• FCMS
  • Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
  • Rotherham Doncaster and South Humber NHS Foundation Trust
  • Nottingham and Nottinghamshire
  • South Yorkshire ICB

Shared Care Protocol for the Management of Attention Deficit Hyperactivity Disorder (ADHD) for DONCASTER: children, adolescents and adults BASSETLAW: children and adolescents (upto age 17yrs 364 days)  click here & for Proforma click here

Modafinil in Narcolepsy Shared Care Protocol & Proforma click here

ADHD

Use as part of a comprehensive treatment programme for attention-deficit/ hyperactivity disorder in children aged ≥6 years and adults when remedial measures alone prove insufficient

Rationale:1,2,3

Restricted Prescribing

Refer to Shared Care Protocol & Proforma

MR methylphenidate products should be prescribed by brand and are not interchangeable  under normal circumstances, but where there are stock shortages product substitution should be made with caution and following the SPS guidance. For more information click here

Brands:

  • Affenid XL tablets
  • Concerta XL tablets
  • Delmosart tablets
  • Equasym XL capsules
  • Matoride XL tablets
  • Medikinet XL capsules
  • Meflynate XL capsules
  • Metyrol XL capsules
  • Xaggitin XL tablets
  • Xenidate XL tablets

Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations Drug Safety Update Sept 2022 

Advice To Community Pharmacy Teams Re ADHD (Methylphenidate) Stock Shortages

Sent On Behalf Of NHS South Yorkshire Integrated Care Board (ICB)

Dear Pharmacy Teams,
 
As you will be aware there has been national shortages of ADHD Medication for some time now. For full details see the CAS Alert: NPSA Alert

As part of the actions taken to help mitigate the impact of the shortage on patients and healthcare professional, South Yorkshire ICB colleagues are working to explore ways to support Practices and Pharmacies, help meet the supply needs of their patients.

In Rotherham and Doncasterworking with RDaSH, ICB colleagues have produced a MethylPhenidate M/R Preparations Comparison Aid to support Practices and Pharmacies with recommending/prescribing alternatives.

In addition, local Prescribers would greatly welcome any ADHD stock availability intel Pharmacies are able to share to support prescribing decisions. Please use Feedback Form link or scan QR code to feedback what you have/can get in-stock.

ADHD Medication Stock Availability – Feedback Form

In Rotherham: polite reminder that since March 2024, Accurx OOS process became the preferred way for Pharmacies to contact GPs re medicines out-of-stocks for ALL Rotherham GP Practices.

The Accurx OOS process streamlines medicine availability/stock communications (between CPs to GPs) into “one single way”, aiding prompt responses to queries and reducing workload for both parties.

If you are not already using or have any questions re Accurx OOS process, please use this link, to sign-up and/or further info.

Useful ADHD References:

Reminder: SPS Medicines Supply Tool provides info on most supply issues, actions to take, alternatives to use and expected resolution dates. (Content regularly updated by DHSC and CMU)

Review Date: 01/07/2023

Dexamfetamine Tablets

ADHD 

Brand: Dexedrine

Restricted Prescribing

Refer to Shared Care Protocol & Proforma

Rationale: 1,2,6,8

NICE NG87
Attention deficit hyperactivity disorder: diagnosis and management

NICE CG 158 Antisocial behaviour and conduct disorders in children and young people: recognition and management

 

 

Pack Price
28 tablet £21.24

Review Date: 01/07/2023

Atomoxetine Capsules

ADHD 

Brand : Strattera

Restricted Prescribing 

Refer to Shared Care Protocol & Proforma

NICE NG87 Attention deficit hyperactivity disorder: diagnosis and management


NICE CG158 Antisocial behaviour and conduct disorders in children and young people: recognition and management

Drug safety update Volume 2, Issue 8 March 2009

 

Pack Price
28 capsule £59.05
Pack Price
28 capsule £58.67
Pack Price
28 capsule £58.55
Pack Price
28 capsule £57.21
Pack Price
28 capsule £62.03

Review Date: 01/07/2023

ADHD in children and adolescents

Brand: Intuniv

Restricted prescribing

Refer to Shared Care Protocol & Proforma

NICE NG87 Attention deficit hyperactivity disorder: diagnosis and management

 

 

Pack Price
28 tablet £56.00
Pack Price
28 tablet £58.52
Pack Price
28 tablet £65.52
Pack Price
28 tablet £76.16

Review Date: 01/07/2023

ADHD when response to previous methylphenidate treatment is considered clinically inadequate.

Brand: Elvanse 

Refer to Shared Care Protocol

Restricted prescribing

NICE NG87 Attention deficit hyperactivity disorder: diagnosis and management

 

Review Date: 01/07/2023

ADHD

Rationale: 1,2,6,8

Restricted Prescribing

Refer to Shared Care Protocol & Proforma

NICE NG87 Attention deficit hyperactivity disorder: diagnosis and management

 

Pack Price
30 tablet £3.46
Pack Price
30 tablet £3.03

Review Date: 01/01/2026

Excessive sleepiness associated with narcolepsy with or without cataplexy

Brand : Provigil

Rationale 1,2

Refer to Shared Care Protocol for Modafinil in Narcolepsy

MHRA warns modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil. November 2020


http://www.nice.org.uk/mpc/evidencesummariesunlicensedofflabelmedicines/ESUOM9.jsp
ESU0M9 April 2013

The European Medicines Agency has recommended that the use of modafinil should be restricted to treat only sleepiness associated with narcolepsy, and that it should no longer be used for the treatment of excessive sleepiness associated with obstructive sleep apnoea or chronic shift work sleep disorder.
On the basis of the available data, the Agency's Committee for Medicinal Products for Human Use (CHMP) concluded that the benefits of these medicines only outweighed their risks in the therapeutic indication narcolepsy. For all other indications the Committee found that the risks outweighed the
benefit shown in clinical trials. Therefore, the Committee concluded that all other indications should be withdrawn from the marketing authorisations of these medicines.
MHRA Drug Safety Update Volume 4, Issue 1 August 2010

The MHRA Drug Safety Update has issued a reminder advising that modafinil should be withdrawn in patients who experience a rash or psychiatric symptoms, and makes the following recommendations:
* Modafinil should be discontinued at the first sign of rash and not restarted
* Modafinil should be discontinued in patients who experience any psychiatric symptoms and not restarted *Update 2020* Letter sent to Healthcare Professionals - Modafinil: potential risk of congenital malformations during pregnancy

 

Pack Price
30 tablet £2.07
Pack Price
30 tablet £8.43

Review Date: 01/07/2026

Counteracting sedation with opioids in palliative care (off-label use)

Methylphenidate is indicated for use in opioid-related drowsiness, and depression where prognosis <2-4 weeks.
The dose should be stable before asking the GP to prescribe and is usually within the range of 5mg BD to 20mg BD, where the second daily dose is given around lunchtime.
DBHFT Aug 2015

Pack Price
30 tablet £3.46
Pack Price
30 tablet £10.92
Pack Price
30 tablet £3.03