👩‍⚕️Step 3 - GP Prescribing

If you are diagnosed with ADHD by the psychiatrist, they will send a detailed report to Dr Shaw.

This will include all of the possible medications that may be used to treat the condition.

Dr Shaw is then required to apply to the Health Department of Victoria for a Permit to Prescribe.

Approval usually takes about 10 days, but can be longer at times.

Note, before stimulant medication can be prescribed, all investigations/requirements described earlier must have been completed and be normal.

Once this approval has been granted, Dr Shaw will contact you to come in for a face-to-face consultation.

The Follow-up Appointment:

At this appointment, Dr Shaw will review the psychiatrist’s recommendations, including a detailed discussion regarding the medication options.

In addition, a pathology form will be given for a repeat of the blood tests, urine drug screen, and ECG to be completed before the 6 month review.

ADHD is regarded as a chronic disease, and as such you may be eligible to be placed on a GP Chronic Disease Plan. If so, the extra permit fee (~ $70) will be waived. The total fee will then be $240 with a $156.55 Medicare rebate ($83.45 gap). If you are ineligible, the total fee will be $233.65 with an $83.65 Medicare rebate ($150 gap).

Medications:

First line medications are the stimulants.

There are essentially 2 different types - dexamfetamine or methylphenidate. Both have short-acting and long-acting versions. These will be discussed in further depth on the next page.

Second line medications include Atomoxetine, Guanfacine, and Clonidine. These are used if there are contraindications to the patient being prescribed stimulant medications such as an illicit drug history or cardiovascular problems. Clonidine is often used in combination with stimulants if insomnia is a problem.

If a stimulant medication is decided upon, Dr Shaw needs to ring up to obtain an Authority to Prescribe. This is done at the (post permit approval) consult.

Initially, doses need to be low, with gradual titration upwards, usually on a weekly basis. These follow-up appointments may be done via phone.

Once effective doses are established, medication supply should last for 6 months.

After 6 months, another face-to-face consult is required to monitor blood pressure and pulse as well as to review the repeat ECG and pathology test results.

After this, if all is stable, no further testing will be required until the end of the 2 year permit period.

Note, if illicit drug use is suspected, a urine drug screen may be required at any time.