Provider Briefing: The Dextroamphetamine Shortage in 2026

The amphetamine shortage that began in October 2022 continues to impact clinical practice across the United States. Dextroamphetamine — prescribed as Dexedrine, Zenzedi, ProCentra, and various generics — remains intermittently unavailable at pharmacies nationwide. For providers managing ADHD and narcolepsy patients, this means ongoing challenges with treatment continuity, patient frustration, and clinical decision-making.

This briefing covers the current state of the shortage, its root causes, prescribing considerations, and practical tools to support your patients.

Shortage Timeline

Understanding how we got here helps frame the current landscape:

• October 2022: Teva Pharmaceuticals, the largest manufacturer of generic mixed amphetamine salts (Adderall), reported supply disruptions. The FDA added amphetamine mixed salts to its Drug Shortage list.
• 2023: The shortage expanded to include pure dextroamphetamine products. Multiple manufacturers reported intermittent back orders. The FDA reported increased demand driven by a 6% year-over-year growth in prescriptions.
• 2024: Supply improved modestly for some formulations, but shortages persisted for specific strengths and extended-release products. Patient complaints and advocacy pressure mounted on the DEA to increase production quotas.
• October 2025: The DEA raised the Aggregate Production Quota (APQ) for d-amphetamine from 21.2 million grams to 26.5 million grams — a 25% increase. While significant, analysts noted this increase still trails estimated demand.
• Early 2026: Some formulations remain on the FDA and ASHP shortage lists. Extended-release capsules in 10 mg and 20 mg strengths have been particularly affected, with some manufacturers estimating restock dates in Q1 2026.

Prescribing Implications

The shortage creates several practical challenges for prescribers:

Treatment Discontinuity

Patients who cannot fill their Dextroamphetamine prescriptions face gaps in treatment that can affect work performance, academic functioning, driving safety, and mental health. Abrupt discontinuation of stimulants can also cause fatigue, depression, and rebound symptoms.

Dose and Formulation Flexibility

Consider writing prescriptions with flexibility in mind:

• If a patient's specific strength is unavailable, prescribing a different strength with instructions to split or combine doses may help (e.g., two 10 mg tablets instead of one 20 mg).
• Switching between immediate-release and extended-release formulations may improve fill rates. Note that dosing equivalencies differ — ER capsules are typically dosed once daily at a higher mg than the individual IR doses.
• The oral solution (ProCentra, 5 mg/5 mL) is sometimes overlooked but may be available when tablets are not.

Therapeutic Alternatives

When Dextroamphetamine is consistently unavailable, consider these alternatives:

• Mixed Amphetamine Salts (Adderall/Adderall XR): Contains dextroamphetamine and levoamphetamine. Similar efficacy profile; also affected by the shortage but may have better regional availability.
• Lisdexamfetamine (Vyvanse): Prodrug of dextroamphetamine. Generic became available in 2023. Smoother pharmacokinetic profile with lower abuse potential. Increasingly available.
• Methylphenidate (Ritalin, Concerta, Focalin): Different mechanism of action. Generally less affected by the current shortage. First-line for many patients; reasonable switch for amphetamine-responsive patients, though some may not respond as well.
• Atomoxetine (Strattera): Non-stimulant SNRI. Appropriate for patients with comorbid anxiety or substance use concerns. Takes 4-6 weeks for full effect. No controlled substance restrictions.

For patient-facing alternative information to share: Alternatives to Dextroamphetamine.

Current Availability Picture

Availability varies significantly by:

• Geographic region: Urban areas with more pharmacies may have better access; however, high-demand areas can also see faster depletion.
• Pharmacy type: Independent pharmacies often work with different wholesalers than chain pharmacies and may have stock when chains don't.
• Specific formulation and strength: IR tablets in mid-range strengths (10 mg, 15 mg) tend to be more available than ER capsules or very high/low doses.

Medfinder for Providers offers real-time pharmacy inventory data that can help you direct patients to pharmacies with current stock.

Cost and Access Considerations

During a shortage, patients may face higher costs due to reduced competition and limited alternatives:

• Generic Dextroamphetamine IR: ~$30-$80/month with discount coupons
• Generic Dextroamphetamine ER: ~$50-$120/month
• Brand Zenzedi: $200-$400+/month without insurance
• Discount cards (GoodRx, SingleCare) can significantly reduce out-of-pocket costs for uninsured or underinsured patients

Patients with financial hardship may benefit from NeedyMeds or RxAssist databases for patient assistance programs. For a patient-facing cost guide: How to save money on Dextroamphetamine.

Tools and Resources for Your Practice

• Medfinder for Providers: Real-time pharmacy availability search. Help patients find Dextroamphetamine in stock near them.
• FDA Drug Shortage Database: Official shortage status and manufacturer updates.
• ASHP Drug Shortage Resource Center: Detailed shortage information including estimated restock dates by manufacturer.
• DEA Quota Information: Track aggregate production quota changes that affect supply.

For a practical workflow guide, see: How to help your patients find Dextroamphetamine in stock.

Looking Ahead

The DEA's October 2025 quota increase should bring additional supply to market through the first half of 2026. However, with ADHD diagnoses continuing to grow and manufacturing timelines measured in months, full resolution of the shortage is unlikely in the near term.

Providers should continue to:

• Maintain open communication with patients about availability challenges
• Offer flexibility in prescribing (strengths, formulations, alternatives)
• Direct patients to tools like Medfinder for real-time pharmacy search
• Document shortage-related treatment changes for continuity of care

Final Thoughts

The Dextroamphetamine shortage is a systemic issue with no quick fix. As prescribers, you play a critical role in helping patients navigate the gap between supply and demand. By staying informed, being flexible with prescribing, and leveraging real-time availability tools, you can help ensure your patients maintain access to effective treatment despite the ongoing challenges.