S8 stimulant medicines

In addition to the requirements of the Medicines and Poisons Regulations 2016, all prescribing must conform to the criteria and conditions outlined within Part 1 and Part 3 of the Code.

A ‘stimulant prescriber’ includes Approved Specialists listed in Table 3 of the Code and General Practitioners who have completed additional training and received individual designation from the Department to initiate treatment of ADHD with S8 stimulant medicines for eligible patients, aged 10 years and over.

Under Regulation 126(2) of the Medicines and Poisons Regulations 2016, the initial prescription for a S8 stimulant must be written by a stimulant prescriber.

Only one stimulant prescriber is permitted to prescribe at one time for each patient. Prior to prescribing a S8 stimulant medicine, the prescriber should check ScriptCheckWA to ensure there is no current active prescription or outstanding repeat.

All prescribing should be in accordance with current published and approved Product Information, recommendations from the Royal Australian and New Zealand College of Psychiatrists (RANZCP), Royal Australasian College of Physicians, and Royal Australian College of General Practitioners, best practice guidelines, and evidence-based medicine standards. Treatment should be in accordance with a management plan, which considers all available treatment options, including non-pharmacological.

RANZCP’s Professional Practice Guideline 7: Guidance for psychotropic medication use in children and adolescents (external site), recommends that “The psychiatrist best placed to prescribe psychotropic medication is a child and adolescent psychiatrist with specialist training and experience with children."

Treatment of any patient less than 2 years of age with a S8 stimulant medication is not permitted.

Under a Shared Care Model (external site), medical practitioners who are not stimulant prescribers, and nurse practitioners, may continue treatment for patients who are under regular stimulant treatment. This prescribing must be in accordance with written instructions from the patient’s stimulant prescriber and must be consistent with the dose and form previously prescribed. It is expected that there will be only one prescriber for stimulants at any given time, which can be verified by reviewing the patient's history on ScriptCheckWA.

Part 3.5.1(ii) of the Monitored Medicines Prescribing Code outlines the requirements for medical practitioners and nurse practitioners when prescribing Schedule 8 stimulants under a Shared Care Model.

There may be circumstances where it is appropriate for a prescriber, such as a GP who is not participating in a  shared care arrangement, to continue stimulant treatment when the patient’s stimulant prescriber is unable to do so. For example, during transitions of care or periods of unavailability. In these cases, prescribers must still meet all requirements of the Code, and prescriptions should only cover the period until the patient’s planned stimulant prescriber appointment. The prescribing must be consistent with the dose and form previously prescribed.

As part of determining if treatment meets the Product criteria (Section 3.5.3) outlined in the Code, practitioners must ensure the maximum total daily dose of stimulants does not exceed an equivalent dexamfetamine dose of:

• 1 mg/kg/day, up to a maximum of 60 mg/day, for patients under 18 years;
• a maximum of 60 mg/day for patients greater than or equal to 18 years.

To determine the total daily stimulant dose as dexamfetamine equivalents, please use the: 'Dex-Equiv Dose- Converter' (Excel 387KB). This information is a guide to calculating dexamfetamine equivalents only. It is not intended to be used alone to switch patients from one stimulant agent to another.

Further information around dose limits, including dose limits of methylphenidate and lisdexamfetamine as single agents, is available in Section 3.5.3 of the Code. 

The Health (Notification of Stimulant Induced Psychosis) Regulations 2010 (external site) requires medical practitioners to notify the Department of any person believed to have stimulant induced psychosis.

To notify the Department the medical practitioner must use the Notification: Stimulant induced psychosis form (Word 809KB).

Where an S8 stimulant medicine is being ceased because of one or more of the following reasons, prescribers must notify the CEO in writing:

• the patient has experienced stimulant induced psychosis (Word 809KB);
• the patient has developed drug dependence, substance abuse, diversion, or misuse of a S8 stimulant medication; or
• the patient has been oversupplied S8 stimulant medication. 

For each patient a notification must be made on the approved form to terminate treatment of stimulant medicines (PDF 376KB).