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Attention Deficit Hyperactivity Disorder (ADHD) medication shortage
Attention deficit hyperactivity disorder (ADHD) medication shortages guidelines November 2024
- Available medicines to treat ADHD: Prescribing available medicines to treat ADHD – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice
- Practical advice to adjusting the clinical management plan for patients affected by the supply disruption of ADHD medicine: Supporting system response to the ADHD medicine shortage
- Prescribing and switching between methylphenidate products:
In discussion with the patient, prescribers can make adjustments to certain methylphenidate brands in short supply, without the need for additional specialist advice. This may be by making a short-term switch to an alternative bio-equivalent brand or formulation, or generic prescription for a methylphenidate modified-release product. Prescribers should revert to normal brand prescribing during periods of normal supply.
Resources to help with switching between methylphenidate products:
· Choice and medication ADHD medication handy facts sheet: A comparison of stimulants to help treat the symptoms of ADHD: handyfactsheetadhdformsuk.pdf
Equivalent MR tablets
The following MR methylphenidate tablets are considered bioequivalent to one another. Generic prescribing could be undertaken and products switched between using the same dose and quantity were that to be necessary:
o Concerta XL
o Affenid XL tablets
o Delmosart tablets
o Matoride XL tablets
o Xaggitin XL tablets
o Xenidate XL tablets
Equivalent MR capsules
The following MR methylphenidate capsules are considered bioequivalent to one another. Generic prescribing could be undertaken and products switched between using the same dose and quantity were that to be necessary:
o Metyrol XL
o Meflynate XL
o Ritalin XL
Note, however, that whilst switches from or to Medikinet XL capsules are also possible, these should be undertaken with particular care since this product is not completely bioequivalent with the other three.
Do not switch Equasym XL capsules
o No other MR products are bioequivalent to Equasym XL capsules and these should not be switched to or prescribed generically.
Do not switch from Methylphenidate MR tablets to MR capsules as they aren’t bioequivalent. Switching from Methyphenidate MR tablets to a bioequivalent dose of MR capsules will require lowering the dose by about 1/3. So 36 mg of Methylphenidate MR tablets equals roughly 20 mg of Methylphenidate MR capsules.
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that affects how children and young people manage attention, activity levels, and impulses.
ADHD can include:
- Inattention – difficulty concentrating, being disorganised or forgetful, struggling to finish tasks
- Hyperactivity – finding it hard to sit still, fidgeting, seeming constantly “on the go”
- Impulsivity – acting or speaking without thinking, interrupting others, difficulty waiting
For a diagnosis of ADHD, these difficulties must:
- Have been present for at least 6 months
- Occur in more than one setting (for example home and school)
- Cause significant impact on learning, behaviour, or social life
Many children show some of these behaviours at times. ADHD is considered when difficulties are persistent, developmentally inappropriate, and affect every day functioning. Strengths, interests, and abilities are always an important part of understanding a child, not just their difficulties.
What should I do if I’m worried?
If you are concerned your child may have ADHD, there are important steps you can take before considering a referral.
1. Access early support and information
In line with national guidance, parents and carers should be offered access to parent education or support for ADHD-like behaviours without waiting for a diagnosis.
This may include ADHD-focused programs or other evidence-based parenting support, such as the Solihull Approach or equivalent local services.
These programs can help you:
- Better understand attention, activity, and emotional regulation difficulties
- Learn practical strategies to support your child at home
- Decide whether further assessment may be needed
2. Talk to your child’s school
Share concerns with your child’s teacher, SENCO, or school nurse.
School staff can help put appropriate support in place and monitor how your child manages in the classroom.
3. Put support strategies in place
Support strategies should be tried at home and school, such as:
- Clear routines and structure
- Visual supports
- Behaviour or learning strategies
Many children show improvement when the right support is in place.
4. Monitor progress over time
It is important to observe and record:
- What strategies have been used
- What has helped
- What difficulties remain
Before an ADHD assessment referral
Before referring a child for an ADHD assessment, we usually expect evidence that:
- Support strategies have been used consistently for at least 10 weeks
- School-based support has been in place for at least one school term
- The impact and outcomes of these strategies have been recorded
This information helps ensure that any assessment is appropriate, thorough, and in line with national clinical guidance.
When can a referral be considered?
A referral to the Herefordshire and Worcestershire ADHD pathway may be considered if:
- The child is aged 5½ to 17½ years
- ADHD-like difficulties have been present for 6 months or more
- Difficulties occur across more than one setting
- There is clear impact on education and/or social functioning
- Information is available from home and school (or another setting)
- Support strategies have been tried and have not been sufficient on their own
If a child shows ADHD-like behaviours but can manage education and social life without significant impairment, they may not meet criteria for a diagnosis, although support may still be appropriate.
Private ADHD assessments
If your child has had a private ADHD assessment, and you are seeking NHS involvement, we require:
- A full copy of the assessment report, including all raw data from assessment tools (not just summary scores or conclusions)
- Completion of the Herefordshire and Worcestershire Community Paediatrics ADHD Referral Form by parents/carers and the child’s school or education setting
Private assessments are reviewed using the same clinical standards as NHS assessments to ensure care is safe, evidence-based, and in line with NICE guidance.
The NHS is not automatically able to accept or continue care without this information.
Make a referral for an ADHD assessment
To make a referral, please complete the Herefordshire and Worcestershire Community Paediatrics ADHD Referral Form , which must be completed jointly by parents/carers and the child’s school or education setting and returned to: whcnhs.access.commpaeds@nhs.net.