National Patient Safety Alert: Shortage of methylphenidate prolonged-release capsules and tablets, lisdexamfetamine capsules, and guanfacine prolonged-release tablets (27 September 2023)

Summary

There are supply disruptions affecting various strengths of the following medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD): methylphenidate (Equasym® XL) capsules, methylphenidate (Xaggitin XL® , Concerta XL® , Xenidate XL® ) prolonged-release tablets, lisdexamfetamine (Elvanse® ) capsules, and guanfacine (Intuniv® ) prolonged-release tablets.

This is a safety critical and complex National Patient Safety Alert. Implementation should be co-ordinated by an executive lead (or equivalent role in organisations without executive boards) and supported by clinical leaders in pharmacy, community pharmacy, GP practices, mental health services and those working in the health and justice sector.

Content

Prescribers should:

1. not initiate new patients on products affected by this shortage until the supply issues resolve.

Healthcare professionals in primary care (and secondary care if appropriate) should:

2. identify all patients currently prescribed these products, and

3. make early contact with patients to establish how much supply they have remaining.

Where patients have insufficient supplies to last until the re-supply date, contact:

4. community pharmacies, hospital pharmacy departments, or other dispensing pharmacy services, to establish availability of supply; and

5. patient’s specialist team for advice on management options if the product cannot be sourced.

Specialist teams should:

6. support primary care teams seeking advice for patients currently prescribed the affected products,

7. provide individualised management plans, where required; and 8. recommend alternatives in line with NICE guidance, where appropriate.