National Shortage of ADHD medication

Updated advice for GPs -- December 2023
(Original advice for GPs)

Information and advice from One Devon

UPDATE (JULY 2024) 

The national shortage of ADHD medications is continuing and impacts heavily on our patients despite every effort from our team, GPs and pharmacists to help patients manage the situation.

Currently supplies of Lisdexamfetamine have improved but some doses remain in short supply. Atomoxetine is available but again particular doses are sometimes hard to obtain. Guanfacine has been consistently available for the small number of our patients who are prescribed this medication.

However, supplies of modified release methylphenidate have been very patchy and some brands have not been obtainable for months. This is particularly the case for the tablet preparations such as Concerta XL and Xenidate XL and some patients have had to switch to capsule preparations. Predicting which medications community pharmacies can supply is very difficult as shortages appear to be localised and stock availability changes from day to day.

Information and advice is available from One Devon by clicking on the link below:

Information and advice from One Devon

Please note that the general advice about how to manage the impact of the ADHD medication shortages in the update (18 December) below is still relevant.

Update (18 December)

On 2 September 2023 the Department of Health and Social Care issued a National Patient Safety Alert informing us of a national shortage of methylphenidate prolonged-release capsules and tablets, lisdexamfetamine capsules and guanfacine prolonged-release tablets. There was already a problem in the supply of Atomoxetine.

Affected medicines are listed below. Other ADHD products remain available, but stocks may not be sufficient to meet increased demand potentially resulting in further shortages. Disruption in supply is now expected to last until April 2024*.

(*Re-supply dates vary for different medicines and different strengths of the same medication. These are subject to change).

The Alert stated: The supply disruption of these products is caused by a combination of manufacturing issues and an increased global demand.

This situation is very challenging. Our service has no control over ADHD medication supply issues and we can only give advice to our patients to support them with managing the medication supply issues. The following suggestions may be helpful:

1. The pattern of medication shortages varies across Devon and some pharmacies still have small amounts of stock on their shelves. The only online stock checker available is for Boots.
   If one pharmacy cannot dispense your medication then it is permitted to ask to be given the prescription and you can take it to an alternative pharmacy. However if the pharmacy can only fulfil part of the prescription they will not give you the prescription to obtain the remainder elsewhere. In this situation you can opt not to take the partially completed medication amount and then ask for the prescription to take it elsewhere. If doing this you need to be confident that you will be able to get the medication from somewhere else.
2. Some patients already take breaks from their medication, for example at weekends. You could try doing this to eke out the supplies that you have left. If you do try this, it is important to ensure that you are safe to engage in activities such as driving or operating machinery.
3. If you are taking Equasym XL, Concerta XL, Xaggitin XL or Xenidate XL and your GP is prescribing your ADHD medication at the moment, your GP may be able to switch you to an alternative brand that is available. We have emailed all GPs with advice about doing this if appropriate.
4. If you are taking Lisdexamfetamine, some doses are likely to be available sooner than others. GPs have been advised that they can combine different doses to achieve the daily dose that the patient is prescribed.
5. If you are an adult taking Guanfacine please contact us urgently if your supplies are low and your pharmacy cannot access supplies of this medication.
6. Ask your GP to please issue your repeat prescription slightly earlier (we have suggested to GPs up to 7 days earlier) in order that you have time to take your prescription to a different pharmacy to the one that you usually use or to ask the GP for a prescription for a different brand of medication or different dose.
7. If you are forced to take a break from your ADHD medication we agree that this is unfortunate. Some people come off their medication and decide they prefer not taking it anymore. There are strategies you can use to manage your ADHD symptoms. There are some resources available at: https://www.dpt.nhs.uk/our-services/adult-autism-and-adhd/adhd

Our small team is really busy at the moment responding to queries about medication shortages. As the supply issues are not envisaged as long-term and are affecting all types of ADHD medication we do not have a plan to change people’s ADHD medication at the moment. Please try and manage as best you can using the advice above. If you feel vulnerable or at risk please contact us but be aware that there may be a delay in responding to you because of high demand on our team at the moment.

