ADHD Medication Shortage and “Substitutions” for Vyvanse, Adderall, Focalin and Other Stimulants

Individuals struggling with ADHD receive a great deal of benefit from both routine and consistency. Maintaining routine and consistency becomes incredibly difficult when a child, adolescent or adult with ADHD cannot consistently receive treatment for their condition. We’ve seen an explosion of providers (some trained in mental health, others not-so-much) moving into the mental health space and promoting themselves as “ADHD Experts.” Some of these providers (particularly large Telehealth only national companies) unfortunately will often write patients for the same medications over-and-over (Adderall, Vyvanse or Ritalin) even when a patient repeatedly tells them that they have difficulty filling their script at their local pharmacy. While some individuals benefit greatly from treatment for ADHD with medications such as Adderall, Vyvanse or Ritalin, providers need to educate themselves on similar medications (often with the exact same active ingredients) that DO tend to have availability at local pharmacies.

This blog was written to help both patients and providers, to better understand “substitute” medications, and how to increase the likelihood that a patient will be successful in consistently filling their ADHD medications, for treatments for ADHD such as Adderall, Adderall XR, Vyvanse, Concerta and Focalin.

For additional information on the ADHD medication shortage, you can see our rather lengthy page covering this topic here.

Substitutes for “Amphetamine” Stimulants for ADHD such as Adderall, Adderall XR and Vyvanse

• Adderall and Adderall XR are comprised of Dextro-amphetamine (75%) and Levo-amphetamine (25%) as their active ingredients (3:1 Ratio). These compounds are simply mirror images of each other, similar to right and left hand gloves.
  • Adzenys XR-ODT is a dissolvable tablet that contains D and L-Amphetamine (also in a ratio of 3:1). Because it’s dissolvable, it’s under patent and it tends to be readily available at specialty pharmacies (who can often ship directly to patients) with the manufacturer’s coupon. Click here.
  • Evekeo (amphetamine sulfate) is available in trade name and generic forms. It is a combination of amphetamine salts, similar to both Adderall and Adderall XR, with a 1:1 ratio between Dextroamphetamine and Levoamphetamine. Some patients prefer this medication to Adderall or Adderall XR, stating that it is better tolerated with less insomnia, anxiety, irritability and “crash” of energy as it wears off.
  • Dynavel XR is a patented ADHD medication with a ratio of 3.2 to 1 Dextro to Levo-Amphetamine. It is often readily available with the manufacturer’s coupon, which can be found here.
  • Mydayis can be considered an “extended extended release Adderall.” It contains beads of D and L-amphetamine, that dissolve at different times after taken. Therefore, the medication provides ADHD relief for about 16 hours. It is available in both trade and generic forms. Coupons can often be found on GoodRx. Some believe it may have less abuse potential than immediate release Adderall, as patients do not feel a more immediate effect.
• Vyvanse is a “pro-drug” of Dextro-amphetamine. This means, that the active ingredient of Vyvanse (lisdexamphetamine) is turned into D-Amphetamine by the body.
  • Xelstrym is a transdermal patch, that patients wear for 8-9 hours a day. It slowly releases D-Amphetamine as its active ingredient into the blood stream. It is often readily available (within a couple of days from ordering) with the manufacturer’s coupon, which can be found here.
  • Dexedrine ER is an extended release D-Methylphenidate generic product. This medication is sometimes available, when other methylphenidate medications are not. It may be of benefit to ask your pharmacist if they can stock this medication, if you take Vyvanse but have difficulty filling it consistently.

Substitutes for “Methylphenidate” Stimulants for ADHD such as Ritalin, Concerta and Focalin

• Ritalin, Ritalin LA and Ritalin ER have a mixture of 50% (1:1) Dextro and Levo-Methylphenidate, as their active ingredients. Concerta is an extended release methylphenidate product, which also contains D and L-Methylphenidate as its active ingredients.
  • Contempla XR-ODT is a dissolvable tablet containing both D and L-Methylphenidate as its active ingredients. This medication can often be ordered by local pharmacies. The manufacturer’s program can be found here.
  • Jornay PM is a medication containing both D and L-Methylphenidate as its active ingredients. It is taken at night, and therefore, begins to work as a patient wakes in the morning (and lasts about 16 hours). Information on the manufacturer’s program can be found here.
  • Daytrana is a patch that slowly releases a combination of both D and L-Methylphenidate into the blood stream. Patients can wear this patch for 8-9 hours, with it lasting through the work or school day. It is available in both generic and trade name forms, and can typically be ordered by local pharmacies, with minimal delay. Even if paying out of pocket, cost may be reasonable with a GoodRx coupon.
• Focalin and Focalin XR contain D-Methylphenidate (Dextromethylphenidate) as its active ingredient (as opposed to a mixture of D and L-Methylphenidate).
  • Azstarys is a “pro-drug” of D-Methylphenidate. This means that the body turns it into Dextro-Methylphenidate as its active ingredient. It often provides 8-9 hours of symptom relief for patients with ADHD. It is often readily available at pharmacies, and information on the manufacturer’s program can be found here.

Don’t Forget Non-Stimulant & Non-Controlled Options for ADHD Treatment!

We believe that it’s incredibly important for patients to ask their providers about (and providers to discuss with their patients) non-controlled medications for ADHD such as Strattera (Atomoxetine), Qelbree (Viloxazine), Clonidine, Intuniv (Guanfacine) and others. There are also “less” controlled medications, which may have less abuse potential than Adderall, vyvanse and similar “control 2” medications, such as Provigil (Modafinil) and Nuvigil (Armodafinil). Wellbutrin (buproprion) is often used off-label for ADHD as well. Look out for additional blogs on these medications, or visit our youtube channel for videos on specific medication.

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