Your Patients Are Struggling to Find Their Medication

If you prescribe dextroamphetamine XR (extended-release dextroamphetamine sulfate, formerly Dexedrine Spansule), you're likely hearing from patients who can't fill their prescriptions. The ongoing stimulant medication shortage has made this a recurring challenge since late 2022, and as of 2026, availability remains limited for key strengths.

As a prescriber, you can't control the supply chain — but you can take practical steps to minimize disruption to your patients' treatment. This guide provides five actionable strategies, alternative medication options, and workflow tips for managing shortage-related issues in your practice.

For a broader overview of the shortage timeline and prescribing implications, see our companion article on the dextroamphetamine XR shortage for providers.

Current Availability of Dextroamphetamine XR

As of early 2026, generic dextroamphetamine extended-release capsules remain in active shortage according to the ASHP:

• 5 mg capsules: Available intermittently from some manufacturers
• 10 mg capsules: Significant back orders; hardest strength to find
• 15 mg capsules: Better availability than 10 mg, but still inconsistent

The brand Dexedrine Spansule has been discontinued. All available supply is generic, manufactured primarily by Teva, Mallinckrodt, and Alvogen.

Why Patients Can't Find Dextroamphetamine XR

It helps to understand the bottlenecks so you can explain them to patients:

• DEA production quotas limit how much dextroamphetamine can be manufactured annually, regardless of demand
• Demand growth from increased ADHD diagnoses — particularly in adults via telehealth — has outpaced supply increases
• Pharmacy stocking decisions mean some locations carry limited controlled substance inventory, especially chain pharmacies under regulatory pressure
• Regional variation creates pockets where supply is adequate alongside areas of severe scarcity

What Providers Can Do: 5 Practical Steps

Step 1: Recommend Medfinder to Patients

Medfinder is a free tool that lets patients search for pharmacies with specific medications in stock. By recommending Medfinder, you can:

• Reduce the volume of "can you call pharmacies for me?" requests to your staff
• Empower patients to find their medication independently
• Provide a concrete action item during appointments when discussing the shortage

Consider adding Medfinder to your patient after-visit summary or printing the URL on prescription-related handouts.

Step 2: Prescribe Flexible Strengths When Clinically Appropriate

If a patient takes 10 mg daily and that strength is unavailable, prescribing two 5 mg capsules achieves the same total dose. This simple adjustment can be the difference between a filled and unfilled prescription.

When writing the prescription, specify the alternative strength and quantity explicitly to avoid pharmacy confusion. For example: "Dextroamphetamine ER 5 mg, take 2 capsules once daily, #60."

Step 3: Have an Alternative Medication Plan Ready

Don't wait until the patient calls in crisis. During routine visits, discuss backup options so patients know what to expect if their medication becomes unavailable. Useful alternatives include:

• Lisdexamfetamine (generic Vyvanse): Prodrug of dextroamphetamine; closest pharmacological match. Generally better availability and comparable cost since going generic in 2023.
• Mixed amphetamine salts ER (generic Adderall XR): 75% dextroamphetamine content; familiar to most patients. Variable availability but more manufacturing sources.
• Immediate-release dextroamphetamine (Zenzedi/generic): Same active ingredient, dosed 2-3x daily. Some patients prefer the flexibility of IR dosing.
• Methylphenidate ER (Concerta, Ritalin LA, generic): Different stimulant class; generally less affected by the current shortage. Conversion ratio: dextroamphetamine 10 mg ≈ methylphenidate 20 mg.

For detailed alternative comparisons, see our patient-facing guide on alternatives to dextroamphetamine XR.

Step 4: Streamline Prior Authorization for Switches

When switching to an alternative medication, prior authorization may be required. To expedite the process:

• Document the shortage as the reason for the switch in the patient's chart
• Reference the ASHP shortage listing as supporting evidence
• Use the insurance plan's expedited review pathway if available
• Consider peer-to-peer review as a last resort for denied PAs

Some insurers have implemented temporary overrides for shortage-related switches — check with the patient's plan directly.

Step 5: Communicate Proactively with Patients

Patients often feel anxious and powerless during medication shortages. Proactive communication from their prescriber can make a significant difference:

• Acknowledge the shortage at the beginning of appointments
• Provide written information about alternatives and tools
• Set expectations about response times for shortage-related calls
• Consider a brief shortage update in your patient portal or practice newsletter

Alternatives at a Glance

Here's a quick-reference comparison for common switching scenarios:

• Dextroamphetamine XR 5 mg → Lisdexamfetamine 20 mg OR Adderall XR 5 mg
• Dextroamphetamine XR 10 mg → Lisdexamfetamine 30 mg OR Adderall XR 10 mg
• Dextroamphetamine XR 15 mg → Lisdexamfetamine 40-50 mg OR Adderall XR 15 mg

Note: These are approximate conversions. Titrate based on individual response and tolerability.

Workflow Tips for Your Practice

Managing the shortage at a practice level can reduce the burden on individual providers:

• Designate a shortage coordinator: Assign one staff member to track current availability and field shortage-related calls
• Create a shortage protocol: Develop a standard operating procedure for what happens when a patient reports they can't fill their prescription
• Maintain a formulary alternatives list: Keep a printed or digital reference of equivalent medications and doses for quick access during visits
• Batch shortage-related prescription changes: If multiple patients are affected, process the switches together to save time
• Direct patients to Medfinder: Having a consistent tool recommendation reduces back-and-forth and empowers patients to act independently

Final Thoughts

The dextroamphetamine XR shortage puts providers in a difficult position — you want to prescribe the best medication for your patient, but supply constraints limit your options. By staying informed, having alternative plans ready, and leveraging tools like Medfinder, you can help your patients maintain treatment continuity even during an extended shortage.

For the cost and savings perspective, direct patients to our guide on saving money on dextroamphetamine XR, and for provider-specific savings strategies, see how to help patients save money on dextroamphetamine XR.