Stimulant Patient Agreement

Your healthcare provider has prescribed a stimulant medication for you. Stimulant medications are commonly prescribed for conditions such as attention deficit/hyperactivity disorder (ADHD) but may also be used to address daytime hypersomnolence, narcolepsy, or cognitive enhancement following a traumatic brain injury. There are three main types of stimulant medications available: methylphenidate products, mixed amphetamine salt products, and dextroamphetamine products. Some familiar brand names for these medications include Ritalin, Concerta, Daytrana, Metadate, Adderall, Dexedrine, and Vyvanse. It's essential to note that all stimulants share potential side effects.

The two most frequently reported side effects of stimulant medications are reduced appetite and insomnia. They may also lead to stomach discomfort and headaches. In children and adolescents who are still growing, stimulants could potentially slow down their growth rate. For this reason, the height and weight of all children and adolescents taking stimulant medications, and sometimes even adults, will be regularly monitored, along with other standard laboratory tests if necessary.

In some instances, individuals taking stimulants may experience motor or vocal tics. If you had tics before starting stimulant medications, approximately 30-40 percent of individuals may notice an exacerbation of their tics. However, tics related to stimulant medications generally resolve or return to baseline after discontinuing the stimulants.

Stimulants can slightly elevate blood pressure and heart rate, but this is rarely of clinical significance. If you have a pre-existing heart condition or high blood pressure, it's crucial to inform your healthcare provider. We may request that you get a blood pressure cuff and regularly check your blood pressure and pulse and share this information during clinic visits.

Stimulant medications carry the potential for misuse, abuse, and dependence. Individuals with a history of substance use may be advised not to take stimulant medications or only take stimulants under careful monitoring. The prescription of stimulants will be determined by your healthcare provider based on safety and appropriateness. Other interventions, such as different medications or therapy, may be necessary to address the underlying causes of your symptoms. It's vital to discuss any history of drug or alcohol use with your healthcare provider, and periodic urine drug screens may be required.

Stimulants are closely monitored by the FDA, pharmacies and your healthcare provider. Prescription monitoring databases are checked frequently to verify your prescriptions.  

To ensure prompt refills of your medication, please request new prescriptions at least 7 days before you run out. Due to the need for close monitoring, lost prescriptions may not be refilled or replaced and early refills are not allowed. Discuss your healthcare provider's policy regarding lost prescriptions and refills. 

Regular follow-up appointments with your healthcare provider are essential to continue your medication. Discuss the frequency of your visits directly with your healthcare provider.

Your clinician will work with you to assess symptoms and determine the most appropriate treatment plan for you.  Your clinician retains the right to discontinue these medications at their discretion. Failure to adhere to the conditions outlined below may result in the discontinuation of your prescription, as determined by your clinician.  When you pick up and start this prescribed medication you agree to the following:

  • I agree to engage in treatments recommended by my clinician. These may include therapy and non-controlled medications. 
  • I will work with my healthcare provider to reduce or discontinue the medication if alternative effective treatments become available.
  • I will follow the prescribed medication plan and will not change the dosage or schedule without my clinician's guidance and approval.
  • I will not sell, share, or give this medication to another person.
  • I will maintain regular appointments with my clinician and other healthcare providers as advised. Failure to attend two appointments canceled within one business day or to miss two appointments may result in the discontinuation of my prescription by my clinician.
  • If I require another clinician's prescription for a controlled substance (e.g., benzodiazepines, barbiturates, opioids or stimulants) due to another condition or if I am hospitalized for any reason, I commit to informing my clinician of my hospital visit and any medication changes.
  •  If I seek this, or other, controlled medications from another provider, I understand that my clinician has the right to discontinue this medication.
  • I understand that lost or stolen medications may not be replaced, and requests for early refills may not be granted.
  • I agree to abstain from drugs and alcohol in accordance with my clinician's recommendations.
  • I will complete requested lab work including drug screens at my clinician's request
  • I assume responsibility for monitoring my medication supply and will proactively plan for refills to prevent running out of medications. I acknowledge that prescription refills are only available during regular business days and hours. I will plan ahead, allowing for at least 7 business days for prescription refill requests.

 

Ultimately, it is your responsibility to ensure the safety and security of your medication. Here are some recommendations:

  • Store your medication in a locked container in a location not easily accessible to others.
  • Avoid carrying your entire bottle of medicine with you when leaving your home. Ask your pharmacist for a duplicate pill bottle to carry a one-day supply at a time.
  • Never share or sell any of your medication.

 

I understand that my provider may STOP prescribing the Stimulant if:

  • I miss two consecutively scheduled appointments or several regularly scheduled appointments. 
  • I developed significant side effects from the medication.
  • I developed a rapid tolerance and the medication lost effectiveness. 
  • I refuse to consent to a drug screening and am found to be selling or misusing my prescription or taking illegal substances.
  • If my provider, for any reason, deems that the stimulant is no longer advisable for treatment. 
  • I fail to fulfill my responsibilities above, which may also lead to the termination of treatment with my provider.

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