The contact details for the First Response Service that supports people experiencing mental health crisis is: 111

(please note that the First Response team will not be able to help with the medication supply shortages).

Information about medication can be found at:

www.choiceandmedication.org/devon/

We hope the supply issue is soon resolved and thank you for your understanding.

From the Adult ADHD service, Devon Partnership NHS Trust.

Original advice (October)

On 27 September the Department of Health and Social Care issued a National Patient Safety Alert informing us of a national shortage of methylphenidate prolonged-release capsules and tablets, lisdexamfetamine capsules and guanfacine prolonged-release tablets. The particular medications were as follows:

METHYLHENIDATE:

• Equasym XL® 10, 20 and 30 mg capsules

• Xaggitin XL® 18 and 36 mg prolonged-release tablets

• Concerta XL® 54 mg prolonged-release tablets

• Xenidate XL® 27 mg prolonged-release tablets

LISDEXAMFETAMINE:

 • Elvanse® 20, 30, 40, 50, 60 and 70 mg capsules

 • Elvanse® Adult 30, 50, and 70 mg capsules

GUANFACINE

 • Intuniv® 1, 2, 3 and 4 mg prolonged-release tablets

The Alert stated: The supply disruption of these products is caused by a combination of manufacturing issues and an increased global demand.

There has also been supply issues with Atomoxetine over the last few months. Stocks of this medication were due to be back in pharmacies by now but we are only seeing a small improvement in stock available at the moment.

This situation is very challenging. Our service has no control over ADHD medication supply issues and we can only give advice to our patients to support them with managing the medication supply issues. The following suggestions may be helpful:

Suggestion one

The pattern of medication shortages varies across Devon and some pharmacies still have small amounts of stock on their shelves. The only online stock checker available is for Boots

If one pharmacy cannot dispense your medication then it is permitted to ask to be given the prescription and you can take it to an alternative pharmacy. However if the pharmacy can only fulfil part of the prescription they will not give you the prescription to obtain the remainder elsewhere. In this situation you can opt not to take the partially completed medication amount and then ask for the prescription to take it elsewhere. If doing this you need to be confident that you will be able to get the medication from somewhere else.

Suggestion two

Some patients already take breaks from their medication, for example at weekends. You could try doing this to eke out the supplies that you have left. If you do try this, it is important to ensure that you are safe to engage in activities such as driving or operating machinery.

Suggestion three

If you are taking Equasym XL, Concerta XL, Xaggitin XL or Xenidate XL and your GP is prescribing your ADHD medication at the moment, your GP may be able to switch you to an alternative brand that is available. We have emailed all GPs with advice about doing this if appropriate.

Suggestion four

If you are taking Lisdexamfetamine, some doses are likely to be available sooner than others. GPs have been advised that they can combine different doses to achieve the daily dose that the patient is prescribed.

Suggestion five

Ask your GP to please issue your repeat prescription slightly earlier (we have suggested to GPs up to 7 days earlier) in order that you have time to take your prescription to a different pharmacy to the one that you usually use or to ask the GP for a prescription for a different brand of medication or different dose.

If you are forced to take a break from your ADHD medication we agree that this is unfortunate. Some people come off their medication and decide they prefer not taking it anymore. There are strategies you can use to manage your ADHD symptoms. There are some resources available on our website.

Our small team is really busy at the moment responding to queries about medication shortages. As the supply issues are not envisaged as long-term and are affecting all types of ADHD medication we do not have a plan to change people’s ADHD medication at the moment. Please try and manage as best you can using the advice above. If you feel vulnerable or at risk please contact us but be aware that there may be a delay in responding to you because of high demand on our team at the moment.

The contact details for the First Response Service that supports people experiencing mental health crisis is: 111

(please note that the First Response team will not be able to help with the medication supply shortages).

We hope the supply issue is soon resolved and thank you for your understanding.