The nationwide medication shortage that began in August of 2022 has NOT resolved and may not resolve for many months to come. If Adderall, Concerta and other medications continue to be affected by shortages patients should consider switching to a different medication for ADD mgmt that has not been affected by the shortage.
The shortage involves generic medications for Adderall, Zenzedi, Focalin and Concerta. Name brand medications do not appear to be affected by the shortage, as a result many patients have switched from generic medications to name brand medications (which are more expensive). If your medication is not available in the generic you may ask your pharmacist to order the name brand medication for you, be prepared to pay considerably more to fill your prescription if you do this.
If the medication you normally use is not available in the name brand or generic product consider switching to an alternative medication. Listed below are a few medications I've suggested to my patients the past several months:
Vyvanse extended release capsules- (AN OPTION FOR PATIENTS WHO HAVE INSURANCE COVERAGE). Update 9/15/23- Vyvanse 60 and 70 mg tablets and capsules have been out of stock at most pharmacies since mid-August.
Manufacturer's website: https://www.vyvanse.com/
Generic option:NO- there is no generic available, it is available only as a name brand medication
Update 9/15/23- The patent for Vyvanse expired in August 2023. Several pharmaceutical companies have begun shipping their generic version of Vyvanse to pharmacies. Patients who take Vyvanse will likely be required by their insurance provider to try the generic medication and may need prior authorization (approval) to receive name brand Vyvanse.
Onset of action: 1-2 hours
Duration of action: 6-12 hours (varies per patient).
Pharmacokinetics: This medication is a prodrug (lisdextroamphetamine), which means that it is converted by the body into the active ingredient (dextroamphetamine) after it's been consumed. The conversion takes place in the liver and takes 1-2 hours to reach the full therapeutic dose in the bloodstream. The onset of action is subtle, patients who are used to taking an immediate release stimulant and feeling it "kick in" will not experience the same feeling with Vyvanse. Vyvanse also wears off very slowly, so patients are less likely to experience symptoms of "crashing" (fatigue, irritability, yawning, brain fog) compared to immediate release medications. It can be difficult for patients to tell exactly when Vyvanse has worn off.
Manufacturer's coupon: The co-pay (if approved by insurance) is $30/mo with a manufacturer's coupon.
This medication often requires prior authorization by insurance, patients need to contact their provider's office if PA is required (they should not rely on the pharmacy to contact their provider's office). We do charge a $30 administrative fee to process PA paperwork.
If insurance does not approve this medication patients can still use the manufacturer's coupon to receive $60 off the retail price but this medication is still quite expensive if paying "out of pocket" (usually $300-400 for 30 capsules)
Patients with questions about the discount offer should call 1-866-441-3469.
There is NO generic yet available for Vyvanse
Takeda's Help at Hand program (provides deeply discounted or free medication for one year)
Patients may be approved by the manufacturer to receive Vyvanse at NO COST for one year by applying for Takeda's Help at Hand patient assistance program, a link to apply for the program may be found at the bottom of this page. The application is simple and easier to qualify for than you might think. Patients whose household income is at or below 5x the Federal Poverty Level (FPL) are eligible to receive reduced price or free medication. The current income levels to qualify for discounted medication is:
number of persons in the household. household income limit 1 $72,900 2 $98,600 3 $124,300 4 $150,000
Strengths available: Capsules and chewable tablets are available in the following strengths: 10, 20, 30, 40, 50, 60, and 70 mg
The dose of medication can be titrated by emptying the contents of a capsule (which is powder) into 5-10 ml of water and dissolving it. Then a patient can take a fraction of the solution to adjust the dose, for example- pouring out 1/2 of the solution and consuming the rest of it is decreasing the dose by 50%.
A physician can prescribe a 5-10 day supply of medication for the patient to try to see how they respond to Vyvanse. Patients do NOT have to try this medication for an entire month before requesting a change to a different medication.
Received a 7.4 on a 1 to 10 scale from 918 reviewers
AdzenysXR extended release tablets- (AN OPTION FOR PATIENTS WHO HAVE INSURANCE COVERAGE)
Manufacturer's website: https://adzenysxrodt.com/
Generic option: NO- there is NO generic available, this is only available as name brand medication
Onset of action: 30-60 minutes.
(Taking this medication with food may delay the onset of action by 1-2 hours.) Patients who have already built up some tolerance to stimulants can take this on an empty stomach to obtain a faster onset of action. Adzenys does not cause as much appetite suppression as other stimulants like Adderall.
Duration of action: 6-12 hours (varies per patient)
Manufacturer discount program: The manufacturer offers a discount (at participating pharmacies like HEB or Professional Building Pharmacy in Webster) that brings a patient's maximum out of pocket expense down to $35/mo. The discount is offered as long as the patient has health insurance and his insurance provider allows him to use any pharmacy of his choosing.If a patient's insurance company requires that they use a specific pharmacy then they cannot take advantage of this discount program but CAN download a manufacturer's coupon to take to their regular pharmacy.
