Methylphenidate HCl (Various brands – see Shared Care Agreement) – Attention Deficit Hyperactivity Disorder in Children and Adolescents

Norfolk and Waveney Formulary

NICE recommendations, summary of meeting discussions, links to additional supporting docs etc.

NICE Guidance No. 98 (March 2006):

If a child or adolescent needs treatment with medication for ADHD, methylphenidate, atomoxetine and dexamfetamine are all recommended as possible choices. When deciding which to use, doctors should consider the following:

Whether the child or adolescent has other conditions such as epilepsy.

The side effects of each medicine.

Factors that might make it difficult for the person to take the medicine at the right time (for example, if it is difficult to take a dose during school hours).

The possibility that the medicine might be misused, or passed on to another person for misuse.

The individual preference of the child or adolescent and/or their family or carer.

Where more than one of the medicines is considered to be appropriate for a child or adolescent, their doctor should choose the cheapest one.

Treatment with methylphenidate, atomoxetine or dexamfetamine should only be started after a specialist who is an expert in ADHD has thoroughly assessed the child or adolescent and confirmed the diagnosis. Once treatment has been started it can be continued and monitored by a GP.

November 2007:

The TAG debated the issue regarding continued drug treatment of ADHD in patients diagnosed in childhood who have reached adult age. The TAG agreed that that there are reasonable grounds to continue treatment where it has been assessed as being beneficial. Drug holidays should be considered to check for continued need. The TAG acknowledged the current lack of specialist services available to manage adults requiring treatment for ADHD.

January 2008: The welcomed the news that the NWMHP NHS Trust is currently discussing the service needs of older ADHD patients.

March 2008: The TAG approved the addition of Medikinet XL® to the protocol. Issues related to responsibility for management of patients >18 years as yet unresolved.

September 2008 NICE CG for ADHD published.

May 2009: Shared Care agreement revised in line with NICE CG.

March 2012: Shared Care Agreement revised in line with current clinical practice. Handover period reduced and now states – “Initiation and dose titration and stabilisation for at least two consecutive consultations with no change in dose. Usually 4-8 weeks with patient contact to clarify dosage and side effects.”

March 2015:  The TAG was advised that Xenidate XL® tablets are a cost-effective option in the treatment of symptoms of ADHD and related disorders with pharmacokinetic equivalence to the brand leader Concerta XL®.

The committee therefore agreed to support use of this product as a cost effective treatment option under the current shared care prescribing arrangements for managing this clinical condition.

i.e. as Amber (Option for GP prescribing under an approved Shared Care Agreement)

March 2015:  The NHS Norfolk & Waveney CCGs’ D&TCG was advised of the TAG’s recommendation to support use of cost-effective and clinically equivalent products to standard treatment, and agreed that where appropriate, clinicians should move their patients to the most cost-effective products at treatment reviews.

March 2017:

An updated version of the shared care agreement was noted and supported by the TAG. The issue of whether GPs should have responsibility for annual review of height, weight, BP and pulse results would be revisited at the May 2017 TAG meeting.

May 2018: The TAG acknowledged NG 87 (March 2018) – Attention deficit hyperactivity disorder: diagnosis and management – which updates and replaces NICE CG72 (September 2008) and NICE technology appraisal guidance 98 (2006) – and noted in particular that baseline ECGs are now required if the treatment being considered may affect the QT interval – this applies to methylphenidate, atomoxetine, lisdexamfetamine (Link), and possibly to dexamfetamine and guanfacine.

The current shared care agreements for stimulants and atomoxetine will be reviewed with reference to NG 87 and returned for the TAG’s consideration in due course.

May 2019: The SCAs for use of Stimulants and for Atomoxetine for Children and adolescents with ADHD were reviewed and updated with reference to NG 87.

The TAG agreed that in view of local children’s ADHD services being commissioned such that GPs could only refer children from age ≥ 6 years, that the age range as stated within the current SCAs should remain.

The TAG also agreed that the updated documents could be published.

May 2019: Noted and supported by the D&TC