Update on ADHD medication shortage in the UK

We are providing an important update on the ongoing ADHD medication shortages affecting the UK. This situation impacts several medications commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD), leading to significant disruptions for patients. We acknowledge the challenges this shortage presents and are committed to providing support to our clinicians and patients.

Current Supply Disruptions

The Department of Health and Social Care (DHSC) has issued multiple alerts and notifications regarding these shortages:

• National Patient Safety Alert (NatPSA) : Issued on 27 September 2023, highlighting shortages of methylphenidate prolonged-release capsules and tablets, lisdexamfetamine capsules, and guanfacine prolonged-release tablets.
• Medicine Supply Notifications (MSNs) :
• Lisdexamfetamine (Elvanse) capsules on 13 February 2024.
• Guanfacine (Intuniv) prolonged-release tablets on 28 March 2024.

These notifications have superseded the earlier NatPSA and provide detailed updates on the supply situation. Prescribing advice is available from the following key resources listed in the NatPSA:

• NICE guideline [NG87]. Attention deficit hyperactivity disorder: diagnosis and management
• MHRA (2022). Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations 

If you are taking any of these medications, please contact your ADHD medicine prescriber using the numbers below for advice about the most appropriate option for you.

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

Please do not share your medication with anyone else.

If your needs are very complex, for example you have mental health problems, or your ADHD symptoms causes you severe difficulty, you can discuss this with your GP, and they may recommend a specialist consultant review. 

Anyone who is currently waiting to be started on ADHD medication will not receive a prescription until stocks are available. 

The medicines affected are:

Methylphenidate

Methylphenidate Modified-Release bioequivalent alternatives. NB: Modified-release methylphenidate preparations MUST be prescribed by brand due to differences in bioavailability
Medicines affected	Anticipated re-supply date	Bioequivalent Alternatives
Xenidate XL 18mg tablets	17th January 2025	Matoride XL 18mg tablets  Concerta XL 18mg tablets
Xenidate XL 27mg tablets (Viatris UK Healthcare Ltd)	22nd November 2024	Affenid XL 27mg tablets Concerta XL 27mg tablets
Xenidate XL 36mg tablets (Viatris UK Healthcare Ltd)	22nd November 2024	Concerta XL 36mg tablets Affenid XL 36mg tablets Delmosart 36mg XL tablets Matoride XL 36mg tablets
Xenidate XL 54mg tablets (Viatris UK Healthcare Ltd)	22nd November 2024	Delmosart 54mg modified-release tablets  Concerta XL 54mg tablets
Xaggitin XL 18mg tablets (Ethypharm UK Ltd)	27th September 2024	Matoride XL 18mg tablets  Concerta XL 18mg tablets
Xaggitin XL 27mg tablets (Ethypharm UK Ltd)	27th September 2024	Affenid XL 27mg tablets Concerta XL 27mg tablets
Xaggitin XL 36mg tablets (Ethypharm UK Ltd)	27th September 2024	Concerta XL 36mg tablets Affenid XL 36mg tablets Delmosart 36mg XL tablets Matoride 36mg XL tablets
Xaggitin XL 54mg tablets (Ethypharm UK Ltd)	27th September 2024	Delmosart 54mg modified-release tablets  Concerta XL 54mg tablets
Delmosart 18mg modified-release tablets (Accord-UK Ltd)	Unavailable	Matoride XL 18mg tablets  Concerta XL 18mg tablets
Delmosart 27mg modified-release tablets (Accord-UK Ltd)	Unavailable	Affenid XL 27mg tablets Concerta XL 27mg tablets
Affenid XL 18mg tablets (Zentiva Pharma UK Ltd)	16th August 2024	Matoride XL 18mg tablets  Concerta XL 18mg tablets
Affenid XL 54mg tablets (Zentiva Pharma UK Ltd)	30th September 2024	Delmosart 54mg modified-release tablets  Concerta XL 54mg tablets
Matoride XL 54mg tablets (Sandoz Ltd)	31st August 2024	Delmosart 54mg modified-release tablets  Concerta XL 54mg tablets
NB: Matoride XL is not available in 27mg strength

Most patients will be able to switch between their currently prescribed 12-HOUR duration brand/branded generic to another 12-HOUR duration brand/branded generic without concern. Switches can take place in primary care.

However, due to the relatively wide confidence limits allowed, it is possible that a minority of patients could experience a change in symptom control or tolerability following a switch.

