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.
Abstract:
Stimulant shortages, driven by manufacturing delays, regulatory production quotas, and rising demand, have created significant challenges in the treatment of attention-deficit/hyperactivity disorder. This review provides a systematic framework for medication substitution during shortages, including dose equivalence table and conversion formulas. Critical considerations guiding substitutions include pharmacological distinctions between amphetamine (AMP) and methylphenidate (MPH), isomer composition, dose equivalence, and duration of action. Nonstimulant agents such as atomoxetine and α2-adrenergic agonists are reviewed with attention to their efficacy, tolerability, need for gradual titration, and delayed onset. Patient-specific factors, including age, psychiatric comorbidities, substance use history, and cardiovascular risks, remain essential when selecting alternatives. Systematic monitoring is emphasized to ensure effectiveness and treatment safety during transitions. By integrating pharmacological and patient-centered considerations, this review provides a practical approach for clinicians to maintain treatment continuity during stimulant shortages.
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