Information for patients, carers, and families
Shortage of medicines for ADHD (Attention Deficit Hyperactivity Disorder)
There is a national supply shortage of the medication prescribed to help manage ADHD symptoms.
This information leaflet has been produced to help you understand the shortage and how it may impact you.
We are asking you to:
- Check how much medication you have.
- Make sure you order your next supply in plenty of time.
- Only order medicine that you need, to help pharmacies manage supplies.
- Try a few different pharmacies in your local area if you cannot obtain your prescription from your usual pharmacy.
This information leaflet includes information to help you:
- Manage your supply of medicine so that you are less likely to run out.
- Reduce your dose safely if you are unable to get your medicines.
What medicines are affected by the shortage?
Methylphenidate
- Equasym XL® 10, 20, and 30mg capsules
- Xaggitin XL® 18 and 36mg prolonged-release tablets
- Concerta XL® 54mg prolonged-release tablets
- Xenidate XL® 27mg prolonged-release tablets
Lisdexamphetamine
- Elvanse® 20, 30, 40, 50, 60 and 70mg capsules
- Elvanse® Adult 30, 50 and 70mg capsules
Guanfacine
- Intuniv® 1, 2, 3 and 4mg prolonged-release tablets
Atomoxetine
- Atomoxetine 10mg capsules
- Atomoxetine 25mg capsules
- Atomoxetine 40mg capsules
- Atomoxetine 60mg capsules
Other ADHD products remain available. They may not be suitable for everyone and may not be able to meet the increases in demand. Unfortunately, there may be unavoidable gaps in your treatment.
How long will the shortage last?
The shortage is currently expected to last until December 2023, however there is no definite date for when new supplies will become available, and we continue to monitor the situation carefully.
The supply disruption of these products is caused by a combination of manufacturing issues and an increased global demand.
Your local pharmacy, GP practice, and ADHD services know how important your medication is to you. We are working hard to try to find supplies of these medicines and to minimise the impact on patients and carers.
Who should I contact for advice about my medicines?
If you are trying to get your medicines, contact your community pharmacy first to see if they have supplies. Try a few different pharmacies in your local area if you cannot obtain your prescription from your usual pharmacy.
If you have trouble sourcing supplies of your medication, your community pharmacy, GP practice and/or ADHD service may be limited in how they can help until stock levels return to normal.
If you have followed the advice in this leaflet and need more support, your healthcare team can help you manage any changes in symptoms.
If you usually get your ADHD medication on a repeat prescription, please contact your GP practice.
If you get your prescriptions from a service at South West Yorkshire Partnership NHS Foundation Trust, from the Child and Adolescent Mental Health Services (CAMHs) please contact 01226 644829. For the adult ADHD service please contact 01924 316492
Please be patient with our staff if you contact us.
What if I’m unable to get my usual medication?
Although this may cause you worry, running out of these medications is not an emergency. If you have no medication left, your community pharmacy, GP practice and/or ADHD service may be limited in how they can help further until stock levels return to normal.
Check your supply of medication and order your next supply in plenty of time.
Before running low on your medications, please read the advice in this leaflet and consider how you can best manage your medicine.
What can I do to manage my ADHD during the shortage?
If you are taking methylphenidate or lisdexamfetamine, you could make your supply of medicine last longer by not taking it every day. Think about if there are any days you could manage without medication, for some people this could be at weekends when they are not at work or school. It is safe to take breaks with this medication.
If you take methylphenidate, your prescription may be switched from the brand to generic to reduce the likelihood of supply issues. This change is safe and will not affect your treatment.
You may want to let your family, friends, school, or workplace know about the shortage of medication so that they can provide support in case you have an increase in your ADHD symptoms if you have problems obtaining your prescription.
You may want to think about what helped you to manage your symptoms before you started medication, so that you prepare to manage your symptoms as well as possible in case you have difficulty getting your medicines.
