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Related Concept Videos

Attention-Deficit/Hyperactivity Disorder01:30

Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and impulsivity. It affects approximately 5-8% of children globally, with around 60-70% of cases persisting into adulthood. ADHD has significant implications for educational attainment, social interactions, and occupational success.
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Drug Therapy

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Cognitive enhancers, also known as "smart drugs," are substances used to enhance memory, mental alertness, and concentration. These can be natural or synthetic and improve cognition in conditions like Alzheimer's disease (AD) and other neurodegenerative diseases. Some common examples include caffeine, amphetamines, methylphenidate, modafinil, arecoline, donepezil, vortioxetine, and piracetam. These enhancers work on the principle of synaptic plasticity and altered circuit function. They...
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Adrenergic Agonists: Mixed-Action Agents

Mixed-action adrenergic agonists, like ephedrine and pseudoephedrine, directly and indirectly affect adrenergic receptors. These agents stimulate adrenoceptors and indirectly release stored neurotransmitters, amplifying the adrenergic response.
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Strategies for Substituting ADHD Medications During Stimulant Shortages.

Gul Hwang1, Hyogun Yi2, Aaron Pinkhasov1

  • 1Department of Psychiatry, NYU Grossman Long Island School of Medicine, Mineola, NY, USA.

Journal of Pharmacy Practice
|May 16, 2026
PubMed
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Stimulant shortages pose challenges for ADHD treatment. This review offers a framework for medication substitution, considering drug properties and patient factors to ensure treatment continuity.

Keywords:
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Area of Science:

  • Pharmacology
  • Neuroscience
  • Clinical Pharmacy

Background:

  • Current stimulant shortages for ADHD treatment stem from manufacturing delays, regulatory issues, and increased demand.
  • These shortages significantly disrupt patient care and treatment adherence.

Purpose of the Study:

  • To provide a systematic framework for clinicians to manage medication substitution during stimulant shortages for ADHD.
  • To outline critical considerations for selecting alternative ADHD medications, including nonstimulant options.

Main Methods:

  • Systematic review of pharmacological differences between amphetamine (AMP) and methylphenidate (MPH) formulations.
  • Analysis of dose equivalence, duration of action, and isomer composition for stimulant substitutions.
  • Evaluation of nonstimulant alternatives like atomoxetine and α2-adrenergic agonists regarding efficacy and tolerability.
  • Consideration of patient-specific factors such as comorbidities and cardiovascular risks.

Main Results:

  • A framework for medication substitution is presented, including dose equivalence tables and conversion formulas.
  • Key distinctions between AMP and MPH, isomer composition, and pharmacokinetics are crucial for effective substitution.
  • Nonstimulant agents require careful titration and have a delayed onset but offer alternative treatment pathways.
  • Patient-specific factors are essential for selecting appropriate alternatives and ensuring safety.

Conclusions:

  • Clinicians can maintain ADHD treatment continuity during stimulant shortages by integrating pharmacological data with patient-centered considerations.
  • Systematic monitoring is vital to ensure the effectiveness and safety of alternative ADHD medications.
  • This review provides a practical guide for managing ADHD treatment amidst medication supply challenges.