Havent seen any mention of this yet but the reason for this is well known in the recreational drug community : amphetamine is a chiral molecule. The D isomer is more psychologically active. The L isomer creates more physical side effects. There is no regulation for the % of each isomer in the product. This means that one brand may be 70% L, 30% D, and a different brand could be the opposite.
I take this drug daily. The current supply crunch has meant I've had to take inferior versions of the product for nearly a year now. It fucking sucks. I need it to work but the side effects often mean little sleep, strange repetitive behaviour, absurd hypersexuality, etc.
Its a travesty, not in the best interest of the consumer. If you are on this medication you are treated like dog shit from the doctor to the insurance company to the pharmacy to the pill itself. All in the name of either preventi g addicts from getting it (who cares?) Or making more money for some massive company.
> There is no regulation for the % of each isomer in the product. This means that one brand may be 70% L, 30% D, and a different brand could be the opposite.
This is true for the unregulated illicit drug market, but it's most certainly not true for regulated drugs like Adderall.
The ratios of the different isomers in Adderall are well-defined and are part of the drug definition. There are also stimulant variants that are 100% d-amphetamine, which would obviously be in violation of their drug definition if manufacturers starting shipping racemic versions.
> Havent seen any mention of this yet but the reason for this is well known in the recreational drug community : amphetamine is a chiral molecule. The D isomer is more psychologically active. The L isomer creates more physical side effects.
This is over-simplifying the matter. The L-isomer has different effects and duration, but it's incorrect to suggest that it's all "side effects". Some patients do better on racemic mixtures with L-amphetamine. Some patients do better on pure D-amphetamine. It's not correct to suggest that one is pure side effects.
Yeah, naw. You can state the hypothetical way things are supposed to work in the best case -- and you can state so confidentially -- but that doesn't mean that reflects the real world at all.
Look through the FDA warning letters database for manufacturers of adderall (f.e. the "Auro" family of producers). You'll notice a lot of warnings have already been issued for quality control and adulteration issues (and continue to be issued yearly, ad infinitum).
Yeah, the 3rd world factory where these drugs are manufactured, for sure tested their product themselves and found it to be bio-equivalent and within the acceptable FDA variance of "how much of the active drug is actually in each pill, vs. what's stated on the specs."
And yeah, the FDA for sure trusts these factories which are thousands of miles away are always up-to-snuff -- even when they don't have an inspector around.
Your statements about the illicit market aren't true either (pro-tip: the legal and illegal market for the usual, non-exotic synthetic drugs comes from the same source; with minor exceptions in local markets).
And a final pro-tip: if you think the only reason brand drugs are expensive is branding/marketing/some other bullshit -- some of the cost is in proper quality control (they're incentivized to maintain high standards, so people keep coming back to ask for the brand-name -- instead of some nameless generic any fly-by-night shop can manufacture).
You are correct. After looking it up it seems I was misinformed about the enantiomers in generics thing.
As far as the effevts of l amph- eh. Yes. There is some amount of evidence the the L isomer produces symptom relief similar to d amph. Frankly ive never had the two seperated so I wouldnt know from experience, but I have read repeatedly over the years that L amph is associated with more norepinephrine effects than D, and norepinephrine agonists produce ohysical side effects such as vasoconstriction.
>This is true for the unregulated illicit drug market, but it's most certainly not true for regulated drugs like Adderall.
It's not even consistently true for the illicit drug market. You can just Google "amphetamine isomer separation tartrate" to get a bunch of information about it. The l-isomer of amphetamine is very weak, and sellers want return business.
There is no regulation for the % of each isomer in the product.
Do you have a source? The FDA label says it's 50% d,l-amphetamine (50/50) plus 50% d-amphetmaine, so you end up with a 3:1 ratio of dextroamphetamine to levoamphetamine.
Why would a manufacturer do more work to change the 50/50 mix? And why would it vary from batch to batch? The FDA has requirements on manufacturing that each lot is made to the same specifications.
The more reasonable explanation is that the binding agents changed, which may change the rate at which the drug dissolves and is absorbed.
This actually happened a while back with generic bupropion. Generic manufacturers made a 300 mg version, which had 300 mg of drug in it. However, the medicine was absorbed much more quickly leading to a rash of side effect complaints from patients. The FDA eventually recalled the drug.
"In that study, the results of which became available in August 2012, Budeprion XL 300 mg failed to demonstrate bioequivalence to Wellbutrin XL 300 mg."