Useful links
These websites have information that might be useful in helping you manage your condition and any changes in symptoms because of medication shortages:
https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd
https://www.youngminds.org.uk/
What should I do if I cannot get my ADHD prescription from the pharmacy?
If your usual pharmacy cannot provide your ADHD medication, firstly contact a few different pharmacies in your local area.
This website can help you find pharmacies in your local area: Find a pharmacy – NHS (www.nhs.uk)
Are there alternative medications available?
Other ADHD products remain available. They may not be suitable for everyone and may not be able to meet the increases in demand. There may be unavoidable gaps in your treatment.
Your healthcare team are always happy to talk to you about your medicines and to explain why getting your medicine may be difficult at the moment. We will also explain what that will mean for your treatment.
Is it safe to stop taking Atomoxetine if I run out?
Yes, it is safe. Atomoxetine does not have a recognised withdrawal syndrome, which means there are no side-effects if you stop taking it. However, if you stop taking this medicine it can cause changes in your ADHD symptoms..
Is it safe to stop taking methylphenidate or lisdexamfetamine if I run out?
Yes, it is safe. These medications can safely be stopped for a few days, for example over weekends, and taking breaks from medication on days when you feel you don’t need it can help your supply last longer. Where possible (for those prescribed some brands of methylphenidate) your prescription may be switched from the brand to generic by a clinician at your GP practice, to reduce the likelihood of supply issues.
Is it safe to stop taking guanfacine if I run out?
No, Guanfacine must always be stopped slowly by gradually decreasing the dose over a period of time. If you stop taking this medication suddenly it can cause your blood pressure to increase.
GP practices and ADHD services are identifying patients who take Guanfacine and will be in touch soon, to discuss how to adapt your treatment safely.
When will there be an update on the shortage?
We are carefully monitoring the situation and will provide more information as soon as possible. We expect to receive an update on the national shortage at the end of October.
Is this shortage affecting all pharmacies?
This is a national shortage affecting all pharmacies – including hospital pharmacies and community pharmacies.
Pharmacies may use different suppliers or wholesalers to source medicines so availability will depend on whether each pharmacy’s suppliers have stock or not. Where there is a known shortage of a medicine, supply levels can change quickly. This is why some pharmacies may be able to find a medicine while others may not.
Why is my medicine not in stock at the pharmacy?
Medicine supply issues can be caused by lots of things. It could be problems at the manufacturing stage, problems with safety or problems with delivery. Problems can develop quickly and can be shared nationally or can be more of a local issue.
The supply disruption of ADHD medicines is caused by a combination of manufacturing issues and an increased global demand.
Your community pharmacy team are working hard to try to get your medicines. Please be patient with them if they are having difficulty getting the medicines for you.
Community Pharmacy England have produced a patient factsheet regarding medicines supply: Medicines Supply Factsheet
Frequently Asked Questions:
- Shortages of Medicines for Attention Deficit Hyperactivity disorder (ADHD)
General Questions
- Why is there a shortage of certain ADHD products?
Answer: The shortage is due to supply chain disruptions caused by a combination of manufacturing issues and an increased global demand. There have been shortages of some medicines for several months but recently more types are affected.
- Which ADHD products are affected by the shortage?
Answer:
- Methylphenidate prolonged-release capsules (Equasym XL®) in 10 mg, 20 mg, and 30 mg strengths.
- Methylphenidate prolonged-release tablets (Xaggitin XL®) in 18 mg and 36 mg strengths.
- Methylphenidate prolonged-release tablets (Concerta XL®) in 54 mg strength.
- Methylphenidate prolonged-release tablets (Xenidate XL®) in 27 mg strength.
- Lisdexamfetamine capsules (Elvanse®) in various strengths, including Elvanse Adult.
- Atomoxetine capsules in various strengths and Strattera 4mg/1ml oral solution.
- Guanfacine 1,2,3 and 4mg prolonged release tablets (Intuniv®)
- When are these supply disruptions expected to resolve?
