Use these best practice recommendations when considering stimulant prescriptions for youth and adults.
Check K-TRACS prior to writing each stimulant prescription and use it as a tool to assist with clinical decision-making.
Perform a medical history and physical exam with the patient and consider alternative pharmacological and non-pharmacological therapies for patients with heart-related conditions because stimulants have been known to cause an increase in heart rate and blood pressure.
Consider a trial prescription for Selective Serotonin Reuptake Inhibitors (SSRI), Tricyclic Antidepressants (TCA) or Serotonin and Norepinephrine Reuptake Inhibitors (SNRI) if anxiety or depression cannot be ruled out before beginning a treatment plan that involves stimulants.
Consider short-acting stimulant medications as they may be titrated to doses that produce symptom relief with manageable adverse reactions.
Have a provider/patient agreement signed by both parties for accountability and clarification of treatment goals as well as for liability reasons.
Consider urine drug screens to confirm that illicit drugs are not being used and that the prescribed medication is being taken.
When prescribing stimulants that are greater than the FDA-approved, maximum daily dosage, document in the medical record justification and discussion with patient (i.e., mixed amphetamine salts >40mg/day, methylphenidate >60mg/day).
Assess the patient quarterly to monitor for side effects and possible treatment goals and plans.
Monitor for diversion if the patient exceeds maximum daily dosage amounts of prescribed medication.
Keep prescription pads in a locked device that only the providers have access to.
Sources: CDC, CMS, Kansas Board of Healing Arts, and Rhode Island and Wisconsin state health departments