Which Prescription Is ADHD Medication Written On in Turkey?

For someone who is going to take ADHD medication, the first thing they meet is not the medication itself but the procedure for getting it. Which doctor can write it, why the prescription is red, why two boxes at a time, why a report is asked for.

This article lays out that framework in one place. The rules can be updated over time; the information here is the general framework, and for the current state of the practice ask your doctor and your pharmacist.

What red prescription means

In Turkey prescriptions are divided according to the level of control of the medication they contain. The red prescription ("kırmızı reçete") is a numbered, tracked type of prescription used for controlled stimulants and similar substances.

Medications containing methylphenidate are in this group. That is, products such as Ritalin, Concerta and Medikinet are not written on the ordinary white prescription.

This has practical consequences:

• Not every doctor can write the prescription.
• The prescription has to be used within a certain period.
• The pharmacy puts the prescription on record.
• The number of boxes that can be written on one prescription is limited.

The prescription being red does not mean the medication is "dangerous." It is a system set up to monitor substances with misuse potential. I wrote, with sources, about the difference between use under a doctor's supervision at the recommended dose and misuse in the article on addiction.

Which doctor can write it

Under the framework introduced by the Ministry of Health's circular no. 2010/26, medications containing methylphenidate can be written by specialists in adult psychiatry and specialists in child and adolescent psychiatry.

In practice this means: you cannot ask your family doctor to write this medication. Even if the diagnosis was made by another doctor, you need to go to a psychiatry specialist for the prescription.

The diagnostic process itself is a separate subject; I explained it step by step in the articles on how adult ADHD is diagnosed and where to get it.

The box limit

The amount that can be written on one red prescription is limited. According to the practice reported in the announcements of the Istanbul Chamber of Pharmacists, a certain number of boxes per product, corresponding to two months of treatment, cannot be exceeded, and short-acting and long-acting forms can be written together on the same prescription.

Because the figures here can be updated from time to time, I am not putting a fixed number in the article. The practical information you need is this: the prescription covers not the whole of the treatment but a certain period of it, and when it runs out you need to go to a check-up for a new prescription.

Writing this in the calendar is a measure that really works in this picture. Instead of noticing the day the prescription runs out, setting a reminder two weeks before it does; in a system where finding an appointment takes time, that is what makes the difference.

The report and reimbursement

Being able to write the prescription is one subject, the reimbursement of the medication is another.

Reimbursement depends on the provisions in the Health Implementation Communiqué ("Sağlık Uygulama Tebliği") of the Social Security Institution (SGK). For some medications a medical report is requested; who will issue the report, its duration and its content are also set in the same regulations.

Because this part changes often, I am not writing rates, durations or amounts here. The right way is this: ask your doctor whether a report is needed, if it is, get the report before the prescription, and take the two together when you go to the pharmacy.

What the pharmacy asks for

When getting medication with a red prescription, ID is generally asked for. If a relative is going to collect the medication on the patient's behalf, an additional document may be asked for depending on the pharmacy's practice.

The prescription also has a validity period: it has to be used within a certain period after it is written. A prescription forgotten in a drawer is no use once its period has passed.

If the medication is not at the pharmacy

In Turkey there are supply problems from time to time with medications containing methylphenidate. Not being able to find the medication even though you hold a valid prescription is a real possibility.

In that situation, what must not be done is to use another form that happens to be on hand on your own decision. A short-acting product and a long-acting product, even if they carry the same active substance, have different effects through the day; I explained this in detail in the article on Ritalin and Medikinet.

What to do is call your doctor. An alternative form, a different active substance or a temporary plan can be talked over.

When traveling abroad

When traveling with a controlled medication, the general rule is to carry the medication in its original box and together with the prescription. For some countries an additional document may be needed; the rules of the country you are going to need to be checked beforehand.

Instead of thinking about this at the airport, asking your doctor weeks before the trip is the most practical way.

What I am left with

The most tiring side of this procedural part is that none of it is written in one place. You learn who will write the prescription from one place, where to get the report from another, and what the pharmacy will ask for from a third.

The useful thing I took from this article is to turn it into a one-time job: a single note containing the name of the doctor who writes the prescription, the date of the last prescription, the expiry date of the report if there is one, and the name of the pharmacy. Updating that note after every check-up is enough.

The rules can change. Take the framework here as information; what is binding is the current practice that your doctor and your pharmacy tell you.