Manufacturer coupon: This coupon will bring the cost down to $50/month even if Adzeny's is not covered by the patient's insurance plan or the patient has not yet met their deductible. Patients sometimes report that staff at non-participating pharmacies find this coupon confusing and do not always process it correctly, which can be inconvenient
Strengths available: Tablets are orally disintegrating (melt away) and come in the following strengths: 3.1, 6.3, 9.4, 12.5, 15.7 and 18.8 mg
The tablets are NOT designed to be cut in 1/2. They are not scored by patients can try using a pill cutter to take 1/2 a tablet, but the tablet may crumble.
Titration is usually achieved by prescribing a lower dose tablet and having the patient take 2 or 3 tablets to see which dose is effective.
Tablets are packaged in a tray containing #30 tablets that are each individually wrapped so patients will need to pay for a minimum of #30 tablets to try Adzenys. Prescribing only a few day's worth of medication for a trail is not an option.
Received a 6.1 on a 1 to 10 scale from 62 reviewers
Nuvigil extended release tablets- (AN OPTION FOR PATIENTS WHO ARE SELF PAY)
This stimulant is not FDA approved to treat ADD/ADHD but has been used "off label" by physicians and has favorable patient reviews for management of ADD/ADHD.
Dr. Sachdev's website (for information about using Nuvigil for ADD/ADHD management): https://www.novawellnesscenter.com/nuvigil-alternative-medication.html
A link to this information is available at the bottom of this page
Manufacturer's: website: https://www.nuvigil.com/
Generic option: YES- this medication is available as a name brand or generic medication
Duration of action: 1 tablet usually lasts 12-15 hours
Manufacturer coupon: Coupons for the name brand medication (Nuvigil) are available from the manufacturer but patients are unlikely to get their insurance provider to approve the use of this medication to treat ADD because it has not been FDA approved for that. Patients are also unlikely to have their insurance provider approve the use of name brand medication without trying the generic version (armodafinil) first. Some patients have reported that generic versions of this drug are not as effective as the name brand version.
GoodRx discount coupon: Patients may use a coupon from GoodRx.com to help cover the cost of generic armodafinil
Strengths available: Tablets are available in the following strengths: 50, 150, 200, 250 mg
It is available in an affordable generic. GoodRx discount coupons may be used to bring the patient's out of pocket expense down.
The maximum daily dose of Nuvigil is typically 400 mg/day. Doses higher than 400 mg/day may not be safe to use. The maximum FDA approved daily dose is actually lower than 400 mg/day. For adult patients with circadian rhythm disruption or shift work sleep disorder the maximum daily dose is 150 mg/day. For adult patients with narcolepsy or obstructive sleep apnea with hypersomnolence the maximum daily dose is 250 mg/day. Doses up to 400 mg/day have been used clinically and appear to be safe although there isn't strong evidence that doses exceeding the maximum FDA approved doses confer added clinical benefit. In my practice the risks and benefits of higher doses of Nuvigil will be determined on an individual basis.
A physician can prescribe a 5-10 day supply of Nuvigil so the patient can try it to see how it works for them before committing to filling a larger prescription. Patients do NOT have to try this medication for an entire month before requesting a change to a different medication.
Nuvigil is not a CII controlled substance, it is a CIV controlled substance because the FDA does not consider it to be a likely to be abused or cause addiction compared to other stimulants and amphetamines. The benefit of a CIV controlled substance is that a provider CAN authorize up to 6 month's worth of refills when a prescription is written. This makes Nuvigil a very convenient medication option for patients because they do NOT have to contact their provider every 30-90 days to request another prescription.
For more information on using Nuvigil for ADD management click the link at the bottom of this page
Zenzedi immediate release tablets- (AN OPTION FOR PATIENTS WITH INSURANCE OR WHO ARE SELF PAY)
This is an immediate release, short acting stimulant that is chemically very similar to Adderall. It typically has fewer or less severe side effects (appetite suppression, insomnia, blunting of personality) compared to Adderall. Zenzedi is slightly more expensive than Adderall for patients who are paying out of pocket, but it still an affordable alternative.
Generic option: YES- this is available in generic or name brand medication
Onset of action: 30-60 minutes
Duration of action: 4-6 hours (varies from 2-8 hours)
Manufacturer Copay Savings Card: For eligible patients, if your copay exceeds $30 (insured patients) or $75 (non insured patients), provide your copay savings card information to the pharmacist for an instant discount. (The retail price for 30 tablets of name brand Zenzedi is $200-300. The retail price for 30 tablets of generic Zenzedi is $80-250). Patients may use the copay savings card each time a prescription is filled for up to 360 days’ supply per year. Copays are based on 30-tablet count prescriptions. Benefit limitations apply. Patient is responsible for the remaining balance after benefit limits are reached. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call +1-855-558-1630
GoodRx discount coupon: Can be used to obtain discounts on name brand or generic medication if patients are paying out of pocket. The GoodRx discount for the NAME BRAND medication usually results in better savings than the manufacturer's copay savings card. GoodRx coupons are available only for the large retail chain pharmacies (Walgreens, CVS, Kroger, HEB, Walmart), they are NOT available for privately owned or independent pharmacies.