Answer: The supply disruptions are expected to resolve at various dates between October and December 2023.
- When will the Atomoxetine supply be restored?
Answer: We’ve been informed that the supply is expected to normalise on various dates throughout October. A national Patient safety alert has been issued with actions for healthcare professionals in general practice and specialist services.
- Is this shortage affecting all pharmacies?
Answer: This is a national shortage affecting all suppliers. Other ADHD products remain available but cannot meet excessive increases in demand. All pharmacies including community pharmacy and hospital pharmacy.
- Which services are affected by these shortages?
Medicines for ADHD are prescribed by Adult ADHD services, CAMHS services and paediatric services in some areas. Private providers may also prescribe these medicines.
Prescribing is also manged by GPs under shared care agreements.
All services and their patients will be impacted.
For up-to-date information of availability
You may need to request a free registration.
| Preparation affected by shortage | Switch options |
| Equasym XL® 10, 20, and 30mg capsules | Medikinet XL® Metyrol XL® MPH IR |
| Xaggitin XL® 18 and 36mg prolonged-release tablets | Affenid XL® Concerta XL® Delmosart XL® Matoride XL® Xenidate XL® |
| Concerta XL® 54mg prolonged-release tablets | Affenid XL® Delmosart XL® Matoride XL® Xaggitin XL® Xenidate XL® |
| Xenidate XL® 27mg prolonged-release tablets | Affenid XL® Concerta XL® Delmosart XL® Xaggitin XL® |
[click link for anticipated supply dates for various strengths] Shortage of Atomoxetine capsules and oral solution – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice
Patient-Specific Questions
- What can I do now?
Answer: Make sure you order your next supply before you run out but do not over order.
- What should I do if I cannot get my ADHD prescription from the pharmacy?
Answer: Firstly, try other pharmacies as another one may have it in stock.
You can use the find my pharmacy to help you locate the pharmacies and their contact details that are close by to you :-
Find a pharmacy – NHS (www.nhs.uk)
Please contact your General Practitioner (GP) or your specialist service for advice on management options if the product cannot be sourced (contact your GP surgery if you are currently obtaining your prescription from them or you specialist service if they are providing your prescriptions).
- Are there alternative medications available?
Answer: There are alternatives, but they may not be suitable for everyone. Some types can be safely swapped but specialist advice may be sought to provide individualised management plans where required.
- Are there alternative to medications to help with symptoms?
Answer: Specialist advice must be sought to provide individualised management plans where required.
These websites have information that might be useful in helping you manage your condition and any changes in symptoms because of medication shortages:
- Is it safe to stop taking Atomoxetine abruptly if I run out?
Answer: Atomoxetine doesn’t have a recognised withdrawal syndrome, but it’s always best to consult your GP or our Service for guidance on how to manage any medication interruption. Missing doses or stopping may affect the maintenance of response.
- Is it safe to stop taking methylphenidate or Lisdexamfetamine if I run out?
Answer: It can safely be stopped for a few days, for example over weekends or school holidays, but it is best to consult your GP or our Service for guidance on how to manage any medication interruption. You may wish to consider this to prolong your supplies.
Is it safe to stop taking guanfacine if I run out?
No, Guanfacine must always be stopped slowly by gradually decreasing the dose over a period of time. If you stop taking this medication suddenly it can cause your blood pressure to increase.
GP practices and ADHD services identifying patients who take Guanfacine and will be in touch soon, to discuss how to adapt your treatment safely.
Healthcare Professionals in Primary Care Questions
Key Instructions for Primary Care:
Until supply issues are resolved, avoid starting new patients on the affected medications. We will continue to review the situation in South and West Yorkshire and communicate any updates.
Identify all current patients on these medications using the available search functions in clinical systems.
