When Your Prescription Can't Be Filled

You need your ADHD medication, but Dexmethylphenidate XR (Focalin XR) is nowhere to be found. The ongoing stimulant shortage has left millions of patients searching for alternatives — and if you're one of them, this guide is for you.

We'll explain how Dexmethylphenidate XR works, then walk through the most common alternatives your doctor might consider. Important: Never switch medications on your own. Always work with your prescriber to find the right option for you.

What Is Dexmethylphenidate XR and How Does It Work?

Dexmethylphenidate XR is an extended-release stimulant used to treat ADHD in patients aged 6 and older. It contains the active "d" isomer of Methylphenidate — the same ingredient in Ritalin — which means it's essentially the more potent half of that well-known medication.

It works by blocking the reuptake of dopamine and norepinephrine in the brain. These are neurotransmitters involved in attention, focus, and impulse control. By keeping more of them available in the spaces between nerve cells, Dexmethylphenidate XR helps reduce ADHD symptoms like inattention, hyperactivity, and impulsivity.

The extended-release capsule is designed to last about 12 hours with a single morning dose. It's a Schedule II controlled substance, and the brand name is Focalin XR, made by Novartis.

For a deeper dive, see our article on how Dexmethylphenidate XR works.

Alternative #1: Methylphenidate ER (Concerta, Ritalin LA)

Methylphenidate ER is the closest alternative to Dexmethylphenidate XR because they share the same active ingredient family. The difference? Methylphenidate contains both the "d" and "l" isomers, while Dexmethylphenidate contains only the active "d" isomer.

In practice, this means:

• A 20 mg dose of Methylphenidate ER is roughly equivalent to a 10 mg dose of Dexmethylphenidate XR
• Same mechanism of action (dopamine and norepinephrine reuptake inhibition)
• Similar duration of effect (8-12 hours depending on formulation)
• Available as Concerta (OROS delivery system, up to 12 hours) and Ritalin LA (beaded capsule, about 8 hours)

Methylphenidate ER has multiple generic manufacturers, which can make it somewhat easier to find during shortages — though it's also been affected by supply issues.

Typical cost: Generic Methylphenidate ER starts around $25-$60/month with a discount coupon.

Alternative #2: Adderall XR (Mixed Amphetamine Salts)

Adderall XR is an amphetamine-based stimulant, which puts it in a different sub-class than Dexmethylphenidate XR. Instead of blocking reuptake, amphetamines work primarily by increasing the release of dopamine and norepinephrine from nerve cells.

Key differences:

• Different mechanism — may work for patients who don't respond well to Methylphenidate-based medications
• Comes in extended-release capsules lasting about 10-12 hours
• Available in strengths from 5 mg to 30 mg
• Also a Schedule II controlled substance

Adderall XR has also experienced significant shortages, but generic versions from multiple manufacturers may improve availability. It's one of the most commonly prescribed ADHD medications in the U.S.

Typical cost: Generic Adderall XR starts around $30-$70/month with a coupon.

Alternative #3: Vyvanse (Lisdexamfetamine)

Vyvanse is a prodrug of Dextroamphetamine. That means it's inactive when you swallow it — your body converts it into the active drug during digestion. This design gives Vyvanse a smoother onset and offset and is thought to carry a lower risk of abuse compared to other stimulants.

Key features:

• Lasts up to 14 hours — the longest-acting stimulant available
• Available as capsules and chewable tablets (10 mg to 70 mg)
• FDA-approved for ADHD and binge eating disorder
• Generic Lisdexamfetamine became available in 2023, lowering costs

Vyvanse is a strong option for patients who need long-lasting coverage or who have concerns about abuse potential.

Typical cost: Generic Lisdexamfetamine starts around $30-$80/month with a coupon.

Alternative #4: Strattera (Atomoxetine) — A Non-Stimulant Option

Not everyone can or wants to take a stimulant. Strattera (Atomoxetine) is a non-stimulant ADHD medication that works by selectively blocking the reuptake of norepinephrine.

Key differences from Dexmethylphenidate XR:

• Not a controlled substance — no DEA quota restrictions, easier to prescribe and fill
• Takes 4-6 weeks to reach full effect (stimulants work the same day)
• Can be taken morning or evening
• May be a better fit for patients with anxiety, tic disorders, or substance use history
• Not affected by the current stimulant shortage

The main trade-off is that Atomoxetine generally isn't as effective for core ADHD symptoms as stimulants, and it takes longer to start working. But for some patients, it's a reliable option — especially when stimulants are unavailable.

Typical cost: Generic Atomoxetine starts around $15-$40/month with a coupon.

How to Talk to Your Doctor About Switching

If you're considering an alternative, here's how to approach the conversation:

1. Explain the situation. Tell your doctor that you've been unable to fill your Dexmethylphenidate XR prescription due to the shortage.
2. Share what you've tried. Let them know you've checked multiple pharmacies, used tools like Medfinder, and still can't find it.
3. Ask about equivalents. Your doctor can calculate an equivalent dose of a similar medication and write a new prescription.
4. Discuss temporary vs. permanent switches. You may want to switch back to Dexmethylphenidate XR once supply stabilizes, or you may find that an alternative works even better for you.

Final Thoughts

Not being able to fill your ADHD medication is stressful — but it doesn't mean you're out of options. Methylphenidate ER, Adderall XR, Vyvanse, and Strattera are all established alternatives with proven track records for managing ADHD.

Work with your doctor to find the best fit, and use Medfinder to check availability of both Dexmethylphenidate XR and any alternative your prescriber recommends. You can also read about how to find Dexmethylphenidate XR in stock near you if you'd prefer to stick with your current medication.