Frankly, ive done all kinds of amphetamines, ingested them by every means except iv.
It is not a matter of the rate of absorption. The experience is qualitatively different. Perhaps I am wrong about the stereoisomer mixture - but amphetamine salts are NOT racemic in the first place - so some amount of seperation is happening- I am quite certain that the different brands do not contain the same proportions.
Man, this helps me understand so much of what I’m experiencing. I had to switch to cheap stuff about two months ago and I’ve been all over the place. Absolutely terrible sleep, too.
My understanding is much of the difference between name brand and generics is the excipients used, as they effect drug delivery. Not all generics will use the same and the name brands generally have patents on the ones they use. For psychoactive compounds this can make a considerable difference in how the drug functions for an individual.
YSK that lisdexaphetamine has come off patent this year, and is purely a dextroamphetamine prodrug. It might provide more consistent results compared to adderall even in a generic formulation.
Thank you so much. I had no Idea. I used to take vyvanse but my insurance no longer covers it. It was far superior to adderall so Ill see if my doc can get me back on it. Thanks!
Some of the rules around prescribed controlled substances seem to have no legitimate purpose in actually "preventing addicts from getting it" though.
Not US, Australia, but wouldn't be surprised if same rules apply there – suppose you are prescribed 50mg Vyvanse. You start to feel like 50mg is too much (the side effects are too bad), and you want to try 40mg instead. Can the pharmacist dispense you 40mg instead of 50mg? No. Because it is a controlled substance (or "Schedule 8" as it is called in Australia), the pharmacist can only legally dispense the exact thing you were prescribed – they'll tell you to go back to the prescriber and get a new prescription. If it wasn't a controlled substance, the pharmacist would have more flexibility; in the past, I've gotten pharmacists to dispense prescription drugs without a prescription because I hadn't got around to getting a new script – something they are legally allowed to do (at least here in Australia) for non-controlled substances. They can't do that again and again – it is important the prescriber is kept in the loop – but as a short-term once-off, it does no harm. But going back to the prescriber involves getting another appointment, taking the time out of one's day to attend it, paying for it, etc. In the end one might just decide to put up with the side effects–which is a clearly less than optimal health outcome. Or, one can be reduced to trying to cut the dosage one's self – open the capsule, dissolve the contents in a measured quantity of liquid, then measure out the liquid – which will seem like too much effort to bother with.
I can understand how someone who is prescribed 50mg asking for 60mg or 70mg could be a sign of a developing addiction, but asking for less than one is prescribed is the complete opposite of how an addicted person behaves. So why isn't it allowed? Because the rules only have a rather diffuse relationship with preventing addiction (or other health harms). I think, to a great extent, the rules have come to exist for their own sake, not for the sake of anyone's health.
If a drug is available and there is addicts of said drug, the addicts don't suddenly stop being addicts just because the drug is not available, they'll just move on to a different drug. The problem is that addicts are not being treated, not that a specific drug is available or not.
My next door neighbor (who has since moved away, but I see his kids around the neighborhood still) is a very successful salesman and takes 120mg of Adderall “to get out of bed in the morning”. Which I thought was crazy considering I take 15-30mg in a day, but he didn’t seem like a bad guy or to have any ill effects from it (aside from assumably spending a good chunk of change a month buying Adderall off friends/dealers).
I think there’s way worse things to be addicted to than Adderall and feel like this guy is a “worst case scenario” but he’s still a productive contributing member of society.
I was previously consistantly using a generic that I tolerated well. In the last year I have had several months (maybe 6) where I was only able to obtain generics produced by actavis or amneal. These 2 absolutely suck compared to sandoz, teva (which I think may be exactly the same) or shire.
The side effects are overwhelming
Kind of bizarre that the author won’t entertain the most obvious explanation given the documented problems with many generic drugs [1]. I guess the difference in this case is that the patients can tell right away.
the generic concerta all have a KNOWN issue with manufacturing. The slow release mechanism is mechanic, not chemical, and only ONE generic is manufactured the right way.
Two of our kids are on Concerta and can confirm that the first time we got generics it was very fucking obviously working quite differently (in our case, it manifested like them barely working at all). Took us a little bit to put two and two together, but sure enough, the change was just as we switched (well, got switched) to generics.
Be great if the FDA would ensure that a generic is actually the same damn thing.