For patients who have switched between 12-hour formulations before and previously experienced a change in symptom control or tolerability, and are prescribed Concerta XL for this reason, refer to the specialist.

The specialist may consider the following: if there were problems with:

• symptom control - consider if this change in symptom control might be acceptable for a short period of time, until the shortage of the brand they take resolves, or whether an alternative medication would be more appropriate.
• tolerability – establish what the tolerability issues were and consider whether it would be appropriate to temporarily prescribe a lower dose of their currently unavailable brand (assuming that strength is available) or to switch to a lower dose of the previously less-well tolerated brand. Decisions should be made on an individual case-by-case basis and if lower doses are used, this should consider the potential for a reduction in efficacy.
• More information can be found on Considerations when prescribing modified-release methylphenidate – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice

Lisdexamfetamine

Lisdexamfetamine
Medicines affected	Anticipated re-supply date as per Takeda/SPS	Alternatives
Elvanse 40mg capsules (Takeda UK Ltd)	Limited supply – Anticipated resupply date: 12/8/24	Refer to ‘Clinical Advice’ section below    NB: Information from Takeda RE: Elvanse Adult vs Elvanse: The physical attributes of Elvanse® (lisdexamfetamine dimesylate) and Elvanse Adult® (lisdexamfetamine dimesylate) are exactly the same, the only difference between the two medications is the indication population (licensing) where Elvanse is only indicated for paediatric patients (6 years and older), whereas Elvanse Adult is indicated for adults. Elvanse Adult and Elvanse can be used interchangeably off label – this would be at the prescribers clinical discretion
Elvanse 60mg capsules (Takeda UK Ltd)	Limited supply – Anticipated resupply date: 12/8/24
Elvanse Adult 60mg capsules (Takeda UK Ltd)	Unavailable – Anticipated resupply date: 23/8/24

 

 

 

 

 

 

 

 

 

 

 

Atomoxetine

Atomoxetine
Medicines affected	Anticipated re-supply date	Alternatives
Atomoxetine 25mg capsules	Back in stock	Refer to ‘Clinical Advice’ section below
Atomoxetine (Strattera) 4mg/ml oral solution (Eli Lilly)	Limited supplies, anticipated resupply 31/7/24 available via AAH or Phoenix
NB:  Atomoxetine 10, 18, 40, 60, 80 and 100mg capsules are back in stock as of 06/11/23 Atomoxetine 25mg capsules are back in stock as of 6/12/23, Glenmark brand available via Phoenix Healthcare Distribution Ltd, Lexon UK Ltd, Alliance Healthcare Distribution, Bestway Pharmacy, Trident Pharmaceuticals, Sigma Pharmaceuticals. NB:  Several manufacturers have discontinued.

 

 

 

 

 

 

 

 

 

Guanfacine

Guanfacine
Medicines affected	Anticipated re-supply date as per Takeda	Alternatives
Intuniv 1mg modified-release tablets (Takeda UK Ltd)	Currently available as of 9/8/24	Refer to ‘Clinical Advice’ section below
Intuniv 2mg modified-release tablets (Takeda UK Ltd)	Currently available as of 9/8/24
Intuniv 3mg modified-release tablets (Takeda UK Ltd)	Currently available as of 9/8/24
Intuniv 4mg modified-release tablets (Takeda UK Ltd)	Currently available as of 9/8/24

 

 

 

 

 

 

 

 

 

 

 

Methylphenidate Modified-release preparations	Lisdexamfetamine	Guanfacine	Atomoxetine
In the first instance, we would suggest offering reassurance to patients on stimulant medication of the following: o   The simplest initial intervention would be to consider ONLY using their current supply of medication on days they most need o   Reducing the dose (where formulation allows this) may be helpful to allow current supply to last longer o   We recognise that this is a worrying situation, but a temporary pause in medication is not physically harmful despite it being impactful in other ways o   Switch to a bioequivalent alternative o   Refer to specialist if further information needed.	In the first instance, we would suggest offering reassurance to patients on stimulant medication of the following: o   The simplest initial intervention would be to consider ONLY using their current supply of medication on days they most need o   Reducing the dose (where formulation allows this) may be helpful to allow current supply to last longer o   We recognise that this is a worrying situation, but a temporary pause in medication is not physically harmful despite it being impactful in other ways Refer to specialist for further advice Please see MSN for further info	Patients on guanfacine should NOT stop this suddenly (due to possibility of rebound hypertension) and will need to be reviewed by their specialist ADHD team if patient unable to get supply of medication. (If it is not possible to reduce slowly, monitor BP and HR on stopping. The hypotensive effect of guanfacine may take about 2 – 4 days to resolve. This is usually asymptomatic and clinically insignificant. Monitor BP and HR at day 2, and again at day 4. If blood pressure is raised at day 4, measure again at weekly intervals until normal. If there are signs of clinically significant rebound hypertension, seek advice from specialist. Acknowledging South London and Maudsley) Please see MSN for further info	Patients on Atomoxetine could reduce their dose or take it on alternate days in the short term. Refer to specialist for further advice

