Related guidance:
- Recommends that people with ADHD have a comprehensive, holistic shared treatment plan that addresses psychological, behavioural and occupational or educational needs.
NHS Somerset Neurodivergence page for detailed information on ADHD treatment, updates, supporting information and information on managing manufacturing delays and stock shortages.
NHS Somerset Shared Care and PGDs page to access the current ADHD Shared Care Protocol under ‘Shared Care Protocols (SCPs)’
NHS Somerset Prescribing and Medicines Management Home page to access the current NHS Somerset Traffic light guidance under ‘Useful Documents’
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| CNS Stimulants, Centrally acting sympathomimetics | |||
| NHS Somerset classify methylphenidate as an Amber drug, for the treatment of ADHD in children over 6 years of age, adolescents, and adults in accordance with the agreed shared care protocol and NHS Somerset traffic light guidance. | |||
| Methylphenidate - standard release | Methylphenidate | 5mg tablet: £3.03 (30) | Child 6–17 years: Treatment titrated by specialists to a maximum licensed dose of 60mg daily in 2 to 3 divided doses. Adults: Treatment titrated by specialists to a maximum dose of 60mg daily in 2 to 3 divided doses. See the shared care protocol and individual summary of product characteristics for more information. Immediate release formulations reach maximum plasma concentration after 1 to 2 hours. Duration of action is 4 hours. |
| 10mg tablet: £2.56 (30) | |||
| 20mg tablet: £10.92 (30) | |||
| Methylphenidate - modified release tablet 12 hour preparation | Methylphenidate MR products include an IR component and a MR component allowing a two-phase release of methylphenidate. To avoid confusion, good practice is to prescribe methylphenidate MR products by brand. |
||
| as Affenid XL® | 18mg modified-release tablet: £10.90 (30) | Child 6–17 years: Treatment titrated by specialists to a maximum licensed dose of 54mg once daily in the morning. Adult: Treatment titrated by specialists to a maximum dose of 72mg once daily in the morning. See the shared care protocol and individual summary of product characteristics for more information. Total daily dose of 15mg of standard-release formulation is considered equivalent to modified-release 18mg once daily. Cost-Effective Formulary Brands: Affenid XL, Matoride XL, Xenidate XL, Xaggitin XL and Delmosart – These are considered bioequivalent. Concerta XL is NON-FORMULARY The onset of action of these formulations is 1 to 2 hours, the second peak is at 6 to 8 hours. Duration of action is 12 hours. They can be taken in the morning with or without food |
|
| 27mg modified-release tablet: £12.87 (30) | |||
| 36mg modified-release tablet: £14.85 (30) | |||
| 54mg modified-release tablet: £25.75 (30) | |||
| as Matoride XL® | 18mg modified-release tablet: £15.58 (30) | ||
| 36mg modified-release tablet: £21.22 (30) | |||
| 54mg modified-release tablet: £36.80 (30) | |||
| as Xenidate XL® | 18mg modified-release tablet: £15.57 (30) | ||
| 27mg modified-release tablet: £18.39 (30) | |||
| 36mg modified-release tablet: £21.21 (30) | |||
| 54mg modified-release tablet: £36.79 (30) | |||
| as Xaggitin XL® | 18mg modified-release tablet: £15.58 (30) | ||
| 27mg modified-release tablet: £18.40 (30) | |||
| 36mg modified-release tablet: £21.22 (30) | |||
| 54mg modified-release tablet: £36.80 (30) | |||
| as Delmosart® | 18mg modified-release tablet: £15.57 (30) | ||
| 27mg modified-release tablet: £18.39 (30) | |||
| 36mg modified-release tablet: £21.21 (30) | |||
| 54mg modified-release tablet: £36.79 (30) | |||
| Methylphenidate - modified release capsule 8-hour preparation | Methylphenidate MR products include an IR component and a MR component allowing a two-phase release of methylphenidate. Proportions of IR and MR methylphenidate differs between cost-effective formulary brands, and non-cost-effective brands. To avoid confusion, good practice is to prescribe methylphenidate MR products by brand. |
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| as Meflynate XL® | 10mg modified-release capsule: £17.50 (30) | Child 6–17 years: Treatment titrated by specialists to a maximum licensed dose of 60mg once daily in the morning. Adult: Treatment titrated by specialists to a maximum dose of 60mg once daily in the morning. See the Shared Care Protocol and Individual Summary of Product Characteristics for more information. The onset of action of these modified-release formulations is 1 to 2 hours, the second peak is at 4 hours. Duration of action is 8 hours. Cost-Effective Formulary Brands: Meflynate XL® and Metyrol XL® release the IR and MR doses at a 50:50 ratio. They can be taken in the morning with or without food. Non-cost-effective brands may differ in their release profile and requirements to take before or with food, see individual Summary of Product Characteristics. |
|
| 20mg modified-release capsule: £21.00 (30) | |||
| 30mg modified-release capsule: £24.50 (30) | |||
| 40mg modified-release capsule: £40.40 (30) | |||
| 50mg modified-release capsule: £47.40 (30) | |||
| 60mg modified-release capsule: £47.40 (30) | |||
