Purpose

This protocol outlines the safe prescribing, monitoring, and ongoing management of stimulant medications. It is intended to support patient safety, regulatory compliance, and clear expectations for continued treatment.

Medications Covered

This protocol applies to stimulant medications, including but not limited to:

• Amphetamine-dextroamphetamine (Adderall, Adderall XR)

• Methylphenidate (Ritalin, Concerta, Focalin)

• Lisdexamfetamine (Vyvanse)

What Stimulant Medications Do

Stimulant medications act on the central nervous system by increasing the availability of dopamine and norepinephrine, which help regulate attention, impulse control, and executive functioning.

Clinical effects may include:

• Improved attention and focus

• Reduced impulsivity and hyperactivity

• Improved task completion and organization

• Enhanced functioning at work, school, and daily activities

Stimulants are evidence-based, first-line treatments for ADHD when appropriately prescribed and monitored.

Risks and Potential Side Effects

Patients should understand the following risks associated with stimulant use:

Common risks:

• Decreased appetite or weight loss

• Insomnia or sleep disruption

• Increased heart rate or blood pressure

• Dry mouth, headache, or gastrointestinal upset

Serious or less common risks:

• Anxiety, irritability, or mood changes

• Worsening of tics in susceptible individuals

• Cardiovascular risks in patients with underlying heart conditions

• Potential for misuse, diversion, or dependence

Stimulants should not be shared and must be taken exactly as prescribed.

Clinic Visit Requirements

To continue stimulant treatment through Miles Med Management, patients must adhere to the following:

• Follow-up visits every 3–4 months (minimum requirement)

• Visits will be via telehealth, as clinically appropriate

• Visits will include:

  • Review of ADHD symptoms and functional improvement

  • Assessment of side effects and tolerability

  • Vital sign review (as indicated)

  • Review of continued medical necessity

Prescription Timing and Refill Policy:

• At each follow-up visit, up to three (3) monthly prescriptions may be sent to the pharmacy.

• Each prescription will have the current date and a clearly marked “Do Not Fill Until” date for subsequent months.

• Each prescription will state “No Refills.”

Important clarification:

• “No refills” does not mean there are no additional prescriptions on file.

• This wording is a federal and state regulatory requirement for stimulant medications.

• Separate prescriptions are issued for each month rather than refills.

Failure to attend required visits may result in delayed prescriptions or discontinuation of stimulant prescribing.

Monitoring and Safety Expectations

Patients agree to:

• Take stimulant medications exactly as prescribed

• Use one prescribing provider for stimulant medications

• Use one designated pharmacy when possible

• Secure medications to prevent loss, theft, or diversion

• Avoid early refill requests

• Notify the clinic of all other controlled or psychiatric medications

Important Pharmacy Rules for Stimulant Medications:

• Stimulant prescriptions cannot be called in to a pharmacy.

• Stimulant prescriptions cannot be transferred between pharmacies once sent.

• If a pharmacy does not have the medication in stock, it is the patient’s responsibility to locate a pharmacy that does have the medication available.

• Patients are encouraged to check locally owned pharmacies, which may have better availability, such as:

  • Lloyd’s Pharmacy (St. Paul)

  • Setzer’s Pharmacy (St. Paul)

Prescription Monitoring Program (PMP) reviews and urine drug screening may be conducted as clinically indicated.

Discontinuation or Change in Treatment

Stimulant medications may be adjusted, tapered, or discontinued if:

• Benefits no longer outweigh risks

• Side effects become clinically significant

• There are concerns for misuse, diversion, or non-adherence

• Required follow-up visits are not maintained

Alternative or adjunctive treatments may be discussed, including non-stimulant medications and behavioral strategies.

Patient Acknowledgment and Initials

Please initial each section below to confirm understanding and agreement:

Understanding of Stimulant Medications

Risks and Side Effects

Clinic Visit Requirement (Every 3–4 Months)

Monitoring and Safety Expectations

Discontinuation or Treatment Changes

Patient Signature

By signing below, I confirm that I have reviewed this Stimulant Medication Treatment Protocol, had the opportunity to ask questions, and agree to follow the outlined requirements.

Miles Med Management

This protocol is intended to support safe, responsible stimulant prescribing and patient care.