> The brand one slow releases very evenly while the generic just slams me with the calm, focused joy followed by a significant emotional low for hours.
Prolonged-release of an orally drug taken in pill form is a "special feature", it's the difference between regular Adderall and Adderall XR.
There are patented techniques involved to make it work like that, generica manufacturers probably don't have access to those/leave it out to save manufacturing costs.
You can try taking the generica in smaller dosages, to compensate for their lack of prolonged-release, as the symptoms you describe sound like you are overdosing by taking too much in too short of a time.
Concerta doesn't need such manual dosage management, as it also has prolonged-release just like Adderall XR.
The FDA allows generics to be sold within much looser tolerances than the brand product (variances allowed of +/- 20% of active ingredient per dose.) If you've ever noticed a "brand medically necessary" checkbox on a prescription a doctor has given you, that's what it is there for.
That sounds like your generic is not extended release but an immediate release version, which sound like different medications overall. Maybe split the dose in half and take the second half 4 hours later which is what they usually do when people are taking immediate release? Whoever your doctor is should understand this dynamic...
I've been on 4 different brands of generic Ritalin. I'm sure I can tell them apart by taking one.
1. Normal (the first one - don't remember the manufacturer - was extremely hard to break in half)
2. Actavis - strong, but slow to hit
3. KVK - strong and hits fast
4. Mallinkrodt - weak
For years Mallinkrodt was the only brand my drug store would get. Now they switched back to KVK and it's like night and day. I only have to do half as much.
i've worked in the biotech industry and have been to some generics manufacturing plants and they are "up to code" but also a whole hell of a lot jankier than the big name brands.
The brand name worked significantly better when I took seizure medication with fewer side effects. The differences between the brand name and generic medications were very pronounced.
I don't think it's still manufactured, and maybe it's unrelated to this current situation, but around 8-15 years ago, one of the manufacturers of generic Adderall XR did something that made it much less effective. It was obvious which ones were theirs, because they were the only company that put theirs in blue capsules.
Subjectively, it felt about half as effective as anyone else's. There were many, many forum discussions at the time from adults taking it as well as parents of kids who'd received it and noticed a big difference.
It was especially frustrating because of all the rigamarole one has to deal with to get the medication in the first place. To not have it work and also have to wait another month to get one that does is ridiculous.
I submitted a complaint to the FDA about it at the time. Never even got a form letter back. It's caused me to avoid generic drugs where possible ever since because if that can slip through, what else can?
I assumed at the time it was some difference in the capsule itself or the delayed-released mechanism, as opposed to the active ingredients being different.
You see this with a lot of psychotropic medications (and likely others).
It’s why when you fill a generic the label will specifically list the manufacturer. I’ve heard of at least a few instances with psych meds where people will either try to get a specific generic manufacturer or go back to name brand because of the significant impact due to variability you’re describing.
I would also say that ADHD meds are much more susceptible to this, because the psychological effect is just so noticeable. Taking Vyvanse by itself compared with taking it with a little snack it makes quite a difference in the absorption for me; when I take it with Psyllium husk, then...
EDIT: I guess I should expand on the effects of Psyllium. I mean the meds take longer to kick in
I am in a similar situation as you and trying to figure out the best way to take my medication. I never really thought about my psyllium husks having an effect, so I'm very curious what you've noticed
the stuff in here about 'minor differences in coating could make a difference but shouldn't' is surprisingly badly researched
both teva + shire manufacture a branded and a generic -- just ask them what the difference is between the two, right? and if they hang up you can write, 'both teva and shire refused to say if their generic works'
(from plasma concentration, the double-pulsed one looks as smooth as continuous delivery, but I'm guessing the brain + blood half lives are different)
but the bead material is probably FDA scrutinized, and any chemical difference between the branded + generic version is in theory public knowledge; shocking nyt didn't like, call a chem lab or something before hitting send on this one
the author speculating that someone is complaining about switching from an immediate release to an XR also feels bogus -- presumably I would say in my tiktok that it's a capsule instead of a tablet?
I suppose things might have changed in ~half a century, the FDA used to care about everything.
Back in the late '80s the VAX-11/750 that was part of the Siemens MRI scanners was shipped in the old blue trim color long after DEC had switched to the very chic "brown on tan" color scheme. The FDA approval for the scanner would not let them change the color of the paint because of some bleedover of medication regulation language into the equipment approval regulations.
