ADHD med shortages ‘a merry-go-round you just can’t predict’

As thousands of children return to school for another year, shortages of attention deficit hyperactivity disorder (ADHD) medications are leaving parents worried and GPs reconsidering their prescribing options.
 
This time it is methylphenidate hydrochloride (sold as Concerta) that is low, with limited supply of its 18 mg, 27 mg, 36 mg and 54 mg modified-release tablet products until the end of May, according to the Therapeutic Goods Administration (TGA).
 
It follows last year’s shortages of lisdexamfetamine dimesilate (sold as Vyvanse), which has since been resolved.
 
The Concerta supply shortage is due to manufacturing issues, according to the TGA, which also notes another supplier, Teva Pharma Australia, has limited availability for all strengths of its modified-release methylphenidate hydrochloride tablets until the end of the year.
 
The TGA said other forms of methylphenidate medicines, including immediate-release tablets and modified-release capsules, are still available.
 
Chair of RACGP Specific Interests ADHD, Autism Spectrum Disorder, and Neurodiversity Associate Professor John Kramer, who is among the GPs with the authority to prescribe stimulants to treat ADHD, acknowledged the potential of the short supply to impact on the new school year.
 
‘If a kid does have significant ADHD and is significantly affected in their learning capacity, it’s really important that they start their school year well – and this a concern that might interfere with that,’ he told newsGP.
 
He said current supply issues are variable, with some areas affected worse than others.
 
‘There are four different strengths of Concerta, and it really depends on the particular strength that the person’s on whether they can get it or not,’ he said.   
 
‘It’s unpredictable.’
 
At the moment, he said he is using long-acting and short-acting alternatives.
 
Perth-based Dr Andrew Leech, a GP with a special interest in paediatrics, said he only recently found out about the shortage.
 
‘We tend to get these by word of mouth a bit later than they actually happen, when patients start to run out a few months later after [getting] their script,’ he told newsGP.
 
‘It does challenge us a little bit trying to look at alternatives, trying to change the dose to something that is available, and giving [patients] reassurance that this is a short-term issue.’
 
Dr Leech says prescribers are now accustomed to adapting to ADHD medication shortages.
 
‘One dose will go out of stock for a few weeks, then we advise people to change, but then that dose comes back, and another dose goes out of stock because we put everyone on the other dose,’ he said.
 
‘It’s a merry-go-round you just can’t predict.’
 
Associate Professor Kramer believes the shortages support his belief that prescribing GPs should have more autonomy to adapt.
 
‘If a GP can be given an authority to prescribe stimulants, it should be any stimulant within the set range – not unrestricted, but so you can interchange them in terms of effect, without putting the patient in any sort of risk,’ he said.
 
‘There’s a lot of harmonisation of the regulations that needs to happen.’
 
While Dr Leech is confident there are effective workarounds in place with the current shortage, he remains concerned about future supply issues.
 
‘If it does get worse, then it will become harder for families trying to get the right management,’ he said.
 
‘You just have to go with it a bit and have a good relationship with your local pharmacy.’
 
There has been a surge in ADHD diagnoses and prescriptions in recent years, a shift attributed to growing awareness surrounding the disorder.
 
In November 2023, a Senate committee inquiry into ADHD assessment and treatment barriers recommended GPs play a greater role in diagnosis and management under a shared care model with other health professionals.
 
Its report highlighted long waits for non-GP specialists and high costs as significant barriers for patients living with the condition.
 
The recommendations, which included many of those in the RACGP’s own submission, also called for consistency in prescribing rules.
 
In recent years, the RACGP has been consistently advocating for GPs to play a greater part in managing ADHD presentations.
 
A new prescribing guide for the disorder was also launched last year.
 
But for Associate Professor Kramer, the shortages are an important reminder that medication is only one aspect of treatment.
 
‘Managing ADHD is never just about medication,’ he said.  
 
‘It’s always medication and then our after-strategies: behaviour management, education, exercise, good sleep, hygiene, good diet, all those things.
 
‘Medication, once you can get to see somebody who can prescribe it, that step is relatively straightforward.’

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