Quillivant and QuilliChew Shortage Disrupts ADHD Treatment
A manufacturing issue, first identified in November, has caused a supply shortage of two forms of methylphenidate produced by Pfizer.
February 21, 2018: Pfizer spokesperson Thomas Biegi said the QuilliChew ER shortage “has been resolved and the product is now available.” Quillivant XR, however, is still experiencing a supply shortage. “Pfizer is working diligently to restore the supply,” he said, but “the duration of the supply shortage is unknown at this time.”
January 29, 2018
Two popular ADHD medications, Quillivant XR and QuilliChew ER, are currently in short supply across the United States due to a manufacturing issue first identified in November — and some ADDitude readers are reporting disrupted treatment as a result.
Some patients are reportedly taking lower doses than those prescribed to them so as to lengthen their supply of Quillivant XR or QuilliChew ER. Others are working with their doctors to find alternative medications, a difficult process of trial-and-error than disrupt home and academic life. Still others are doing all of the above — and more — to help their children navigate this treatment change.
“When I tried to refill my daughter’s prescription during the last week of December, I had to call five pharmacies to find one that had a bottle in stock, which was a slightly lower dosage than currently prescribed,” said Lillian, a parent who chose to withhold her last name for privacy reasons, in response to an ADDitude Facebook post on January 19. “But there will be no refills available after the end of this month, so I’m planning to call my pediatrician on Monday to see what medication we can switch to. I’m very worried because Quillivant has been a game changer for my daughter, who has been on it two years. She will fail classes for sure if she can’t get a suitable replacement!”
Pfizer, which produces both medications, sent a Drug Shortage Communication to healthcare professionals on November 8, 2017. The drug manufacturer indicated that, due to an undisclosed “manufacturing issue,” its supply of Quillivant XR, a liquid form of methylphenidate, would be short later that month. The shortage of QuilliChew, a chewable version of the same medication, was predicted to start in December. Both medications are approved for use by patients over the age of 6, and are most frequently used by children with ADHD, especially those who struggle to swallow pills.
When reached on January 26 for a statement, a spokesperson for Pfizer, Thomas Biegi, said: “We have a robust action plan in place and are working with the manufacturer and the FDA to resolve the issue; however, the duration of the supply shortage is unknown at this time.”
Some ADDitude readers speculated that the shortage was caused by Hurricane Maria’s devastation of Puerto Rico, where Pfizer has several production plants. However, Biegi said storm damage did not factor into this medication shortage.
Patients Given Little Advance Notice
“We struggled to find [Quillivant] this month,” said Amanda Miller in a Facebook comment last week. “I never heard a thing about [the shortage] until I was calling pharmacies looking for the medication.”
Many ADDitude readers echoed Miller’s surprise and dismay. They said they remained unaware of the medication shortage until it came time to refill their or their child’s prescription in December or January — despite Pfizer’s warning of a potential shortage in early November.
“I was quite panicked when I found out last week that none of the pharmacies in our area has any [Quillivant],” said parent Teresa Devroe Brown on January 19. “After several conversations with the pharmacist and our doctor, we decided to try extended-release capsules [instead].”
Brown said her son can’t swallow pills — part of the attraction of both Quillivant and QuilliChew for many parents — and, though the new medication seems to be working adequately, she remains frustrated with Pfizer for the lack of consumer communication.
“Knowing that the medication is used by children with ADHD, the manufacturer should have given way more notice about this,” she said. “It’s not fair to the children or the families.”
Drug manufacturers are legally required to notify the FDA of any upcoming drug shortages, which Pfizer did. The FDA, in turn, maintains a database of all the drugs currently in shortage in the U.S. on its website. The FDA cannot, however, compel a pharmaceutical company to increase production of a medication to make up for a shortage — and the brunt of the responsibility falls on doctors, pharmacists, and individual consumers to keep track of shortages and to respond to medication disruptions.
Some readers report learning of the medication shortage from their pharmacists. “I have been hearing from my pharmacy that the medicine has been on backorder for three months now,” said ADDitude reader Cyndi Pressman, whose son takes the medication for ADHD. “It does not look like the problem will be fixed anytime soon.”
Others said their pharmacists gave them no warning.
“We found out when we went to refill my son’s prescription last week,” said Jaime, who chose to withhold her last name for privacy reasons. “I’m very frustrated, especially since we had no notice. He’s been without meds since. His doc is going to have him try another drug in the meantime.”
Some Parents Travel to Find Medication
Michelle Kirby said she traveled 100 miles from her house to find Quillivant for her child because it is the “only thing that worked for my daughter; other options have all made her an emotional wreck.”
Others did the same. “I had to travel for our most recent refill — and would travel anywhere!” said parent Leann Collins. “My son is in such a great place on this medication. We have about 15 days until refill, and [are] wondering what an equivalent substitute would be.”
Traveling isn’t always a straightforward solution, though. “We found out on the first day of Christmas break that our regular pharmacy had not been able to receive orders [of Quillivant] for a couple of weeks,” recalled Carlie. “It was only in stock out of state — but they couldn’t transfer the prescription out of state. I had a huge hassle trying to work with any other pharmacies — who would insist that they had it, [but] then when we got there, they said it was expired… or it was the wrong amount.”
The hassle — especially during the holiday season — was difficult to manage, she said. “Dealing with that in a snowstorm, followed by an ice storm, and the weekend before Christmas all in that mix — I was stressed.”
Patients Forced to Try Sub-Optimal Alternatives
“We remain committed to restoring supply as quickly as possible and regret any inconvenience this may cause patients and physicians,” Biegi, the Pfizer spokesperson, said. “Patients should speak with their physician to determine appropriate treatment alternatives.”
But several ADDitude readers say they only began taking or administering Quillivant or QuilliChew after a long process of trial and error — and they worry about re-surging ADHD symptoms if the medication is abruptly discontinued, or if they are compelled to try an alternative medication.
“My son has been on Quillivant XR for almost two years,” said Brittany Olson. “After years of trying to find the right meds, we did. I got my baby back.”
But Olson started running into problems finding Quillivant in November, and was finally informed of the shortage in January. “My son is now on Metadate CD,” she said. “It’s not working — this is not my child, and it scares me. I just want to scream.” Unfortunately, past negative reactions to certain medications make her doctor hesitant to try another option, she added.
“He’s always been a straight A student,” she said. But “now he’s struggling this month because of this issue. I’m just a mess.”
Some parents report seeing unpleasant side effects as their children try new medications.
“I was informed about the shortage Monday” and given a replacement prescription, said Melissa Teem. “[On] Tuesday, my daughter took her new medicine — she came home with a full lunchbox and complained of a headache. Today, the same — she had two bites to eat, and I had to pick her up early because her head hurt so bad. This sucks. She’s a tiny child as it is, and her lack of appetite on Quillivant was something we had already had to deal with. This new medicine has made it a million times worse.”
Making Small Quantities Last
Despite Pfizer’s uncertainty regarding the duration of this shortage, some parents are making do with their current supplies, in hopes of waiting out the problem.
“I give him a day off [of medication] each weekend, so I try to stretch it out,” said parent Amy Cowan Krantz. “The pharmacy told me about this in November. I’ve been able to refill it — but am now worried they won’t have it for February.”
“We have reduced our son’s medication dosage to make sure we can make it to February,” said Wendy S., who chose to withhold her last name for privacy reasons. “It’s so frustrating [that] the pharmacy and our doctor’s office did not notify any of the parents.”
ADDitude will continue to monitor this medication shortage and report updates from Pfizer as they arrive.