Lack of regular ADHD medication - "vulnerable to children"

Elvanse is a prescription drug that is given to adults and children over 6 years with ADHD. It helps to improve attention, concentration and reduce impulsive behavior.

Elvanse in the dose of 20, 40 and 60 milligrams has been listed at the Swedish Medicines Agency since October 28 this year and is believed to be until 31 January 2020. However, doses 30, 50 and 70 milligrams have not been listed.

According to the National Board of Health, 45,163 people Elvanse had been prescribed at least once in 2018, which makes the drug the second most common ADHD medicine in Sweden after the drug methylphenidate. But unlike methylphenidate, which is manufactured by several companies, there is no alternative to Elvanse.

- We try to help families as best they can. But when there is only one type, and manufacturer, of this medicine, it becomes vulnerable to the children, says Björn Serrander, ST physician at the Child and Adolescent Psychiatry (BUP) in Gothenburg.

In addition, Elvanse is not a so-called first-hand preparation.

- If you take this medicine you have already tried others that have not worked well, says Serrander.

According to Björn Serrander, it is difficult to know how residual listing will affect patients, as the medication is very individually tailored. For some it is possible to change the dose, while for others it is not as good.

- If you have found exactly the right dose that fits well, it can be quite sensitive to change. Then it may even be better to pause their medication, than to switch. One tip is to take a break during the Christmas holidays, if you can manage it, he says.

More than 18,000 of those who got Elvanse printed last year were under 19 years. When SVT News contacts BUP-receptions in Stockholm, Gothenburg and Malmö, everyone says that the lack of medicine has been marked.

- Parents must turn to the BUP clinic and discuss with the nurse and doctor to find solutions if the usual dose is over. The patient must make checks of heart rate and blood pressure, which takes time for the patient, parents as well as the care and displaces other patients, says Madeleine Ardbo, patient safety consultant and assistant operations manager at BUP Stockholm.

If the patient does not feel comfortable with a changed dose, treatment may need to be discontinued, which may result in the patient being at risk of being un-medicated and having increased ADD or ADHD symptoms, and lower functional levels.

- The lack of medicine is not a disaster situation in my assessment, but it creates concerns and leads to practical difficulties for those affected, says Gunnar Moustgaard, medical advisor for psychiatry and rehabilitation in the Skåne region.

Takeda, which produces and distributes Elvanse, writes in an e-mail to SVT News that they "are working to minimize any adverse effects for patients" and that "they prioritize delivery to the affected countries, where Sweden is prioritized".