Provider Briefing: The Dextroamphetamine XR Shortage in 2026

The amphetamine medication shortage that began in October 2022 remains one of the most persistent drug supply disruptions in recent memory. For providers prescribing dextroamphetamine extended-release (formerly Dexedrine Spansule), the situation in 2026 continues to require careful navigation — both clinically and logistically.

This article provides a concise, evidence-based overview for prescribers: where the shortage stands, what's causing it, how it affects prescribing decisions, and what tools are available to help your patients access their medication.

Shortage Timeline: How We Got Here

Understanding the timeline helps contextualize the current situation:

• October 2022: The FDA formally acknowledges a shortage of amphetamine mixed salts (Adderall) following reports of widespread availability issues. Dextroamphetamine products are also affected.
• 2023: The shortage extends across multiple amphetamine formulations. ASHP lists both immediate-release and extended-release dextroamphetamine as in shortage. The DEA begins increasing annual production quotas.
• 2024: Supply improves modestly for some formulations, but extended-release products — including dextroamphetamine ER — remain inconsistently available. Additional generic manufacturers enter the market.
• 2025: The shortage persists. ASHP continues to list amphetamine extended-release oral presentations as in active shortage with multiple manufacturers on back order.
• Early 2026: The 10 mg and 20 mg dextroamphetamine ER capsules remain on back order from several manufacturers. Supply is regional and unpredictable.

Prescribing Implications

The ongoing shortage has several important implications for clinical practice:

Treatment Continuity Concerns

Patients who have been stable on dextroamphetamine XR for months or years may face abrupt gaps in their medication supply. Unplanned treatment interruptions can lead to symptom recurrence, functional impairment, and patient frustration. Proactive communication about the shortage — and having a backup plan — is essential.

Prior Authorization and Formulary Challenges

When switching patients to alternative medications due to the shortage, providers may encounter prior authorization (PA) requirements or step therapy protocols. Documenting the shortage as the reason for the switch can help expedite PA approvals. Many insurance plans have implemented temporary overrides for shortage-related substitutions.

Dose Equivalency Considerations

When switching between stimulant formulations, dose conversion isn't always straightforward:

• Dextroamphetamine XR → Vyvanse: Dextroamphetamine 10 mg is roughly equivalent to lisdexamfetamine 30 mg, though individual responses vary. Vyvanse has a longer duration (10-14 hours vs. 8-10 hours for dextroamphetamine XR).
• Dextroamphetamine XR → Adderall XR: The conversion is approximately 1:1 in total daily milligrams, since Adderall XR is 75% dextroamphetamine by content.
• Dextroamphetamine XR → IR dextroamphetamine: Total daily dose remains the same, split into 2-3 doses per day.
• Dextroamphetamine → Methylphenidate: The amphetamine-to-methylphenidate conversion ratio is approximately 1:2 (e.g., dextroamphetamine 10 mg ≈ methylphenidate 20 mg), though this is an approximation.

Controlled Substance Documentation

Switching between Schedule II medications requires a new prescription for each change. Electronic prescribing of controlled substances (EPCS) has streamlined this process in most states, but providers should ensure that patients understand they'll need a new prescription — not just a pharmacy substitution.

Current Availability Picture

As of early 2026, the availability landscape for dextroamphetamine ER is as follows:

• 5 mg capsules: Intermittently available from multiple manufacturers
• 10 mg capsules: Significant back orders; limited availability at most pharmacies
• 15 mg capsules: Intermittently available; better availability than 10 mg

Manufacturers with generic dextroamphetamine ER products include Teva, Mallinckrodt, and Alvogen. Supply levels vary by wholesaler and region.

Alternative amphetamine products (Adderall XR, generic mixed amphetamine salts ER, lisdexamfetamine) have variable but generally better availability than dextroamphetamine ER.

Cost and Access Considerations

Cost can be a barrier to alternative medications, especially for uninsured or underinsured patients:

• Generic dextroamphetamine ER: $32 to $180 for 30 capsules (with discount card vs. cash price)
• Generic lisdexamfetamine: $30 to $80 for 30 capsules with discount card
• Generic Adderall XR: $30 to $80 for 30 capsules with discount card
• Brand Mydayis: $300 to $400/month without manufacturer savings

No manufacturer savings program exists specifically for generic dextroamphetamine ER. Patient assistance programs through NeedyMeds and RxAssist may help uninsured patients. Encourage patients to use discount cards from GoodRx or SingleCare to reduce out-of-pocket costs.

Tools and Resources for Your Practice

Several tools can help you support patients navigating the shortage:

Medfinder for Providers

Medfinder allows patients to search for pharmacies with specific medications in stock. Recommending this tool to patients can reduce the volume of availability-related calls to your office and help patients locate their medication faster.

ASHP Drug Shortage Database

The ASHP maintains a regularly updated database of current drug shortages, including estimated resolution dates and affected manufacturers. This is the most reliable source for tracking shortage status.

FDA Drug Shortage Database

The FDA's database provides additional context on shortage causes and any regulatory actions being taken to address supply issues.

Patient Education Resources

Consider directing patients to the following resources:

• How to find dextroamphetamine XR in stock near you
• Alternatives to dextroamphetamine XR
• How to save money on dextroamphetamine XR

Looking Ahead

Several factors suggest the shortage will gradually improve, though a full resolution remains uncertain:

• The DEA has continued to increase production quotas for amphetamine-based medications
• Additional generic manufacturers have entered or are entering the market
• Generic lisdexamfetamine availability provides a viable alternative pathway for many patients

However, structural factors — including the DEA quota system, ongoing demand growth, and the complexity of controlled substance manufacturing — mean that intermittent supply disruptions may continue for some time.

Final Thoughts

The dextroamphetamine XR shortage requires providers to be proactive: have alternative medication plans ready, communicate openly with patients about supply issues, and leverage tools like Medfinder to help patients navigate availability challenges.

For a complementary guide on practical steps to help patients find their medication, see our post on how to help your patients find dextroamphetamine XR in stock.