Can a patient with a 10-year history of stability on Adderall XR (amphetamine and dextroamphetamine) 30mg and Adderall IR (amphetamine and dextroamphetamine) 20mg be approved for a refill while their primary care physician, Dr. Cobb, is out of the office?

Management of ADHD Medication Refill Request

The patient should be approved for a refill of Adderall XR 30mg and Adderall IR 20mg given his 10-year history of stability on these medications and no evidence of misuse or adverse effects.

Patient Assessment

The patient presents with:

• 10-year history of stable ADHD treatment under Dr. Cobb's care
• Current medications: Adderall XR 30mg and Adderall IR 20mg
• Last medication fill on July 1,2025
• No suicidal or homicidal ideation
• Reports stability on current medication regimen
• Requesting refill while regular provider is unavailable until September

Medication Refill Considerations

Established Treatment History

• The patient has a well-documented 10-year history of stability on his current medication regimen
• The medications have been previously filled by the medical center
• No evidence of misuse, diversion, or adverse effects is noted

Guideline Support for Continuation

• The American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry guidelines support continuing effective stimulant therapy when patients demonstrate stability and benefit 1
• Regular follow-up is recommended at least monthly until symptoms have stabilized, after which maintenance phase monitoring can occur 1

Medication Efficacy and Safety

• Adderall (mixed amphetamine salts) is an FDA-approved medication for ADHD with established efficacy 2
• The combination of Adderall XR (extended-release) and IR (immediate-release) provides both all-day coverage and flexibility for symptom control 3, 4
• Adderall XR has demonstrated 12-hour duration of action, which provides consistent symptom control throughout the day 4

Risk Assessment

Potential Risks of Discontinuation

• Abrupt discontinuation of stimulant medication could lead to:
  • Return of ADHD symptoms
  • Functional impairment in daily activities
  • Potential psychological distress
  • Disruption of established treatment plan

Monitoring Considerations

• Verify patient's identity and prescription history
• Confirm appropriate use patterns (no early refills, appropriate dosing)
• Document the temporary nature of the refill until regular provider returns

Refill Plan

1. Approve refill for Adderall XR 30mg and Adderall IR 20mg at current doses
2. Provide enough medication to last until Dr. Cobb returns in September
3. Document the rationale for continuing therapy in the patient's medical record
4. Schedule follow-up with Dr. Cobb upon his return

Important Considerations

• Stimulant medications should be administered at the lowest effective dosage that provides symptom control 2
• The patient's established dosage of Adderall XR 30mg and Adderall IR 20mg appears appropriate given his long-term stability
• Maintaining continuity of care is important for patients on controlled substances for legitimate medical conditions
• Disruption in treatment could negatively impact the patient's quality of life and daily functioning

Conclusion

Based on the patient's long-term stability on his current medication regimen, absence of concerning symptoms or behaviors, and the established treatment relationship with Dr. Cobb, approving the refill request is appropriate to maintain continuity of care until the patient's regular provider returns.