A practical guide to switching ADHD medications during shortages
STUDY: Hwang G et al, J Pharm Pract 2026;0(0):1–10
STUDY TYPE: Review
FUNDING: Independent
Background
The U.S. stimulant shortage started with Adderall in late 2022, when Teva reported manufacturing delays, and quickly spread to Vyvanse, Concerta, and Ritalin. The crisis was driven by:
- Aging production facilities
- DEA production quotas
- Surge in ADHD diagnoses (which rose 15% between 2020 and 2023)
This review addresses what clinicians face when a patient’s stimulant is simply unavailable.
How to Convert
The authors offer a straightforward conversion formula: multiply the current dose by the new drug’s equivalence factor divided by the current drug’s equivalence factor. Those equivalence factors are in this table:
Here’s how that looks for switching from Adderall XR 20 mg to Dexedrine Spansule:
For cross-class switches (amphetamine to methylphenidate or vice versa), start at roughly half the equivalent amphetamine dose and titrate up. When titrating, consider that amphetamines are roughly twice as potent as methylphenidate agents and carry a higher risk of sleep disruption, appetite suppression, and misuse. Methylphenidate is more often associated with depression and stomachache.
When stimulants are contraindicated or unavailable, atomoxetine works in both children and adults, though its benefit-risk profile in adults is debated. Guanfacine and clonidine work in children but have not demonstrated efficacy versus placebo in adults.
Some stimulants have unique conversion factors because they are absorbed differently, and I’ve covered those in more details in this Psych Times article.
Practice Implications
When your patient’s stimulant is out of stock, try a different manufacturer of the same drug first, then consider a within-class substitution before crossing to the other class.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
