some, be sure to ask for a nurse’s note when getting the prescription.
Remember to schedule your next visit!
If able, schedule the next visit before you leave the doctor’s office. Bring your calendar to each visit!
Call as soon as you can to schedule if you don’t have your calendar available at the doctor’s office or you were unable to schedule for any reason.
If you notice no more refills on the bottle when picking up your medicine, call that day to schedule an appointment. The later you wait, the fewer appointment times will be available. Early morning and later in the day fill first!
If you always forget to call when your doctor’s office is open, look for options for them to call you. Leave a message on their office voicemail and be sure to leave the best time frame and number to call when they return your call. Utilize online appointment requests if available.
Once habits form, it is easier to remember, but until then be sure to set reminders– especially if the medication must be taken at a certain time each day or if missed doses can be dangerous.
Learn what to do if you forget a dose by talking with your doctor or pharmacist. Some medicines are fine to skip a dose, others are not so forgiving and must be taken as soon as remembered.
My last post was how to start and titrate ADHD medicines. Today I’d like to discuss more of the fine-tuning issues, such as what happens if medicine isn’t taken every day, how to remember it, what to do if parents disagree about medicine, and even how to plan for travel.
Time Off ADHD Medicines
Once a good dose is found, parents often ask if medicines need to be taken every day.
Stimulants work when they work, but they don’t build up in the body or require consistent use. (This is not true for the non-stimulants, which are often not safe to suddenly start and stop.)
Some kids fail to gain weight adequately due to appetite suppression on stimulants, so parents will take drug holidays to allow better eating.
Days off the medicine also seems help to slow down the need for repeated increases in dosing for people who are rapid metabolizers.
Drug holidays off stimulants were once universally recommended to help kids eat better and grow on days off school. Studies ultimately did not show a benefit to this, so it is not necessary. Some kids suffer if they are not on medications. Behavior issues, including safety issues while playing (or driving for older kids) can be a significant problem when not medicated. Self esteem can also suffer when kids are not medicated.
Despite the fact that some kids need daily medicine, others don’t. When kids can manage their safety and behavior adequately, it isn’t wrong to take days off. Many kids want to gain better weight, and taking a drug holiday can help with appetite.
Talk to your child’s doctor if you plan on not giving your child the medicine daily to be sure that is the right choice for your child.
Remembering the medicine
It’s difficult to get into the habit of giving medicine to a child every day. Tomorrow’s post will be about how to remember medicines.
My favorite tip is to put the pills in a weekly pill sorter at the beginning of each week. This allows you to see if you’re running low before you run out and allows you to see if it was given today or not. These medicines should not be kept where kids who are too young to understand the responsibility of taking the medicine have access.
Controlled substances, such as stimulants, cannot be called in or faxed to a pharmacy. Many physicians now have the ability to e-prescribe these.
Controlled substance prescriptions cannot have refills, but a prescriber can write for either three 30 day prescriptions or one 90 day prescription when they feel a patient is stable on a dose.
Stimulants are not controlled substances because of increased risks and side effects. Some of the more significant side effects of ADHD medicines are seen in non-stimulant medicines.
They are controlled substances because they have a street value. Teens often buy them from other teens as study drugs. This can be very dangerous since it isn’t supervised by a physician and the dose might not be safe for the purchaser. It is of course illegal to sell these medicines.
The DEA does monitor these prescriptions more closely than others. If the prescription is over 90 days old, many pharmacists cannot fill it (this will vary by state), so do not attempt to hold prescriptions to use at a later time.
Acids and Stimulants
It has been recommended that you shouldn’t take ascorbic acid or vitamin C (such as with a glass of orange juice) an hour before and after you take medication.
The theory is that ADHD stimulants are strongly alkaline and cannot be absorbed into the bloodstream if these organic acids are present at the same time.
High doses of vitamin C (1000 mg) in pill or juice form, can also accelerate the excretion of amphetamine in the urine and act like an “off” switch on the med.
In reality have never seen this to be an issue.
If anyone has noticed a difference in onset of action or effectiveness of their medicine if they take it with ascorbic acid or vitamin C, please post your comment below.
When Mom and Dad disagree
It is not uncommon that one parent wants to start a medication for their child, but the other parent does not.
It’s important to agree on a plan, whatever the plan is.
Have a time frame for each step of the plan before a scheduled re-evaluation.
If the plan isn’t working, then change directions.
Be cautious of how you talk about this with your child. If kids know it is a disagreement, they might fear the medicine or think that needing it makes them inferior or bad.
Do not talk about the diagnosis as if it’s something the child can control. They can’t.
Don’t make the child feel guilty for having this disorder. It isn’t fair to the child and it only makes the situation worse.
Having the medicine when you need it
There is nothing more frustrating for a parent and child than to realize that there’s a big test tomorrow and you have no medicine left and you’re out of refills.
Technically none of the stimulant medicines can have refills, but a prescription covering 90 days at a time can be given. This can be done with a 90 day prescription or three 30 day prescriptions.
The technicality of this is sometimes difficult. You cannot call your pharmacy to request a refill. You must ask to have the next prescription filled if your physician provided 3 prescriptions for 3 months.
Be sure to know the procedure for refills at your doctor’s office.
It’s very important to plan ahead prior to travel if your travel involves the timeframe of needing new medication.
You must plan ahead so that if a refill will be needed during the trip you will either be able to fill a prescription you have on vacation or you will need to fill the prescription in advance.
Most people can get a prescription 7 days prior to the 30 day supply running out but not sooner, so you might need to fill a couple prescriptions a few days earlier in the month each to have enough on hand to make it through your vacation. It takes planning!
Sometimes you can work with your physician and pharmacist to get medicines early prior to travel. Talk to your pharmacist to see if they can help arrange this.
If you are out of town and you realize you forgot your child’s non-stimulant, call your doctor to see if they can e-prescribe it. Many of the non-stimulants are not safe to suddenly stop, so they are likely to send in a prescription. Insurance is not likely to pay for these extra pills if it was recently filled.
International travel will require that you find the laws in the other country to find out if you can bring controlled substances into the country. If you will need additional medicine while you are in that country, you will need to find a way to get the medicine.
Some insurance companies will allow mail order 90 day prescriptions.
There are insurance companies that not only allow, but require them on daily medicines.
Others do not allow it.
In general I advise against a 90 day prescription if the dose is not established or if there are any concerns that it might not be the perfect dose. If there is any concern that it might need to be changed, a 30 day prescription is a better option.
If you will need to do a mail order, be sure you schedule your appointment to get the prescription early enough to account for the lost time mailing.
Looking for more?
Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!
CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!
Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.
Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.
Midwest ADHD Conference – April 2018
Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.