There are whole classes of products designed to be eaten for various purported benefits but which are evidently neither sufficiently foodlike not sufficiently druglike to warrant FDA attention. Herbal supplements are apparently just edible magic.
“Inactive ingredient” is a term with similar provenance as “junk dna”, “oldest human tool-making”, and “oldest humans in North America”. These terms represent a state of current understanding more than absolute truth.
As somebody approaching 40 who has been on ADHD meds most of his adult life and for portions of his childhood:
It’s not that (generic) Adderall is different so much as there seems to have been an explosion of generic manufacturers all using wildly different amounts of the actual amphetamine salts and binding agents.
For me personally, the Mallinckrodt generic seems to use a different binding agent that causes bloating and occasional headaches.
The shortage has really demonstrated just how differently these generics are formulated.
Eg: I used to take Sandoz 20mg tablets that were about the size of two baby aspirins. At one point, a few months back, I was forced to modify my prescription so it could be filled as 10mg tablets.
My new 10mg bottle was filled with Teva manufactured pills that each were roughly the size of 2.5 of my old Sandoz 20mgs - despite being half the dosage. That’s a ton of filler.
The worst part about the shortage - beyond the anxious pharmacy hunt each month - is that my insurance pushed a new shortage policy that places a moratorium on modifying ADHD prescriptions. I literally am not allowed to try “creative” solutions like Dexedrine or even something like modafanil.
This is 100% happening, we need these pills tested in a lab. My bet is they are likely thinning it because the demand is too high. The DEA will not approve the new limits because of "The War on Drugs" is being revived.
I was switched to Teva at same dose this past month because of the shortage and it does not work at all. Its very frustrating, like getting your wheel chair and realizing it doesn't have wheels.
The Teva generic or the Teva brand name? They make both a generic and a brand-name. Everyone I've heard swears by the Teva non-generic as "the best" for just adderall.
I'm considering going back to smokeless tobacco because of this sitution. For 400 years, the majority of the population used tobacco/nicotine for increased concentration. Over the last 30 years, that rate has declined, while at the same time, ADHD diagnoses have increased. Studies have shown nicotine is effective in reducing ADHD symptoms, so it seems that society's elimination of nicotine has revealed that it was covering up ADHD for all those years.
Readit News
I take this drug daily. The current supply crunch has meant I've had to take inferior versions of the product for nearly a year now. It fucking sucks. I need it to work but the side effects often mean little sleep, strange repetitive behaviour, absurd hypersexuality, etc.
Its a travesty, not in the best interest of the consumer. If you are on this medication you are treated like dog shit from the doctor to the insurance company to the pharmacy to the pill itself. All in the name of either preventi g addicts from getting it (who cares?) Or making more money for some massive company.
This is true for the unregulated illicit drug market, but it's most certainly not true for regulated drugs like Adderall.
The ratios of the different isomers in Adderall are well-defined and are part of the drug definition. There are also stimulant variants that are 100% d-amphetamine, which would obviously be in violation of their drug definition if manufacturers starting shipping racemic versions.
> Havent seen any mention of this yet but the reason for this is well known in the recreational drug community : amphetamine is a chiral molecule. The D isomer is more psychologically active. The L isomer creates more physical side effects.
This is over-simplifying the matter. The L-isomer has different effects and duration, but it's incorrect to suggest that it's all "side effects". Some patients do better on racemic mixtures with L-amphetamine. Some patients do better on pure D-amphetamine. It's not correct to suggest that one is pure side effects.
Look through the FDA warning letters database for manufacturers of adderall (f.e. the "Auro" family of producers). You'll notice a lot of warnings have already been issued for quality control and adulteration issues (and continue to be issued yearly, ad infinitum).
Yeah, the 3rd world factory where these drugs are manufactured, for sure tested their product themselves and found it to be bio-equivalent and within the acceptable FDA variance of "how much of the active drug is actually in each pill, vs. what's stated on the specs."
And yeah, the FDA for sure trusts these factories which are thousands of miles away are always up-to-snuff -- even when they don't have an inspector around.
Your statements about the illicit market aren't true either (pro-tip: the legal and illegal market for the usual, non-exotic synthetic drugs comes from the same source; with minor exceptions in local markets).
And a final pro-tip: if you think the only reason brand drugs are expensive is branding/marketing/some other bullshit -- some of the cost is in proper quality control (they're incentivized to maintain high standards, so people keep coming back to ask for the brand-name -- instead of some nameless generic any fly-by-night shop can manufacture).
