Second ADHD medication shortage leaves patients in ‘very difficult position’, pharmacists warn

A medicine supply notification warned that atomoxetine 40mg and 60mg capsules will be out of stock until September 2023
atomoxetine capsule in hand

Pharmacists have warned that shortages of a second ADHD medication shortage are “frustrating” and have left patients and prescribers in a “very difficult position”.

The Department of Health and Social Care (DHSC) issued a medicine supply notification for atomoxetine 40mg and 60mg capsules on 21 July 2023.

The alert warned that the capsules, which are used in the treatment of attention deficit hyperactivity disorder (ADHD), would be out of stock from late July 2023 until September 2023.

While other strengths and formulations of atomoxetine remain available, the supply notification advised that there are insufficient quantities to meet any increase in demand.

It added that unlicensed supplies of atomoxetine 40mg and 60mg capsules may be sourced by specialist importers.

A shortage notice was also issued in 2022 for the ADHD treatment methylphenidate.

The shortages have led to concerns among pharmacists working in the field.

Commenting on the atomoxetine shortage notice, Bolu Abifarin, lead pharmacist for neurodevelopmental and learning disabilities services at the North East London NHS Foundation Trust said: “As a third-line option in ADHD, by the time patients are using atomoxetine, they have typically tried the first- and second-line stimulants (methylphenidate and lisdexamfetamine) before becoming stable,” he said.

“As a result, not only is it frustrating having to switch patients who may have had a long journey finding an effective and/or tolerable medication, there are also limited options going forward (guanfacine being the only licensed alternative).”

“In addition, although atomoxetine is available as a liquid, the strength (4mg/mL), means volumes used could be impractical depending on the dose required.”

The Pharmaceutical Journal reported in July 2023 that the number of people in England obtaining central nervous system stimulants and medicines for ADHD on the NHS has more than doubled to 233,000 over the past 8 years, particularly accelerating over the past 2 years.

Beryl Navti, clinical lead for children and adolescent mental health services at North East London NHS Foundation Trust, and a council member of the College of Mental Health Pharmacy, said: “Shortages of medication for ADHD have been ongoing since the beginning of the year, impacting different medications at different times. For example, we had shortages of different brands of methylphenidate extended release.

“Often, the reasons for shortages differ, but have equally distressing consequences for patients and their families who travel far and wide trying get their scripts dispensed.

“[The shortage] leaves prescribers and their ADHD patients in a very difficult position.

“It is important that pharmacists, and other healthcare professionals involved in the care of patients living with ADHD, continue to share information and knowledge between themselves about individual patient management where needed.”

Last updated
The Pharmaceutical Journal, PJ, August 2023, Vol 311, No 7976;311(7976)::DOI:10.1211/PJ.2023.1.193527

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