High and medium-level supply notifications have been issued for norethisterone, methylphenidate prolonged-release and some naltrexone medications.

'High impact' ADHD med shortage may require paper prescriptions

Yesterday (22 August) the Department of Health and Social Care (DHSC) issued a 'high impact' medicine supply notification for methylphenidate prolonged-release tablets.

It said these were currently in 'limited supply', while 'intermittent regional supply disruptions' were expected to continue until October 2024.

Lisdexamfetamine (Elvanse, Elvanse Adult) capsules are available and can support increased demand, the medicine supply notification said, but while methylphenidate (Equasym XL) modified-release capsules are currently available, theses cannot support increased demand.

Prescribers have been told to prescribe Elvanse and Elvanse Adult capsules generically until normal methylphenidate prolonged release tablet supply resumes.

And DHSC noted that unlicensed supplies of methylphenidate prolonged-release tablets can be sourced, while some specialist importers had confirmed that they can source unlicensed desmopressin 4micrograms/1ml solution for injection ampoules and vials.

If prescribers wish to prescribe a specially manufactured or imported product that is not listed on the dictionary of medicines and devices (dm+d), they must issue an FP10 paper prescription - rather than an electronic prescription -  as ‘Methylphenidate XXX (Special Order)’.

This should then be endorsed by the pharmacy as a non-Part VIIIB special with:

  • Amount dispensed over pack size used;
  • Invoice price per pack size from which the order was supplied less any discount or rebate;
  • Manufacturers’/importers’ MHRA licence number;
  • Batch number of the product supplied;
  • SP

Central nervous system drugs were the second-most prescribed category of drugs in 2023/24, making up 19% of NHS England prescribing.

And the most recent NHS Business Services Authority (NHSBSA) annual report highlighted a large jump in the number of medicines prescribed for ADHD in 2023/24, which included a 28% rise in adults and a 9.9% increase in children.

'Medium impact' shortage of contraceptive pill

DHSC also issued a 'medium impact' medicine supply notification for norethisterone (Noriday) 350microgram tablets this week (22 August).

The progesterone-containing pills will be out of stock from late August until early December 2024, it said.

Desogestrel 75microgram tablets remain available and can support increased demand, while levonorgestrel (Norgeston) 30microgram tablets remain available but cannot support an uplift in demand, DHSC said.

The 350microgram tablets are used as a contraceptive pill, while in other doses the drug can be used for period delay, dysmenorrhoea (cramps), dysfunctional uterine bleeding, heavy menstrual bleeding, endometriosis and breast cancer.

'Medium impact' shortage of opioid- and alcohol-dependence drug

A medicine supply notification was also issued this week (22 August) for Naltrexone 50mg tablets, used to prevent relapse in formerly opioid-dependent patients (who have remained opioid-free for at least 7–10 days), as well as in formerly alcohol-dependent patients.

Naltrexone 50mg tablets (Accord) are in limited supply until early September 2024 and then out of stock until late October 2024, DHSC said.

But naltrexone 50mg tablets (AOP Orphan) remain available and can support the increased demand.

Naltrexone (Adepend) 50mg tablets (AOP Orphan) are out of stock until mid-September 2024 and will be unable to support increased demand once back in stock, DHSC added.