Specific Medication Guidance:
a) Methylphenidate MR Tablets: Shift patients from brand-specific to generic versions. This allows pharmacies to provide any bioequivalent brand.
b) Methyphenidate XL Capsules: Note that these are not bioequivalent. Patients can consider a different formulation if their usual one is out of stock. Refer to comparison tables for switching.
c) Lisdexamphetamine: For doses exceeding 50mg/day, advise patients to gradually reduce the dose by no more than 20mg every 3 to 7 days until reaching 50mg, at which point it can be stopped.
d) Guanfacine: Suggest patients gradually lower the dose by up to 1mg every 3 to 7 days, if supply allows. If rapid discontinuation is necessary, monitor blood pressure and heart rate.
If primary care professionals have concerns about a specific patient’s treatment, they should consult specialist services.
Note: Hospital referrals for supply issues are not advised, as hospitals don’t have extra stock. Also, specialist services’ ability to assist may be limited due to capacity constraints and restricted medication options.
- What are the first steps if a patient contacts me about supply issues?
Answer: Establish which medication they are taking.
- For Methylphenidate a switch to a bio-equivalent or near equivalent products can be considered. For methylphenidate prolonged release tablets, prescribe as a generic.
- The patient may wish to consider a treatment break for methylphenidate or Lisdexamfetamine.
- For Guanfacine you should refer to the specialist service who originated the prescription.
- What amendments can be made to an atomoxetine or Lisdexamfetamine prescription prior to referral back to the specialist team?
Answer: You can discuss a drug-free trial for up to 4 weeks prior to referral following unsuccessful attempts at obtaining supplies. For Lisdexamfetamine, sparing use of supplies can be considered. However, for doses above 50mg a day the dose should be tapered to avoid withdrawal effects.
- What amendments can be made to a methylphenidate prescription prior to referral back to the specialist team?
Answer: Please consider prescribing a different bioequivalent product for prolonged release tablets. These products can be switched safely with a very low likelihood of side effects or loss of symptom control.
For Equasym®, the products are not directly equivalent and the closest match to the near-instant release component should be considered.
| Preparation affected by shortage | Switch options |
| Equasym XL® 10, 20, and 30mg capsules | Medikinet XL® Metyrol XL® MPH IR |
| Xaggitin XL® 18 and 36mg prolonged-release tablets | Affenid XL® Concerta XL® Delmosart XL® Matoride XL® Xenidate XL® |
| Concerta XL® 54mg prolonged-release tablets | Affenid XL® Delmosart XL® Matoride XL® Xaggitin XL® Xenidate XL® |
| Xenidate XL® 27mg prolonged-release tablets | Affenid XL® Concerta XL® Delmosart XL® Xaggitin XL® |
- How do I switch between Methylphenidate preparations?
Answer: Concerta XL® and bioequivalent prolonged release tablets generic preparations release characteristics can be switched like for like doses. Prescribe as generic methylphenidate prolonged release tablets.
| Affenid XL®, Concerta XL®, Delmosart XL®, Matoride XL®, Xaggitin XL®, Xenidate XL® | ||
| Total daily dose | Immediate release component | Slow release component |
| 0 – 4 hours | 4 – 12hours | |
| 18mg/day | 4mg | 14mg |
| 27mg/day | 6mg | 21mg |
| 36mg/day | 8mg | 28mg |
| 45mg/day | 10mg | 35mg |
| 54mg/day | 12mg | 42mg |
| 63mg/day | 14mg | 49mg |
| 72mg/day | 16mg | 56mg |
Equasym XL® release characteristics
| Equasym XL® capsules 30/70 | ||
| Total daily dose | Immediate release component | Slow release component |
| 0 – 4 hours | 4 – 8hours | |
| 10mg/day | 3mg | 7mg |
| 20mg/day | 6mg | 14mg |
| 30mg/day | 9mg | 21mg |
| 40mg/day | 12mg | 28mg |
| 50mg/day | 15mg | 35mg |
| 60mg/day | 18mg | 42mg |
| Medikinet XL®capsules 50/50 | ||
| Total daily dose | Immediate release component | Slow release component |
| 0 – 4 hours | 4 – 8hours | |
| 5mg/day | 2.5mg | 2.5mg |
| 10mg/day | 5mg | 5mg |
| 20mg/day | 10mg | 10mg |
| 30mg/day | 15mg | 15mg |
| 40mg/day | 20mg | 20mg |
| 50mg/day | 25mg | 25mg |
| 60mg/day | 30mg | 30mg |
Methylphenidate capsules
You can use the tables to find the IR component of current preparation. For example, if the patient is prescribed Equasym XL 20mg/day, the IR component of the preparation is 6mg. If you would like to prescribe Medikinet XL®, the closest match for the current IR component is 10mg so you can prescribe that dose.