As far as the effevts of l amph- eh. Yes. There is some amount of evidence the the L isomer produces symptom relief similar to d amph. Frankly ive never had the two seperated so I wouldnt know from experience, but I have read repeatedly over the years that L amph is associated with more norepinephrine effects than D, and norepinephrine agonists produce ohysical side effects such as vasoconstriction.
It's not even consistently true for the illicit drug market. You can just Google "amphetamine isomer separation tartrate" to get a bunch of information about it. The l-isomer of amphetamine is very weak, and sellers want return business.
> Combination of
> amphetamine aspartate monohydrate 25% – stimulant (12.5% levo; 12.5% dextro)
> amphetamine sulfate 25% – stimulant (12.5% levo; 12.5% dextro)
> dextroamphetamine saccharate 25% – stimulant (0% levo; 25% dextro)
> dextroamphetamine sulfate 25% – stimulant (0% levo; 25% dextro)
I don't see why there should be no regulation? They are distinct chemicals, in that sense...
But yes I was definitely mistaken. Thank you for the correction
Do you have a source? The FDA label says it's 50% d,l-amphetamine (50/50) plus 50% d-amphetmaine, so you end up with a 3:1 ratio of dextroamphetamine to levoamphetamine.
Why would a manufacturer do more work to change the 50/50 mix? And why would it vary from batch to batch? The FDA has requirements on manufacturing that each lot is made to the same specifications.
The more reasonable explanation is that the binding agents changed, which may change the rate at which the drug dissolves and is absorbed.
This actually happened a while back with generic bupropion. Generic manufacturers made a 300 mg version, which had 300 mg of drug in it. However, the medicine was absorbed much more quickly leading to a rash of side effect complaints from patients. The FDA eventually recalled the drug.
If you want to read how generics are tested and approved, Derek Lowe did a nice blog post on it: https://www.science.org/content/blog-post/generic-wellbutrin...
"In that study, the results of which became available in August 2012, Budeprion XL 300 mg failed to demonstrate bioequivalence to Wellbutrin XL 300 mg."
It is not a matter of the rate of absorption. The experience is qualitatively different. Perhaps I am wrong about the stereoisomer mixture - but amphetamine salts are NOT racemic in the first place - so some amount of seperation is happening- I am quite certain that the different brands do not contain the same proportions.
I presume the families and loved ones of the addicts probably care...
Not US, Australia, but wouldn't be surprised if same rules apply there – suppose you are prescribed 50mg Vyvanse. You start to feel like 50mg is too much (the side effects are too bad), and you want to try 40mg instead. Can the pharmacist dispense you 40mg instead of 50mg? No. Because it is a controlled substance (or "Schedule 8" as it is called in Australia), the pharmacist can only legally dispense the exact thing you were prescribed – they'll tell you to go back to the prescriber and get a new prescription. If it wasn't a controlled substance, the pharmacist would have more flexibility; in the past, I've gotten pharmacists to dispense prescription drugs without a prescription because I hadn't got around to getting a new script – something they are legally allowed to do (at least here in Australia) for non-controlled substances. They can't do that again and again – it is important the prescriber is kept in the loop – but as a short-term once-off, it does no harm. But going back to the prescriber involves getting another appointment, taking the time out of one's day to attend it, paying for it, etc. In the end one might just decide to put up with the side effects–which is a clearly less than optimal health outcome. Or, one can be reduced to trying to cut the dosage one's self – open the capsule, dissolve the contents in a measured quantity of liquid, then measure out the liquid – which will seem like too much effort to bother with.
I can understand how someone who is prescribed 50mg asking for 60mg or 70mg could be a sign of a developing addiction, but asking for less than one is prescribed is the complete opposite of how an addicted person behaves. So why isn't it allowed? Because the rules only have a rather diffuse relationship with preventing addiction (or other health harms). I think, to a great extent, the rules have come to exist for their own sake, not for the sake of anyone's health.
I think there’s way worse things to be addicted to than Adderall and feel like this guy is a “worst case scenario” but he’s still a productive contributing member of society.
Dead Comment
Dead Comment
[1] https://www.npr.org/sections/health-shots/2019/05/12/7222165...
The brand one slow releases very evenly while the generic just slams me with the calm, focused joy followed by a significant emotional low for hours.
