Strategies for Navigating Stimulant Drug Shortages

In October 2022 the FDA announced a potential shortage of ADHD medications in the United States. The impact continues to be felt a year later, with many alternative stimulants also experiencing intermittent shortages or limited availability.  

Multiple factors have contributed to the current state of ADHD medication shortages, which can be particularly challenging for providers and patients to navigate. As mental health awareness and access to telehealth expanded during the pandemic, the number of stimulant prescriptions increased from 2020 to 2022. Implementation of DEA production quotas and staffing shortages at manufacturers also contributed to a perfect storm where demand continues to outpace supply.

The VHAN Pharmacy Team has the following recommendations for coping with the ongoing shortages:

Consider changing formulations or tablet strength.

Depending on availability, different strengths for the desired dose (such as 2 tablets of 5mg to make a dose of 10mg). Alternatively, a different formulation may be substituted (such as Metadate ER vs. Concerta vs. Ritalin LA for methylphenidate). Be aware that insurance may potentially require appeals for quantity limits or prior authorization when making these substitutions.

In general, changing formulations of a stimulant is preferred to changing the stimulant type (such as changing from methylphenidate to amphetamine product). If switching between the two primary stimulants, amphetamine and methylphenidate, limited data is available. Review articles recommend using one-half to one-third of the dose of methylphenidate as an appropriate dose for amphetamine.

Consider non-stimulant therapy options.

Atomoxetine (Straterra), viloxazine (Qelbree), alpha-2 -adrenergic agonists such as clonidine and guanfacine may be reasonable alternatives for some patients. These agents are not controlled substances and may provide an opportunity to try a non-stimulant drug, especially if parents or the patient are concerned about stimulant-related side effects (such as weight concerns, tics, etc.)

Plan ahead and recommend non-pharmacological strategies.

Unfortunately, there is no clear end to the shortage, so it may be helpful to suggest back-up plans to patients if medication cannot be obtained. You may recommend that patients inform their school/workplace about their situation, especially if performance is impacted by lack of medication. Using reminders, keeping a schedule/routine and participating in regular exercise can help with symptom management as well.

For more information about converting between medication classes, VHAN members can download conversion guides for commonly prescribed stimulants on VHAN Hub.

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