Useful table showing ADHD medications with MPH IR:MR ratios: adhd-medications—a-guide-for-healthcare-professionals.pdf (cambscommunityservices.nhs.uk)
ADHD Specialist Team Questions
What are the immediate actions to take?
Answer: No new patients may be initiated on products affected by this shortage until the supply issues resolve. (lisdexamphetamine, guanfacine and affected forms of methylphenidate). Defer of all new initiations of treatment to release clinic time to manage those affected by the shortages.
Patients calling for advice should be informed of current stock situation and a management plan should be agreed with the patient and prescriber.
- What alternatives can I prescribe to my patients?
Answer: Alternative medications are available. It’s essential to provide individualised management plans.
- Should I expect an increase in side effects or withdrawal symptoms among my patients?
Answer: Atomoxetine does not have a recognised withdrawal syndrome, but changes in treatment could potentially cause fluctuations in symptoms. Methylphenidate and Lisdexamfetamine can be stopped for a few days but ideally best to taper down in a stepwise manner to help a patient get used to the change if a drug-free period is agreed. Special care is needed for guanfacine as abrupt stopping and starting is not recommended. Patients maintained on guanfacine should be advised to taper the level of medication by no more than 1mg every 3 to 7 days where supplies allow.
- Are there any recommendations for transitioning patients to alternative treatments?
Answer: Always consult the most recent guidelines for the most up-to-date recommendations.
Atomoxetine and Lisdexamfetamine: gradual tapering off and close monitoring for any adverse effects is recommended. MPH XL as an alternative medication can be considered if not previously tried. IR Dexamfetamine is an option for Lisdexamfetamine, but risk of abuse or diversion must be considered.
Methylphenidate: consider an alternative bioequivalent product using the tables above.
Methylphenidate prolonged release tablets can be prescribed generically. Additional guidance can be found here adhd-medications—a-guide-for-healthcare-professionals.pdf (cambscommunityservices.nhs.uk).
Additional missing brands to consider which are not in the tables:
- Medrol 10mg, 20mg, 30mg, 40mg and 60mg as a 50:50 IR:MR release for Medikinet XL or Equasym products.
Other Stakeholder Questions
- What steps are being taken to resolve the supply issue?
Answer: Unlicensed imports are being sourced for Lisdexamfetamine but lead times vary. Limited parallel imports of Equasym XL remain available but cannot support an uplift in demand. Supply is often variable and unreliable.
- When will this be resolved or reviewed
Answer: The supply disruptions are expected to resolve at various dates between October and December 2023. Availability information will be regularly reviewed and guidance updated as required.
Additional sources of information
National Patient Safety Alert
Current availability status of all ADHD medicines is available here:
MHRA alert caution if switching between products due to differences in formulations
Extended-release methylphenidate: a review of the pharmacokinetic profiles of affected products
Extended-release-methylphenidate-3.pdf (sps.nhs.uk)
Electronic Medicines Compendium (eMC)
www.medicines.org.uk for individual summary of product characteristics (SPCs) for individual brands
NICE Guidance
Overview | Attention deficit hyperactivity disorder: diagnosis and management | Guidance | NICE