Clinical advice

• The shortages are likely to extend to strengths that are not listed in the National Patient safety Alert, do not newly initiate any ADHD medication listed above – this includes ongoing prescribing for those patients who have had a private assessment.
• Maintain 28 day prescribing - Prescribers should avoid increasing quantities for existing patients on ADHD medication as this will add further pressures to the current stock disruption situation.
• The stock availability is currently variable across pharmacies – it is vital you establish how much supply the patient has remaining and consider the risk before referring to specialist services. 
• Methylphenidate modified release preparations can be switched to an alternative in primary care (see table under ‘Anticipated Supply dates’).
• Community pharmacies will use different wholesalers, therefore contact the local pharmacies to understand the stock availability as recommended in the NatPSA alert.
• Community pharmacies will ONLY be able to dispense what is written on the prescription, therefore new prescriptions will be needed for changes to the drug/dose/strength.
• The table above will support you to manage patients impacted by the shortage accordingly, the specialist teams are aware of the situation and will support where needed – see contact details at the end of this document.
• NICE guidelines recommend having regular treatment breaks from ADHD medications. It is not unusual to stop taking medication over the weekend or during school holidays.

Clonidine is not licenced for ADHD and is NOT included in Kent and Medway Shared care guidance.

Frequently asked questions

How long will the shortage last?

At present, the supply disruptions are expected to resolve soon.

This is a national supply problem and all UK ADHD services; Paediatrics, CAMHS, Adults, and Pharmacies within the community and in hospitals are affected. 

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.

We know how important getting your medicines is. Our team are always happy to talk to you about your medicines and to explain why getting your medicine may be difficult now. We will also explain what that will mean for your treatment.

You may be offered the choice between taking a treatment break or changing your medication to one that is not currently affected by the supply shortage.

The change in medication may mean you are taking medication more often through the day, or that they are tablets instead of capsules.

Our service is working closely with primary care to minimise disruption.

Once the supply shortage has been resolved your medication will be changed back to the medicine you were previously prescribed, as clinically appropriate.

Please be aware that there may still be delays at pharmacies in obtaining the newly prescribed medication.

What should I do if I cannot get my ADHD prescription from the pharmacy?

If one pharmacy is unable to obtain supplies, please try a different pharmacy.

The following link will help you find pharmacies in your local area:  https://www.nhs.uk/service-search/pharmacy/find-a-pharmacy   

Pharmacies may use different suppliers or wholesalers to source medicines so availability will depend on whether each pharmacy’s suppliers have stock or not. Please try visiting independent pharmacies as well as the larger pharmacy chains, as their suppliers will differ.

Some larger pharmacy chains have stock checkers online you can access to determine which of their branches have the medication you have been prescribed. An example of a stock checker (other pharmacy chains may have their own versions) is included below:      

Boots stock checker

Where there is a known disruption to medication, supply levels can change quickly. This is why pharmacies in one area may be able to find a medicine and others may not.

Alternatively, it may be best to leave the prescription (FP10) with a pharmacy that could check wholesaler stock levels daily and place an order.

Is it safe to stop taking ADHD medication abruptly?

Please consult your local ADHD service or your GP (see numbers below) for guidance if you think you are running out of medication.

NICE guidelines recommend having regular treatment breaks from ADHD medications. It is not unusual to stop taking medication over the weekend or during school holidays.

Therefore, no harm should come from stopping the medication, but this should be done in a planned way.

If you have any further questions not answered above, please get in touch with the the team in your area:

London CAMHS

Kent and Medway CYPMHS

Essex (SET CAMHS) 

(Last updated 14 August 2024)