Completely unsurprised if an Adderall generic had just as significant impacts.
https://www.goodrx.com/concerta/certain-generics-are-no-long...
Be great if the FDA would ensure that a generic is actually the same damn thing.
Prolonged-release of an orally drug taken in pill form is a "special feature", it's the difference between regular Adderall and Adderall XR.
There are patented techniques involved to make it work like that, generica manufacturers probably don't have access to those/leave it out to save manufacturing costs.
You can try taking the generica in smaller dosages, to compensate for their lack of prolonged-release, as the symptoms you describe sound like you are overdosing by taking too much in too short of a time.
Concerta doesn't need such manual dosage management, as it also has prolonged-release just like Adderall XR.
Deleted Comment
1. Normal (the first one - don't remember the manufacturer - was extremely hard to break in half)
2. Actavis - strong, but slow to hit
3. KVK - strong and hits fast
4. Mallinkrodt - weak
For years Mallinkrodt was the only brand my drug store would get. Now they switched back to KVK and it's like night and day. I only have to do half as much.
Dead Comment
Subjectively, it felt about half as effective as anyone else's. There were many, many forum discussions at the time from adults taking it as well as parents of kids who'd received it and noticed a big difference.
It was especially frustrating because of all the rigamarole one has to deal with to get the medication in the first place. To not have it work and also have to wait another month to get one that does is ridiculous.
I submitted a complaint to the FDA about it at the time. Never even got a form letter back. It's caused me to avoid generic drugs where possible ever since because if that can slip through, what else can?
I assumed at the time it was some difference in the capsule itself or the delayed-released mechanism, as opposed to the active ingredients being different.
It’s why when you fill a generic the label will specifically list the manufacturer. I’ve heard of at least a few instances with psych meds where people will either try to get a specific generic manufacturer or go back to name brand because of the significant impact due to variability you’re describing.
Case in point; https://www.fiercepharma.com/pharma/vallons-abuse-resistant-...
EDIT: I guess I should expand on the effects of Psyllium. I mean the meds take longer to kick in
both teva + shire manufacture a branded and a generic -- just ask them what the difference is between the two, right? and if they hang up you can write, 'both teva and shire refused to say if their generic works'
I'm fairly sure this is Shire's original patent for XR beads https://patents.google.com/patent/US6322819B1/
they have a subsequent patent for a more continuous delivery system https://patents.google.com/patent/US6913768B2/
(from plasma concentration, the double-pulsed one looks as smooth as continuous delivery, but I'm guessing the brain + blood half lives are different)
but the bead material is probably FDA scrutinized, and any chemical difference between the branded + generic version is in theory public knowledge; shocking nyt didn't like, call a chem lab or something before hitting send on this one
the author speculating that someone is complaining about switching from an immediate release to an XR also feels bogus -- presumably I would say in my tiktok that it's a capsule instead of a tablet?
Back in the late '80s the VAX-11/750 that was part of the Siemens MRI scanners was shipped in the old blue trim color long after DEC had switched to the very chic "brown on tan" color scheme. The FDA approval for the scanner would not let them change the color of the paint because of some bleedover of medication regulation language into the equipment approval regulations.
For example: it's colloquially known among RNs that intravenous drips work differently based on the maker and source of the tubing for the drip.
This is not officially discussed.
It’s not that (generic) Adderall is different so much as there seems to have been an explosion of generic manufacturers all using wildly different amounts of the actual amphetamine salts and binding agents.
For me personally, the Mallinckrodt generic seems to use a different binding agent that causes bloating and occasional headaches.
The shortage has really demonstrated just how differently these generics are formulated.
Eg: I used to take Sandoz 20mg tablets that were about the size of two baby aspirins. At one point, a few months back, I was forced to modify my prescription so it could be filled as 10mg tablets.
My new 10mg bottle was filled with Teva manufactured pills that each were roughly the size of 2.5 of my old Sandoz 20mgs - despite being half the dosage. That’s a ton of filler.
The worst part about the shortage - beyond the anxious pharmacy hunt each month - is that my insurance pushed a new shortage policy that places a moratorium on modifying ADHD prescriptions. I literally am not allowed to try “creative” solutions like Dexedrine or even something like modafanil.
Grey market moda is easy to find.
I've been taking a small dose of moda along with my current meds, and it works out.
I was switched to Teva at same dose this past month because of the shortage and it does not work at all. Its very frustrating, like getting your wheel chair and realizing it doesn't have wheels.