When Xelstrym Isn't Available, You Still Have Options

Xelstrym is a unique ADHD medication — the only amphetamine delivered through a skin patch. But between its limited distribution network, brand-only pricing, and the ongoing stimulant supply challenges, many patients find themselves unable to fill their Xelstrym prescription.

If that's you, don't panic. There are effective alternatives that your doctor can prescribe. In this guide, we'll cover what Xelstrym is, how it works, and the best alternative medications to discuss with your healthcare provider.

What Is Xelstrym and How Does It Work?

Xelstrym is a transdermal patch that delivers Dextroamphetamine through the skin over a 9-hour wear period. It's FDA-approved for ADHD in adults and children aged 6 and older, and is manufactured by Noven Pharmaceuticals.

Dextroamphetamine is a central nervous system stimulant that works by increasing levels of dopamine and norepinephrine in the brain. These neurotransmitters play key roles in attention, focus, and impulse control. By boosting their activity, Xelstrym helps reduce the core symptoms of ADHD.

What makes Xelstrym unique is its delivery method. Instead of swallowing a pill, you apply a patch to your hip. This can be helpful for people who have trouble swallowing medications, experience GI side effects with oral stimulants, or want the flexibility to remove the patch and stop medication delivery partway through the day.

For more details on the medication itself, see our guide on what Xelstrym is and how to use it.

Why You Might Need an Alternative

There are several common reasons patients look for Xelstrym alternatives:

• Availability: Xelstrym is distributed through a limited partner pharmacy network, and many pharmacies don't stock it. Read more about why Xelstrym is so hard to find.
• Cost: Without insurance, Xelstrym costs $350–$500 per month with no generic available.
• Insurance denial: Some insurance plans require step therapy (trying cheaper oral stimulants first) before covering Xelstrym.
• Side effects: Some patients experience significant skin irritation at the patch application site.

Alternative 1: Vyvanse (Lisdexamfetamine)

Vyvanse is one of the closest alternatives to Xelstrym. It's a prodrug of Dextroamphetamine, meaning your body converts it into the same active compound that Xelstrym delivers through the skin.

• How it's taken: Oral capsule or chewable tablet, taken once daily in the morning
• Duration: Up to 14 hours
• Generic available: Yes — generic Lisdexamfetamine became available in 2023, making it significantly more affordable
• Typical cost: $30–$80/month for generic with a coupon card
• Key difference from Xelstrym: Oral administration; cannot be removed mid-day to stop medication delivery

Vyvanse is widely prescribed and generally easier to find than Xelstrym. The generic version has made it one of the more affordable brand-equivalent ADHD medications on the market.

Alternative 2: Adderall XR (Mixed Amphetamine Salts, Extended Release)

Adderall XR contains a mixture of four amphetamine salts, including Dextroamphetamine. It's one of the most commonly prescribed ADHD medications in the United States.

• How it's taken: Extended-release capsule, taken once daily in the morning
• Duration: 10–12 hours
• Generic available: Yes — generic mixed amphetamine salts ER are widely available
• Typical cost: $25–$60/month for generic with a coupon card
• Key difference from Xelstrym: Contains both dextroamphetamine and levoamphetamine (a 3:1 ratio), oral administration

Adderall XR has been on the market for over two decades and has a long track record. While the stimulant shortage has affected Adderall supply in recent years, the generic extended-release version is generally available at most pharmacies.

Alternative 3: Dexedrine or Zenzedi (Oral Dextroamphetamine)

If you're specifically looking for a medication with the exact same active ingredient as Xelstrym, oral Dextroamphetamine is the closest match. It's available in two forms:

• Dexedrine Spansules (extended release): Capsules that last 8–12 hours
• Zenzedi or generic Dextroamphetamine tablets (immediate release): Shorter-acting tablets lasting 4–6 hours, typically taken 2–3 times daily

Details:

• Generic available: Yes — both IR and ER forms
• Typical cost: $20–$60/month for generic
• Key difference from Xelstrym: Oral delivery, may require multiple daily doses (IR form)

Oral Dextroamphetamine is the most pharmacologically similar alternative to Xelstrym, since it's literally the same drug — just taken by mouth instead of through a patch.

Alternative 4: Methylphenidate-Based Medications

If amphetamine-based medications aren't working for you or aren't available, Methylphenidate is the other major class of stimulant used to treat ADHD. Common options include:

• Concerta (Methylphenidate ER): Extended-release tablet, lasts 10–12 hours, available as generic
• Ritalin LA (Methylphenidate ER): Extended-release capsule, available as generic
• Focalin XR (Dexmethylphenidate ER): Extended-release capsule, available as generic

Methylphenidate works differently than amphetamines — it primarily blocks the reuptake of dopamine and norepinephrine rather than promoting their release. Some patients respond better to one class than the other, so switching from amphetamines to methylphenidate is a reasonable option to discuss with your doctor.

How to Talk to Your Doctor About Switching

If you can't find or afford Xelstrym, bring it up with your prescriber. Here are some things to mention:

• How long you've been unable to fill your Xelstrym prescription
• Whether cost or availability (or both) is the main barrier
• Any specific reasons you were prescribed the patch form (e.g., trouble swallowing pills, GI issues)
• Whether you've tried other stimulants before and how you responded

Your doctor can help determine which alternative is the best fit based on your medical history, preferences, and what's actually available at your pharmacy.

Don't Give Up on Finding Xelstrym

While exploring alternatives, it's worth continuing to look for Xelstrym if it's the medication that works best for you. Use Medfinder to check availability near you, and read our guide on how to find Xelstrym in stock for practical tips.

Final Thoughts

Xelstrym is a unique medication, but it's not your only option. Vyvanse (now available as generic Lisdexamfetamine), Adderall XR, oral Dextroamphetamine, and Methylphenidate-based medications are all proven ADHD treatments that may be easier to find and more affordable. Talk to your healthcare provider about the best path forward for your situation.