Medicine Supply Information
Information for Patients
There are many reasons why pharmacies are not always able to get certain medicines. Shortages of medicines can happen. For example, manufacturers of medicines can have problems with making the medicine, transporting the medicines or have problems with ingredients for medicines. Sometimes when lots of people are suddenly prescribed a medicine this can use up all the supply. Another example is that there may be pricing concerns about medicines.
In recent years we have seen an increase in shortage problems for a combination of these reasons. The community pharmacy sector is working with Government and others on plans to make sure that the supply of medicines and medical devices is maintained after the UK exits the EU, including in a no-deal scenario. Patients and healthcare professionals, such as pharmacists and GPs, have been asked by the Department of Health and Social Care (DHSC) to order medicines as they usually would. The DHSC says that you do not need to order any more medicines than you need, and you should keep taking the medicines you have as they have been prescribed.
There is a useful leaflet available explaining medicines supply and the current national picture available here:
The leaflet answers questions such as; Why can I not be given my prescribed medicine today? Why is my medicine not in stock? What is the difference between branded medicines and generics? What are you doing to help?
Current Drug Shortages
MIMS recently launched an on-line drug shortages tracker, which clinicians can access to find out information on current shortages and recently resolved issues. The tracker also suggests possible alternatives where appropriate. Users will need to register and log in to view, registration is free for GPs and nurses. Pharmacists based in GP practices can also register for free by emailing firstname.lastname@example.org.
MIMS live drug tracker: https://www.mims.co.uk/drug-shortages-live-tracker/article/1581516
The Medicines Optimisation Team are able to access additional resources, so if you are unable to find the required information on the MIMS drugs tracker, please contact email@example.com. Your local community pharmacist will also be able to provide you with additional information. Our team also work closely with secondary care to provide advice on significant long term out of stock items; please look out for this information in Prescribing Points
Fluoxetine Serious Shortage Protocol (SSP)
A Serious Shortage Protocol (SSP) enables community pharmacists, in the event of a serious shortage of any prescribed item that affects or may affect the whole or any part of the United Kingdom, to supply in accordance with the Protocol rather than against a prescription, without going back to the prescriber.
Serious Shortage Protocols (SSPs) have been issued for:
- Fluoxetine 30mg capsules (expires 18th Dec 2019)
The SSPs will enable community pharmacists in England to supply patients with a different formulation as follows:
SSP for Fluoxetine 30mg capsules, supply
- 1 x 10mg fluoxetine tablet, plus 1 x 20mg fluoxetine capsule
These Serious Shortage Protocols (SSPs) are now published on the NHS Business Service Authority (BSA) website under a dedicated SSP page along with supporting guidance. The SSP is currently due to expire on the dates above. Should this change, the SSPs will be updated accordingly and published on the NHS BSA dedicated SSP page.
UPDATE: Ranitidine Medicines
Since the previous article published in GP Bulletin on 2nd October, the MHRA have issued an alert to healthcare professionals on behalf of GlaxoSmithKline. GlaxoSmithKline are recalling all unexpired stock of four types of Zantac (ranitidine hydrochloride) from pharmacies as a precautionary measure, due to possible contamination with an impurity N-nitrosodimethylamine (NDMA) which has genotoxic and carcinogenic potential. The MHRA has published the following advice for healthcare professionals:
- Stop supplying the above products immediately. Quarantine all remaining stock and return it to your supplier using your supplier’s approved process.
- If you receive queries about this issue from patients, advise them not to stop taking their medication as the health risk of discontinuing the medicine is higher than the potential risk presented by the contaminant. A treatment review is not necessary until the next routine appointment.
This is an ongoing issue and the MHRA is actively involved with the European Medicines Agency and with other medicines regulators to determine any possible impact. An investigation into other potentially impacted products is continuing and further updates will be provided as the investigation progresses.
The MHRA is advising that patients should not stop taking their medication, and do not need to see their doctor until their next routine appointment but should seek their doctor’s advice if they have any concerns.
Updated 18th October
The MHRA have now issued a CAS alert about the supply disruption now affecting all oral formulations of ranitidine. This is available here
The following actions are advised:
All healthcare professionals in primary, secondary or specialist healthcare services who prescribe or dispense ranitidine, should for:
Licensed use for gastrointestinal conditions
• Identify current patients prescribed ranitidine tablets, effervescent tablets and oral solutions, and:
o Review to establish if ongoing treatment is still required.
o If ongoing treatment is still required, then consider switching to an alternative treatment (see table in alert).
• It is recommended that omeprazole is the first-choice proton pump inhibitor (PPI) where clinically appropriate, as there are currently sufficient supplies to manage an increase in demand.
• It is recommended that patients are not switched to alternative H2-receptor antagonists in the first instance as this may exacerbate a shortage of these products. Sufficient supplies will continue to be available to meet current demand.
• Consult specialist clinicians who use ranitidine to identify circumstances when ranitidine cannot be substituted with clinical alternatives.
• Reserve any remaining supplies of oral ranitidine for circumstances where specialists consider there are no clinically appropriate alternatives.
Prescribers should work in close collaboration with their pharmacists to understand which clinical alternatives are available.
We are currently discussing the situation with OUH and will provide more advice from the specialists teams shortly
The market supply of adrenaline auto-injectors is being closely monitored by the Department of Health and Social Care (DHSC) and there are currently sufficient supplies overall to meet normal patient demand. However, due to the supply issues with some brands, it may be necessary to switch patients to an alternative brand that they are unfamiliar with. See communication (including overview of the current supply situation with all brands of adrenaline auto-injectors) here.