This article was first appeared in Attention, the magazine published by CHADD, which graciously agreed to share it with childmind.org readers.
In recent years, many new stimulant medications have been approved by the FDA for treatment of ADHD. These new formulations vary in their duration of benefit, and many offer new ways that the medication is administered or “delivered.” Although this expanded range of stimulant medication options has been a significant benefit for many families, challenges arise when families are unable to get the specific medication that they think is best for themselves or their child.
Perseverance, flexibility, and creativity are key to success in dealing with the ongoing shortage of various ADHD stimulant medications. Here are some helpful tips and strategies:
If your preferred pharmacy does not have the medication that was recommended by your healthcare provider:
- Speak with the pharmacist (not a pharmacy tech) and ask what they recommend. Some chain pharmacies can check inventories at other locations, and they may also be able to advise you as to when they may get the desired medication from their distributor.
- Call other pharmacies that are not affiliated with your preferred pharmacy. In addition to calling other chain pharmacies, you should call non-chain pharmacies as well. As with your preferred pharmacy, ask the pharmacist what they recommend and when the desired medication will likely be available.
- If you call multiple pharmacies and cannot find the specific preferred medication, then wait a few days and repeat this same process of making multiple phone calls. This will be easiest if you keep a written list of pharmacies along with their phone number; you can also use this list to take written notes about what they advised.
- Unfortunately, some pharmacies may not provide information over the phone to families calling to check on the stimulant medications that they have in stock. This is sometimes due to pharmacist concerns about drug-seeking behaviors. If a pharmacist does not want to disclose information about in-stock medication options over the phone, parents can ask the pharmacist to look up their child’s name in a state “prescription monitoring program” to verify that this is not a drug seeking behavior. Parents may have more success at getting this information from a pharmacist at a local, non-chain pharmacy − especially if you have been a longstanding customer of that pharmacy. In some instances, pharmacists may only share this information with a healthcare provider or their staff.
- Pharmacists may, in some instances, be more responsive to the needs of “regular customers” – families who have had many other prescriptions filled at their pharmacy in the recent past. Although it is impossible to know how all pharmacies will prioritize customers when they receive a limited supply of a specific stimulant medication, it is not unreasonable for a pharmacist to give priority to meeting the prescription needs of their longstanding customers. Thus, having a nice relationship with a local pharmacist may be helpful not just in terms of them possibly sharing information over the phone with you about inventory, but also possibly prioritizing your prescription needs for a specific stimulant medication when they have it available.
- Courtesy counts. Although it is understandable that families may get very frustrated and upset when they cannot obtain the stimulant medication that they need, parents need to remember to not verbally assault the pharmacist since it is not their fault, and they are generally very sympathetic to your situation. Kindness toward the pharmacist will likely increase the likelihood that your pharmacist will do everything possible to help you and your family.
- Lastly, you may wish to contact the manufacturer of the medication you are seeking. In some cases, the manufacturer’s website for the medication may be able to provide you with information about availability; if not, you can try calling the manufacturer directly for help in finding the medication.
Stimulant Medication Charts
If you are unable to get the medication that your healthcare provider has prescribed and you are not able to wait for it to become available:
- Speak with your healthcare provider about what stimulant medication alternatives exist and also speak with your pharmacist about what stimulant medications are in stock. Although no two stimulant formulations are exactly the same, there are many stimulant formulations that are extremely similar. And, although there are shortages of many different stimulant formulations, availability can vary day-to-day and can also vary in brand vs. generic, formulation, and even strength.
- Generic stimulant medications are typically less expensive than their branded counterparts; for this reason, generic formulations of stimulants are more likely to be in short supply. Many of the newest stimulant formulations that are not available generically may be more available in pharmacies. And, although they are generally more expensive, their manufacturers often offer patient savings coupons to reduce a patient’s out-of-pocket costs.
- Consider your priorities when choosing the right alternative stimulant medication! If your preferred stimulant medication is not available, you may need to consider trying a different stimulant medication. In these instances, consideration should be given to what are the priorities in selecting an alternative stimulant formulation — is it the medication’s means of administration, its duration of action, or its costs? The accompanying table shows all of the FDA-approved medications organized by means of administration and duration of benefit. Keep in mind that a combination of long-acting and short-acting medications is sometimes needed to achieve the desired duration of benefit or clinical response.
- If you are flexible and willing to try a similar stimulant medication – knowing that it may or may not as good, but it may even be better – then discuss with your healthcare provider what stimulant medications may be a suitable alternative. It would be especially helpful if you can inform your healthcare provider with the name and strength of the medications that are presently available in stock.
- The accompanying chart, “Stimulant Medications for Treatment of ADHD” shows virtually all of the different FDA-approved stimulant medications for treatment of ADHD based on means of administration. Thus, for example, if a child has trouble swallowing a pill or capsule and needs a liquid formulation, then you can look at the different short-acting and long-acting liquid formulations as options.
- Since there are many long-acting formulations that differ in their general duration of benefit (8 vs. 10 vs. 12 hours), recognize that a medication with a somewhat different duration of action may be an adequate (if not perfect) treatment choice.
- Since most children will respond well when treated with either methylphenidate or amphetamine, do not limit yourself to one active ingredient versus the other. The Stimulant Medications Chart shows you various possible options and alternatives.
- If once daily dosing with a stimulant for 12 hours of benefit is not an option, then consider using a combination of medications (if available) to cover that extended time period. For example, an 8-hour medication before school and a 4-hour medication after school will approximate the benefit of the 12-hour medication that may not be available.
Speak with your healthcare provider about “creative” solutions with respect to prescribing based on availability. For example:
- If a patient uses a 15 mg. transdermal Daytrana patch but the pharmacy only has 30 mg patches in stock, perhaps your physician can write a prescription for the 30 mg patch and then guide you to cut the patch so that you only apply one-half of the 30 mg. patch. The unused half can be saved and used the following day.
- Similarly, if a patient is on a 20 mg dose of Vyvanse and the pharmacy only has 40 mg capsules in stock, discuss with your healthcare provider if they are willing to prescribe the higher dose and then have you dissolve a 40 mg capsule in water but have you give only half the medication solution.
Please note that, although these strategies are safe and effective if properly implemented, the FDA does not recommend cutting transdermal patches in half or giving less than a complete Vyvanse capsule when mixed in water.
Don’t wait until the last minute to request a refill. If you receive a 30-day supply of medication, then mark your calendar as a reminder to when you should request a new prescription, which is typically 25 – 28 days from when the last prescription was filled by the pharmacy (not picked up by you). If your child does not take medication every day, you should still pursue a prescription refill at least three-and-a-half weeks after your most recent prescription was filled rather than wait until you only have a few pills or capsules left. You can even call your healthcare provider for a new prescription three weeks after the last prescription; although the pharmacist may not be able to fill the prescription after just 21 days, at least it will be on file and available for when a prescription renewal can be approved by your insurance company.
If you cannot find one or more acceptable stimulant medications, then speak with your healthcare provider about possibly using a non-stimulant medication (such as atomoxetine, viloxazine, or guanfacine) instead. Although these medications are not always as effective as stimulants, they are approved by the FDA for treatment of ADHD and can often play an important role when used alone or in conjunction with a stimulant for treatment of ADHD.