ADHD Drug Shortage Pushes Parents to Seek Substitutes

FRIDAY, Jan. 6 (HealthDay News) — If the current shortage of some
drugs used to treat attention-deficit/hyperactivity disorder (ADHD) has
left you searching for something else for your child to take, experts
suggest you choose a substitute carefully because the effects of these
medications can vary widely.

For example, “generics can sometimes be less bioavailable [how much of
the drug is absorbed into the bloodstream], and that can make it harder to
get an exact dose match between medications,” explained Dr. Eric
Hollander, director of the Autism and Obsessive-Compulsive Spectrum
Program at Montefiore Medical Center in New York City.

“If the dose is too high, sometimes kids can get more withdrawn or
weepy. If it’s too low, they can’t get adequate control of their symptoms
during the day, and they can get a rebound later in the day. The new
medicine may wear off faster. It’s also not easy to switch from
extended-release formulas to immediate-release,” Hollander said.

The driving force behind the shortage is a U.S. Drug Enforcement
Administration (DEA) policy that sets limits on the manufacturing of ADHD
drugs, to limit the supply of these drugs to people who might use them
illegally, according to a report by The New York Times. In some
cases, drug companies manufacture both generic versions of ADHD drugs as
well as the more expensive, branded versions, which can limit choices even
further.

“This is the unfortunate result of well-intentioned policies combined
with free market forces. It’s a very substantial issue, and one that’s
affecting some families more than others,” said Dr. Andrew Adesman, chief
of developmental and behavioral pediatrics at the Steven and Alexandra
Cohen Children’s Medical Center of New York in New Hyde Park.

Whatever the reason behind the shortage, several drug companies that
produce amphetamine products, including Adderall, have reported shortages
to the U.S. Food and Drug Administration. And, companies producing various
forms of methylphenidate are also seeing shortages.

Both Hollander and Adesman said they’ve had reports from parents that
Adderall and its generic equivalent have been harder to get. They both
suggest that parents call from pharmacy to pharmacy in their area to see
which one might carry the needed medication.

If you can’t find any pharmacy that has the medication you’re looking
for, let your child’s doctor know. If the medication isn’t available, they
can first try another medication in the same class of medications. For
example, Adderall is an amphetamine derivative. Vyvanse is another
medication in that class. However, some insurance companies may balk at
paying for medications that aren’t on their preferred drug list, and you
may have to pay a higher co-pay.

If there’s a shortage of generic methylphenidate, the brand-name
versions (Concerta, Focalin, Ritalin, Metadate and Daytrana) may be
available.

There are also non-stimulant medications for ADHD, such as Intuniv,
Kapvay and Strattera, that may be an option, Adesman said.

Dr. Michael Hobaugh has more experience than he’d like with having to
switch children’s ADHD medications. Most of his patients are on public
insurance, which means he has to follow the state prescription drug
formulary for these patients. And that formulary often changes several
times a year.

“Sometimes, the switch is easy. It’s very patient-dependent. Usually
there is a similar product that’s close enough, but some kids have
trouble,” said Hobaugh, who is the chief of medical staff at La Rabida
Children’s Hospital in Chicago.

“It can be a difficult trial-and-error process to figure out what works
for some patients,” he said. “Their lives aren’t uniform from day to day.
Is it a side effect of the medication, or does the child have a virus or
stress, or maybe didn’t get enough sleep? And trying to assess what the
ideal medicine is for school readiness is difficult because there’s so
much you can’t control. This introduces another factor you can’t
control.”

There have been several ADHD drugs that have been difficult to get in
the past year, Hobaugh noted, often because they’re manufactured only by
one company. That means if there’s a production issue, there’s no other
manufacturer to fill in the gap.

“And, with generic drugs there may not be a whole lot of profit, so
they’re not a priority,” he added.

Along with discussing the shortage with your child’s doctor, Adesman
suggested that parents can call or write the FDA, or a local government
representative, and let them know that they’re having trouble getting
necessary medication.

“Patient advocacy is always important,” he said. “It’s the squeaky
wheel that gets the grease.”

More information

Learn more about medications used to treat
attention-deficit/hyperactivity disorder from the U.S. National Institute of Mental Health.

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