National supply shortage of ADHD medication

At the time of writing there are still supply problems with some methylphenidate products, however the exact details of which brands and strengths continues to change. It is likely that patients can continue to be prescribed methylphenidate but it may be necessary to change from one brand to another.

Supply disruption is also still affecting lisdexamfetaime (Elvase®) and this problem may last for a few more months for some strengths.

There currently are supplies available of guanfacine (Intuiniv®) and atomoxetine®

The Government have told us that there is a national shortage of medicines used to help manage ADHD symptoms. The shortage of these products is caused by a combination of manufacturing issues and an increase in global demand.

Unfortunately, the situation continues to change.

Although some products have come back into stock recently, supply chains remain fragile. The same products may only be available on a temporary basis and may go out of stock at short notice. 

It is important to receive health advice before stopping any ADHD medication, or reducing the amount that you take. 

Shortages in ADHD medications have impacted on many people and places and everyone may be affected at some point. This shortage affects children and adults, general and specialist services, and all doctors and pharmacies.

Although some products have come back into stock recently, supply chains remain fragile. The same products may only be available on a temporary basis and may go out of stock at short notice. 

For this reason, and because of the complexities of switching medication, the national advice is to not move away from the product that you are usually prescribed, to an alternative product, unless there are exceptional circumstances. 

Paediatricians, psychiatrists and other prescribers at Derbyshire Healthcare NHS Foundation Trust have been contacted by a number of patients and families requesting to switch to an alternative product, based on a conversation with their GP practice. The response has been in almost all cases that this is not possible or advisable. 

Whilst there may not be an alternative medicine, there are coping strategies to help if you are without medicines. Things such as effective communication, increased physical activity, and supporting an organised approach to daily living can all help cope with ADHD. Other support measures include getting a good sleep, eating a balanced diet, exercise, and psychoeducation.

If you cannot get your ADHD prescription from your usual pharmacy, please try other pharmacies who may have it in stock.  If you are unable to get your prescription after trying a few different pharmacies, please contact the person who prescribed the medication for advice.  This may be your GP or specialist health team.

Please remember that this is national shortage so it still may not be possible to obtain a supply of your medicine. Your pharmacist or doctor is not responsible for the lack of medicines. They will be trying to do what they can to help you.

At the time of writing, guanfacine (Intuiniv®) is available.

Guanfacine should not be stopped suddenly. If there are supply problems in the future your specialist team will contact you to provide advice on what to do.

As it is well known that many ADHD medications may be in short supply, people may be asking if they can ration and conserve their medication stocks.

There is special advice for slowly stopping and starting guanfacine. If you are on guanfacine contact your specialist team or prescriber for advice, ideally before you run out.

It is important to receive health advice before stopping any ADHD medication, or reducing the amount that you take.

It is usually safe to stop medications such as methylphenidate, lisdexamfetamine, and atomoxetine without needing to reduce the dose first.

It is important to receive health advice before stopping any ADHD medication, or reducing the amount that you take. For most people supply is getting back to normal.

There are some specific side effects and possible health risks associated with Intuniv (Guanfacine), where the medication must be gradually reduced before a prescription is stopped. If you are prescribed Intuniv (Guanfacine) please contact your specialist team or prescriber to discuss the best approach for your personal circumstances. At the moment there are supplies of Intuiniv® (guanfacine).

In some circumstances it may be possible to offer different treatment to your usual medication, or to consider different strengths of medication.

Many people already take treatment breaks from their ADHD medication at weekends or certain
days. This national shortage may be a good opportunity to see how you are on a treatment
break. There are pros and cons to a treatment break.

Some Pros of a treatment break:

• Easing of medication side effects such as lack of appetite, weight loss, sleep troubles, or stomach pain.
• A chance to see if other therapies (such as support for your condition in educational setting/work, practical advice around managing ADHD symptoms and or talking therapies) work on their own.
• It can also help you find out if your ADHD symptoms are changing. For many people, ADHD symptoms (especially hyperactivity) lessen over time. Sometimes they even go away completely.
• It may be easier to determine how severe your symptoms are when you are not taking medication.

Some Cons of a treatment break:

• ADHD symptoms may reappear or get worse. Hyperactivity, impulsivity, and inattention may become problems again within a day or so of stopping medication.
• You’ll need to be extra attentive. Medication helps people with ADHD pay attention during tough tasks like driving.
• It may lead to impulsive behaviours such as being indulgent, underestimating tasks, or acting without thinking.
• Once you re-start medication it might take a while for medication such as nonstimulants
  to work again.

You may recently have received a letter with an appointment to discuss starting medication for the treatment of ADHD. Unfortunately, due to the national shortages of ADHD medications, we had had to delay all new appointments until the medication became available with a supply that is consistent and guaranteed. 

We are now beginning to write to people to arrange appointments to discuss starting medication.

If your child is having medication administered at school by staff it is important to let the school special needs (SEN) team know about any shortages in ADHD medication that are affecting your child.

Schools generally like to keep an ‘original pack’ labelled for the child at school. Due to the current shortages, it may not be possible to provide a separate supply for home and school. The advice would be to share the medication between home and school and agree with the school who the medication should be handed to at the start of the school day and who will hand it back to the parent at the end of the school day.

In cases, where the ADHD medication is needing to be shared between home and school, please request the next prescription when you have 14 days of medication left. This should allow enough time for the prescription to come from GP/ specialist team and for the pharmacy to source the medication.

It might be helpful to agree a plan with the school SEN team and class teacher to help support your child whilst they are at school in the event your child attends school and has not taken their ADHD medication. If you or the SEN team would like advice and support please contact your child’s CAMHS team.

If you are open to social care- please let your social worker/ family support worker know of the shortages.

Due to the ongoing issues with the supply chain, it may not be possible to provide a separate supply for multiple homes. The advice would be to share the medication between the homes and ensure the medication moves between households with the child.

In cases, where the ADHD medication is needing to be shared between homes, please request the next prescription when you have 14 days of medication left. This should allow enough time for the prescription to come from GP/ specialist team and for the pharmacy to source the medication.

Things such as effective communication, increased physical activity, and supporting an organised approach to daily living can all help cope with ADHD.

Other support measures include having a good sleep routine, eating a balanced diet, exercising, and psychoeducation.

There are also some useful guidance and resource links below and on our Neurodevelopmental Pathway page. 

Some of our patients are supported through a shared care agreement between a commissioned specialist service and their GP. Under local arrangements, Derbyshire Healthcare is the commissioned specialist service provider for ADHD assessment for children and young people. 

Within a shared care agreement, the usual prescriber is the GP rather than the specialist once a medication has been commenced. In these cases, whilst we (the specialist service) will have a comprehensive overview of the patient’s care and will support as much as possible, it may be helpful for the parent or carer to speak with the prescriber (GP) first, in order to gain a detailed response to an ADHD medication enquiry.