Available strengths: 2.5, 5, 7.5, 10, 15, 20 and 30 mg tablets.
The 10 mg tablet is more commonly prescribed than the other strengths for patients who are paying out of pocket because they are less expensive than the other strength tablets and are more likely to be in stock at pharmacies. The average adult patient will take 20 mg twice daily (morning and noon). If paying out of pocket is it less expensive to obtain #120 of the 10 mg tablets and take 2 tabs twice daily than it is to obtain #60 of the 20 mg tablets.
Dyanavel XR extended release tablets- (AN OPTION FOR INSURED PATIENTS)
This is a chewable (bubble gum flavored) long-lasting tablet amphetamine that uses technology to allow for a continuous release of medication throughout the day. This means that DYANAVEL XR only needs to be taken once each day in the morning, and the medicine is released into the body throughout the day. This medication is NOT a great option for patients who are self pay, the company offers a discount coupon that allows patients to save money only on their FIRST month's supply of medication (total cost is $50) but after the first month patients will pay $350-$450/mo out of pocket. In a clinical study, DYANAVEL XR tablet was found effective at reducing the symptoms of ADHD in adults ages 18-60 years at all measured times (0.5, 1, 2, 4, 8, 10, 12, 13, and 14 hours after taking) compared to a sugar pill.
Manufacturer Copay Savings Card: Insured patients with coverage may be a little as $25 on each prescription. Self pay patients and patients without coverage will pay $50 for their first prescription.
GoodRx discount coupon: Can be used to obtain discounts on name brand or generic medication if patients are paying out of pocket. GoodRx coupons are available only for the large retail chain pharmacies (Walgreens, CVS, Kroger, HEB, Walmart), they are NOT available for privately owned or independent pharmacies. The cost for #30 tablets (one month supply) with a GoodRx coupon brings the monthly cost down to $350-450/month
Available strengths: Tablets come in the following strengths 5, 10 , 15 and 20 mg
Received a 6.7 on a 1 to 10 scale from 30 reviewers
Xelstrym extended release transdermal patch (AN OPTION FOR INSURED PATIENTS)
This is dextroamphetamine (the same active ingredient that is in Zenzedi and Vyvanse) that is delivered via a transdermal patch. The patch may be worn for 9 hours. This product was released to market during the summer of 2023. Many pharmacies don't yet have it in stock but can order it.
Manufacturer's website: https://www.xelstrym.com/
Generic option: NO
Onset of action: The manufacturer recommends applying the patch 2 hours before you need it to start working but the peak blood concentration is attained 9 hours after application
Duration of action: This is unclear from the prescribing information and I do not yet have any clinical experience with this drug. The manufacturer recommends removing the patch after 9 hours.
This is a nonstimulant medication that is classified as an SNRI (serotonin, norepinephrine reuptake inhibitor). It is similar to Cymbalta, Effexor and Pristiq regarding its mechanism of action, they are all SNRI medications. This is not a "take as needed" medication like stimulants. This medication must be taken every day and titrated to an effective dose, which can take weeks. This type of medication can cause withdrawal symptoms if a dose is missed or it is stopped abruptly. Qelbree is NOT a controlled substance so physicians can authorize refills for a prescription. This medication may be a good choice for patients who need round the clock assistance with their ADD symptoms and/or experience a significant amount of anxiety or don't tolerate stimulants well.
Manufacturer's website: https://www.qelbree.com/
Generic option: NO
Onset of action: It may take weeks to titrate up to an effective daily dose. This is not a "take as needed" medication.
Duration of action: n/a, this is an extended release daily mediation that is designed to provide 24 hour symptom relief.
Manufacturer's coupon: https://www.qelbree.com/.
Pay as little as $20/month copay for 12 months
Available strengths: 100 mg, 150 mg, and 200 mg capsules
Received a 4.1 on a scale of 1 to 10 from 32 reviewers. The reviews are worth reading, for some patients Qelbree was a better choice than stimulant medication.
** Contact our office if you decide you would like to switch from Adderall to one of the medications listed above. A follow up visit is NOT required to request a change in medication due to shortage issues (unless you are due or past due for your regular follow up encounter.
Understand that the physician must review your chart to see which alternative is most appropriate for you, this takes more time than it normally does to send in a prescription. Patients should be patient when requesting a change in their treatment plan outside of a follow up encounter. Patients may be able to expedite the process by contacting their insurance provider and speaking with their pharmacist to see which medications are listed on their insurance formulary (is prior authorization required?) and confirming that the medication they are requesting is in stock at their pharmacy. If a new prescription requires prior authorization by their insurance company patients should contact our office DIRECTLY to speak with our staff (do NOT assume that the pharmacy will communicate with us). We charge an administrative fee for completing prior authorization paperwork, the approval process typically takes 3-7 days to receive a decision from an insurance company.
Please note this chart was created in 2004 so it does not show all of the medication options available
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Our mission is to serve as an antidote to conventional healthcare. We educate our patients to promote wellness, prevent disease and decrease the need for prescription medications.
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