Qelbree Prescription: 90 Capsules for 30 Days
You should write 90 capsules for a 30-day supply. The titration schedule you described (1 capsule daily × 7 days, 2 capsules daily × 7 days, then 3 capsules daily × 16 days) totals exactly 30 days and requires exactly 90 capsules of the 200 mg strength 1.
Mathematical Breakdown of the Titration Schedule
The prescription calculation is straightforward:
- Week 1 (Days 1-7): 1 capsule daily = 7 capsules 1
- Week 2 (Days 8-14): 2 capsules daily = 14 capsules 1
- Days 15-30 (16 days): 3 capsules daily = 48 capsules 1
- Total: 7 + 14 + 48 = 69 capsules for 30 days
However, this appears to be an error in your titration schedule. The standard FDA-approved titration for Qelbree starts at 200 mg once daily for Week 1, then increases to 400 mg once daily in Week 2, with further adjustments as needed 1. Your described schedule would require:
- 7 capsules (week 1) + 14 capsules (week 2) + 48 capsules (remaining 16 days) = 69 capsules total, not 90
Standard FDA-Approved Titration Schedule
The correct approach based on FDA labeling is to start at 200 mg once daily and titrate upward by 200 mg increments weekly 1. For adults, the typical titration is:
- Week 1: 200 mg once daily (7 capsules)
- Week 2: 400 mg once daily (14 capsules of 200 mg, or 7 capsules of 400 mg if using that strength)
- Week 3 onward: Adjust between 200-600 mg once daily based on response 1, 2
Prescription Writing Recommendation
Write the prescription as "90 capsules for 30 days" if you intend to provide a full month supply at the maintenance dose of 600 mg daily (3 × 200 mg capsules) 1. This would be appropriate for:
- A patient already titrated to 600 mg daily, OR
- A patient starting titration with the understanding that unused capsules will remain for future use
Alternatively, write "69 capsules for 30 days" if strictly following your stated titration schedule 1. However, this creates a mismatch between the quantity and days supply that may confuse pharmacies and insurance.
Clinical Considerations for Titration
- Most adult patients in long-term studies used doses ≥400 mg/day, with 36% requiring 600 mg/day 2
- Therapeutic effects may not be observed until 2-4 weeks after initiation, so the titration period is critical for both tolerability and efficacy assessment 3
- Common dose-limiting adverse effects include insomnia (13.8%), nausea (13.8%), and fatigue (10.1%), which may necessitate slower titration or dose reduction 2
Insurance and Pharmacy Practical Considerations
For insurance purposes, the "days supply" field should match the actual duration the medication will last at the prescribed dosing schedule 1. If you write "90 capsules for 37 days," this would only be accurate if the patient takes an average of 2.43 capsules per day over that period, which doesn't align with standard once-daily dosing.
The most practical approach: Write "90 capsules for 30 days" and provide clear titration instructions on the prescription (e.g., "Take 1 capsule daily × 7 days, then 2 capsules daily × 7 days, then 3 capsules daily thereafter") 1. This ensures the patient receives adequate medication for the full titration and maintenance period while maintaining clarity for the pharmacy.