Attention Deficit Hyperactivity Disorder (ADHD) medication shortage

Attention deficit hyperactivity disorder (ADHD) medication shortages guidelines November 2024

  1. Available medicines to treat ADHD: Prescribing available medicines to treat ADHD – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice  
  1. 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  
  1. 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

·       Prescribing and switching between modified-release methylphenidate – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice

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.

 

Herefordshire CAMHS (Tier 3)

Our Child and Adolescent Mental Health Service (CAMHS) in Herefordshire provides specialist mental health services for children and young people up to 18 years old and also supports their families/carers. To be referred into the Herefordshire CAMHS service, children and young people should live in Herefordshire and be registered with a GP in the county. This includes children and young people with a diagnosed learning disability.

About the service

Child and Adolescent Mental Services (CAMHS for short) are an NHS service that supports children and young people who experience emotional and mental health difficulties such as:

  • Problems with relationships (with family, carers, or at school)
  • Feeling depressed, anxious, self-harming or problems with eating
  • Experiencing traumatic event(s) in their lives which is affecting them emotionally

CAMHS clinicians are trained and qualified specialists who can treat, assess, and support children and young people’s emotional and mental health difficulties and are good at listening. They work in partnership with the family, the child or young person individually, in groups or directly with professionals. They understand the complexity of family life and the challenges that children and young people face when growing up.

The team is made up of psychiatrists, psychologists, nurses, social workers, occupational therapists, psychotherapists, and art therapists. They work as a team and use their different skills and expertise to provide the best outcomes for the children and young people they support.

CAMHS provide many therapies and interventions such as family work, psychotherapy, cognitive behavioural therapy (CBT), and specialist assessments for autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), self-harm and suicidal thoughts, psychosis and eating disorders.

CAMHS clinicians monitor the effectiveness of their work using feedback forms called routine outcome measures (ROMs). Children and young people will share in planning and monitoring their progress and will be supported to achieve their goals.

The initial appointment

It's natural for you to feel nervous about the initial appointment, but this is just a chance for the CAMHS clinicians to get to know you a bit more and to find out how they can help.

During the appointment the CAMHS clinicians will have a chat with you and will ask some questions to find out more about the issues you are experiencing and feeling, what has been happening and what you might think would help you.

At the end of the discussion the CAMHS clinician will work with you to identify further actions or treatment to help you get better - this may mean attending further appointments at CAMHS, or a referral to another service that is better suited to your needs.

Sometimes a one-off meeting is all to talk through any issues.

What happens if work with CAMHS continues?

If further appointments are agreed, a CAMHS clinician will work in partnership with you through your treatment. The word treatment may sound a little scary, but it's just so you can work together with the CAMHS clinician to help you get better.

A course of treatment will usually be for 7-10 sessions and sometimes more sessions may be needed or less if you get better quicker.

The CAMHS clinician will also complete an assessment and will work collaboratively with you to agree a care plan which will show what work has been agreed and how often appointments will be.

What happens if I'm prescribed medication?

Sometimes a child or young person can benefit from taking medication to help their recovery. If medication is prescribed, the CAMHS clinicians will talk with you and your family about what the medication is, how it will help, and how it is given.

Medication is prescribed and reviewed by psychiatrists and specially trained nurses who have lots of experience and training around this area.

Have you been seen by CAMHS?

If you are, or have been a CAMHS patient what advice would you give to someone starting their journey? Do you have any tips or any words of wisdom? 

Knowing you are not alone can help with recovery so send us your tips, advice or thoughts at whcnhs.communityengagement@nhs.net  and help others today. 

All emails will be treated annoymously, confidentially and only used for the CAMHS website and marketing materials. 

Herefordshire CAMHS Single Point of Access (SPA) referral information

The information below is used to refer to all Herefordshire CAMHS services, apart from the Eating Disorders service.

All referrals into Herefordshire CAMHS must be completed by professionals using the CAMHS referral form. Guidelines for referrers is also available.

The CAMHS team in Herefordshire receive referrals from people who work closely with children and young people such as GPs, school nurses, health visitors, social workers, specialist staff within schools and paediatricians.

Referrals are screened by the team to make sure they are suitable and to identify urgent referrals. When a referral is accepted the family or young person will be invited to make a CHOICE appointment. Other professionals may also be invited to this appointment.

Confidentiality

Confidentiality is very important to CAMHS - all the information given in CAMHS appointments is confidential. Usually only the person who made the referral and the GP will know about the appointments.

The team will only share information about young people when we feel it is absolutely necessary, and the clinicians will always explain what information is being shared and why.

Sometimes it can be helpful to share information, for example with schools or other health staff.

The CAMHS clinician will discuss the information to be shared and ask children, young people and their families/carers for consent to share. Sometimes young people do not want to share their information with their parents/carers. This can be identified in the referral. The CAMHS clinician will discuss this with the young person to understand more about their circumstances and assess whether they are competent to make that decision for themselves.

If there are concerns that a child or young person may be at risk of harm, CAMHS will always share this information with the relevant agencies, though we would hope to inform the child or young person and their family/carers about the referral and the reasons for this.

If you are unsure about anything, please ask the team.

Help and resources

If you are a child or young people please visit the our information section to find out more about feelings and emotions.

Give feedback on our services

We are always looking for feedback on our services and we would love to hear from you. You can complete the quick CAMHS feedback survey here.