Elvanse shortage: everything you need to know

Elvanse Shortage: Patient Advice & Alternative Options

Living with Attention-Deficit/Hyperactivity Disorder (ADHD) can be challenging, but for many individuals, medication like Elvanse has been a lifeline, helping them manage their symptoms and lead fulfilling lives. However, in recent times, the ADHD community has been facing a concerning issue: Elvanse shortage, leaving many individuals in a state of uncertainty and frustration.

In this post, we will look into the current status of Elvanse’s availability, exploring the reasons behind the shortage and the efforts being made to address it. We’ll also discuss alternatives to Elvanse for ADHD treatment, ensuring that those affected have the information they need to make informed decisions about their healthcare.

What is Elvanse? 

Elvanse is a brand name for the prescription medication lisdexamfetamine. It is commonly used in the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). Elvanse is a stimulant medication that affects certain chemicals in the brain and helps with symptoms like inattention, hyperactivity, and impulsivity in people with ADHD. Elvanse range include: 

  • Elvanse 20mg capsules
  • Elvanse 30mg capsules (and Elvanse Adult 30mg)
  • Elvanse 40mg capsules
  • Elvanse 50mg capsules (and Elvanse Adult 50mg)
  • Elvanse 60mg capsules
  • Elvanse Adult 70mg capsules

Elvanse: legal classification

In the UK Elvanse is classified as a Schedule 2 controlled drug (CD 2), which means certain legal requirements apply to the storage and supply of this medication. From the patient’s point of view, two aspects related to the classification of Elvanse are: the limit on quantity prescribed (usually one month) and prescription expiry date, with prescriptions for CD2 drugs being valid for 28 days from the date of prescription. 

What is causing the Elvanse shortage? 

Drug shortages are common in the UK. Every day pharmacies across the UK deal with several drug shortages of common drugs for the treatment of different conditions. Elvanse received a marketing authorization in Europe in 2013 (Elvanse 50mg), however, the demand for Elvanse picked up in the last couple of years, despite its high price (and cost to the NHS). Last year the NHS spent over £15mln on Elvanse alone (OpenPrescribing.net, 2023). 

Elvanse shortage: graph showing increased demand for the drug

At the moment, in the UK, Elvanse is the only brand of lisdexamfetamine available for patients, which means that only one manufacturer produces and supplies the drug in Europe and the UK. 

The surge in demand within the UK market over the last two years has been duly recognized, amplifying the existing supply difficulties. Takeda attributed these challenges, in part, to intermittent production issues at one of their contracted manufacturing partners.

The diagnosis of ADHD has increased over the years. With the increased awareness of ADHD and diagnosis, the demand for ADHD medicines has surged. 

Recently, in the USA, Elvanse’s patent expired, and other manufacturers have already started production of a ‘generic’ form of lisdexamfetamine. In the UK, Elvanse is protected by a patent until 2028. 

Elvanse shortage: current situation 

Elvanse has been short in supply for the last few months. In recent weeks almost all strengths of Elvanse capsules were out of stock. However, the Elvanse availability changes daily. 

ADHD UK announced in November that supply issues with Elvanse will continue until April 2024, in reality, it will be difficult to estimate the duration of Elvanse shortage. NHS and other organizations sometimes publish advice to patients with estimated dates for Elvanse to be back in stock, however, news like that should be taken with a pinch of salt. 

A recent announcement by ADHD UK on Elvanse availability does not mean there will not be any stock of Elvanse in the coming months. As we observed in the last 2-3 weeks Elvanse’s availability somehow became limited from none. 

At the beginning of December limited stock of Elvanse 60mg, 50mg and 40mg became available in the UK. 

What does limited stock mean?

Alliance Healthcare is the sole wholesaler which supplies Elvanse to all pharmacies in the UK. Elvanse 40mg, 50mg and 60mg were immediately available in December. Despite the availability, Alliance Healthcare put restrictions on the Elvanse supply, which means pharmacies have been able to order a limited number of Elvanse capsules. Roughly a box of Elvanse 50mg caps is available to order from Alliance per week. This is not a general rule, just an observation of the supply in the last 2-3 weeks. 

Elvanse shortage: what should you do? 

With Elvanse’s availability slightly improving the best course of action is to ring pharmacies around to see if they may have any 

stock of Elvanse or if the pharmacy can order the stock. The best option for ordering Elvanse is to use the Alliance web portal, rather than the PMR system. The Alliance web portal can show if the supply of Elvanse is restricted or if the order is accepted. Not all pharmacies may use the Alliance web portal. 

Patients should avoid requesting lower strength of Elvanse with the idea of doubling the dose to minimize further supply issues. 

It may be possible for a pharmacy team to reserve a stock once it becomes available. 

Can you transfer a prescription from one pharmacy to another?

With Electronic Prescription Service in place, patients can request for their prescription to be returned to the NHS spine. This allows other pharmacies to download the prescription and supply the medication. Partially supplied prescriptions cannot be returned. 

What about Elvanse alternative medicines? 

Patients should speak to their GP to see if they may suggest Elvanse alternative drug. Several alternative medications can be used for the treatment of ADHD, both stimulant and non-stimulant. Each medication requires a different dosing and is not easily interchangeable with Elvanse. Consultation with a GP is essential. 

Perhaps one of the ‘best’ Elvanse alternative drugs is dexamfetamine (Amfexa), however, the supply limitations with Elvanse already affect Amfexa availability with some strengths being out of stock. 

Lisdexamfetamine vs dexamfetamine (Elvanse vs Amfexa)

Lisdexamfetamine is related to dexamfetamine. Lisdexamfetamine is a prodrug of dextroamphetamine. This means that lisdexamfetamine is inactive when it is initially ingested; it is converted into the active drug dextroamphetamine (and L-lysine) in the body through a process known as first-pass metabolism. This conversion happens primarily in the bloodstream.

The design of lisdexamfetamine as a prodrug was intended to provide a more predictable, extended release of the active drug, which can lead to a smoother therapeutic effect, less abuse potential, and a reduction in the “rush” that can be associated with immediate-release forms of stimulant medications. It’s used in the treatment of ADHD and was developed to provide a long-acting therapeutic effect that can last throughout the day with a single dose.

Both medications are stimulants used to treat ADHD, but their pharmacokinetics and formulations can impact how they are prescribed and administered to individuals based on their specific needs and preferences. The choice between the two may depend on a patient’s response to the medication and GP’s recommendations. 

Conclusion

 In conclusion, the shortage of Elvanse has posed significant challenges for individuals with ADHD who rely on this medication for symptom management. As the only brand of lisdexamfetamine available in the UK, the supply issues have been exacerbated by a combination of increased demand, manufacturing hiccups, and restrictive distribution practices. While efforts are being made to stabilize the supply, patients and healthcare providers are navigating a complex landscape, with electronic prescription services offering some flexibility in obtaining the medication. Alternatives like dexamphetamine may offer a temporary solution, though they come with their own set of considerations regarding availability and therapeutic effects. Patients must consult with their healthcare providers to explore all viable options for treatment and to keep abreast of the evolving situation. The resilience of the ADHD community is being tested, but the collective response to ensure continuity of care reflects a commitment to overcoming the hurdles presented by such shortages.

References

OpenPrescribing.net (2023). Analyse: Elvanse. Available at: https://openprescribing.net/analyse/ Accessed on 17/12/2023

I am a qualified pharmacist working in an independent pharmacy in the UK.
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