Shortage of ADHD drugs? Tips for parents

By Deborah Kotz, Globe Staff

Last week, a rash of news reports detailed a growing shortage of drugs to treat attention deficit hyperactivity disorder including methylphenidate -- Ritalin and its generic equivalents -- and the amphetamine Adderall and its generic equivalents. The US Food and Drug Administration first announced the shortage last year and attributed it to a tightly control of production of the stimulants drugs (which are addictive and often sold illegally) mandated by the US Drug Enforcement Agency.

Dr. Joseph Gonzalez-Heydrich, director of the psychopharmacology program at Children’s Hospital Boston, told me he was all too familiar with the problems those with ADHD face getting prescriptions filled. “This is not new, and many of my patients’ parents have to run around to different pharmacies due to shortages.”

Often, parents must come back to his office after an appointment to request a new prescription for a different dose pill, replacing a 30 milligram pill, for example, with three 10 milligram pills to be taken in the morning, since pharmacies aren’t allowed to make these replacements on their own to handle shortages.

The drug that seems to be in the shortest supply? Adderall XR (extended release), said Gonzalez-Heydrich, which is made by Shire and is available as a generic. (The drug appears on this FDA list of drug shortages and its generic forms are deemed to be in inadequate supply.)

Shire has turned its efforts towards promoting and steadily producing its newer and more expensive drug Vyvanse -- which is in plentiful supply and works similarly to Adderall XR; the DEA allows manufacturers to decide how they will divvy up their restricted production among expensive brand names and lower-priced generics.

“I’ve switched a lot of my patients to Vyvanse since it’s more in stock and has a similar action,” said Gonzalez-Heydrich. But many are forced to pay more for the prescription as a result.

Brand-name Adderall XR, usually priced higher than generics, is currently in good supply, according to Shire. “There has been adequate supply of Shire’s Adderall XR across the US since March of 2011,” said spokesman Matt Cabrey, “following a brief and relatively small, spotty supply issue in January and February of 2011.”

Supplies of the two generic versions are based on specific supply agreements that Shire has with two manufacturers, Cabrey added.

Limits on the quantity that can be manufactured may explain the shortage in some areas.

Gonzalez-Heydrich’s advice to parents? Those expecting to get a new prescription for their recently diagnosed child should be aware of the shortage and ask the doctor to call their local pharmacy to see what’s in stock before walking out with a script.

Those bringing their child in for a prescription refill should call their pharmacy before their child’s appointment -- even in the doctor’s waiting room -- to find out whether the store has their child’s prescription in stock and, if so, in what dosage.

“If they have the drug in stock, ask if the pharmacy can set aside some pills for a prescription that’s about to be filled,” if their stock is running low, advised Gonzalez-Heydrich. Doctors can’t call in prescriptions, so pharmacies can sometimes run out during the time it takes to bring the script in to be filled.

Parents may also want to call around to other pharmacies to see what they have in stock, also before the doctor’s appointment. That way, said Gonzalez-Heydrich, doctors can tailor the dose and number of pills based on what’s in stock.

If the prescription isn’t in stock, ask your doctor to call your pharmacy during the appointment to see if another medication in stock can be substituted.

“This shortage has been a huge hassle for everyone,” said Gonzalez-Heydrich, “but I think that phone call to the pharmacy ahead of time can really help. Patients forewarned can be forearmed.”

Are you or a family member taking a drug for ADHD? Have you had problems getting your prescription filled? Tell me your story in a comment below.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.