Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages. 

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices (see shared care agreement below)

The PCN recommends guanfacine as a treatment option in line with NICE guidance below (NG87 - March 2018).

Offer atomoxetine or guanfacine to children aged 5 years and over if

• they cannot tolerate methylphenidate or lisdexamfetamine

or

• their symptoms have not responded to separate 6-week trials of lisdexamfetamine and methylphenidate, having considered alternative preparations and adequate doses.

Guanfacine will be considered AMBER on the traffic light system with initiation by specialists in secondary care only.