| as Metyrol XL® | 10mg modified-release capsule: £17.94 (30) | ||
| 20mg modified-release capsule: £21.54 (30) | |||
| 30mg modified-release capsule: £25.12 (30) | |||
| 40mg modified-release capsule: £43.07 | |||
| 60mg modified-release capsule: £50.24 (30) | |||
| Dexamfetamine and lisdexamfetamine (long acting prodrug of dexamfetamine) | |||
| NHS Somerset classify dexamfetamine and lisdexamfetamine as Amber drugs, for the treatment of ADHD in children over 6 years of age, adolescents, and adults in accordance with the agreed shared care protocol and NHS Somerset traffic light guidance. See the traffic light guidance for the Somerset position for other indications of dexamfetamine. |
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| Dexamfetamine | as Amfexa® | 5mg tablet: £19.89 | Child 6–17 years: Treatment titrated by specialists up to 20 mg daily. Maintenance dose to be given in 2 to 4 divided doses. Adult: Treatment titrated by specialists up to 20 mg daily. Maintenance dose to be given in 2 to 4 divided doses. Onset of action is 20 to 60 minutes with a duration of action of 3 to 6 hours. |
| 10mg tablet £39.78 | |||
| 20mg tablet: £79.56 | |||
| Lisdexamfetamine | as Elvanse or Elvanse Adult® | 20mg capsule: £54.62 | Lisdexamfetamine is a prodrug of dexamfetamine. Child 6–17 years: Treatment titrated by specialists to a maximum dose of 70mg once in the morning. Adult: Treatment titrated by specialists to a maximum dose of 70mg once in the morning. Onset of action is 20 to 60 minutes and duration of action is 13 to 14 hours. |
| 30mg capsule: £58.24 | |||
| 40mg capsule: £62.82 | |||
| 50mg capsule: £68.60 | |||
| 60mg capsule: £75.18 | |||
| 70mg capsule: £83.16 | |||
| Selective Norepinephrine (noradrenaline) Reuptake Inhibitor (Non-Stimulant | |||
| NHS Somerset classify atomoxetine as an Amber drug, for the treatment of ADHD in children over 6 years of age, adolescents, and adults in accordance with the agreed shared care protocol and NHS Somerset traffic light guidance. | |||
| Atomoxetine | 10mg capsule: £50.11 | Child 6–17 years: (body-weight up to 70 kg) Treatment titrated by specialists. No additional benefit has been demonstrated for doses higher than 1.2 mg/kg/day. Child 6–17 years: (body-weight 70 kg and above) Treatment titrated by specialists. The maximum recommended total daily dose is 100mg. Adult: Treatment titrated by specialists. The maximum recommended total daily dose is 100mg. |
|
| 18mg capsule: £52.87 | |||
| 25mg capsule: £48.77 | |||
| 40mg capsule: £53.29 | |||
| 60mg capsule: £54.57 | |||
| 80mg capsule: £70.22 | |||
| 100mg capsule: £67.98 | |||
| Sympathomimetics, Alpha2-adrenoceptor agonist | Guanfacine as Intuniv® | 1mg modified-release tablet: £56.00 (28) | NHS Somerset classify Guanfacine as an amber drug as per traffice light guidance for attention deficit hyperactivity disorder in children for whom stimulants are not suitable, not tolerated or ineffective (initiated under specialist supervision). Child 6–12 years (body-weight 25 kg and above) Initially 1 mg once daily; adjusted in steps of 1 mg every week if necessary and if tolerated; maintenance 0.05–0.12 mg/kg once daily (max. per dose 4 mg), for optimal weight-adjusted dose titrations, consult product literature. Child 13–17 years (body-weight 34–41.4 kg) Initially 1 mg once daily; adjusted in steps of 1 mg every week if necessary and if tolerated; maintenance 0.05–0.12 mg/kg once daily (max. per dose 4 mg), for optimal weight-adjusted dose titrations, consult product literature. Child 13–17 years (body-weight 41.5–49.4 kg) Initially 1 mg once daily; adjusted in steps of 1 mg every week if necessary and if tolerated; maintenance 0.05–0.12 mg/kg once daily (max. per dose 5 mg), for optimal weight-adjusted dose titrations, consult product literature. Child 13–17 years (body-weight 49.5–58.4 kg) Initially 1 mg once daily; adjusted in steps of 1 mg every week if necessary and if tolerated; maintenance 0.05–0.12 mg/kg once daily (max. per dose 6 mg), for optimal weight-adjusted dose titrations, consult product literature. Child 13–17 years (body-weight 58.5 kg and above) Initially 1 mg once daily; adjusted in steps of 1 mg every week if necessary and if tolerated; maintenance 0.05–0.12 mg/kg once daily (max. per dose 7 mg), for optimal weight-adjusted dose titrations, consult product literature. Monitoring of patient parameters For guanfacine manufacturer advises to conduct a baseline evaluation to identify patients at risk of somnolence, sedation, hypotension, bradycardia, QT-prolongation, and arrhythmia; this should include assessment of cardiovascular status. Monitor for signs of these adverse effects weekly during dose titration and then every 3 months during the first year of treatment, and every 6 months thereafter. Monitor BMI prior to treatment and then every 3 months for the first year of treatment, and every 6 months thereafter. More frequent monitoring is advised following dose adjustments. Monitor blood pressure and pulse during dose downward titration and following discontinuation of treatment. |
| 2mg modified-release tablet: £58.52 (28) | |||
| 3mg modified-release tablet: £65.52 (28) | |||
| 4mg modified-release tablet: £76.16 (28) | |||