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SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Supply Issues Information
Intermittent supply problems can occur due to either manufacturing issues causing shortages of branded products (‘Manufacturer Cannot Supply’, MCS) or supply issues affecting medicines, resulting in generics being difficult to obtain at Scottish Drug Tariff Part 7 (SDT) prices, or at all.
Information on Part 7 generic medicines which are identified as being in short supply is available via the Community Pharmacy Scotland Website which indicates the revised Part 7 prices for agreed shortages.
Community Pharmacists are advised to report problems with obtaining Part 7 items at Tariff prices via the Community Pharmacy Scotland Shortages Reporter
The advice in this table is not intended to serve as a standard of medical care or be applicable in every situation. Decisions regarding the treatment of individual patients must be made by the clinician in light of that patient’s presenting clinical condition and with reference to current good medical practice.
This document is available via the NHS Forth Valley Intranet:
https://staffnet.fv.scot.nhs.uk/a-z/pharmacy/area-wide/supply-issues-information/
A commercial Drug Shortages Tracker is also provided by MIMS to subscribers: https://www.mims.co.uk/drug-shortages-live-tracker/article/1581516
Supply issues are constantly in flux and your local Community Pharmacists will be able to give you up to date advice on availability.
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Contents Supply Issues Information ................................................................................................................................................................................................................. 1
BNF Chapter 1 – Gastro-intestinal System .................................................................................................................................................................................... 3
BNF Chapter 2 – Cardiovascular System ....................................................................................................................................................................................... 5
BNF Chapter 3 – Respiratory System ............................................................................................................................................................................................ 9
BNF Chapter 4 – Central Nervous System ................................................................................................................................................................................... 10
BNF Chapter 5 – Infections ......................................................................................................................................................................................................... 16
BNF Chapter 6 – Endocrine System ............................................................................................................................................................................................ 17
BNF Chapter 7 – Obstetrics, gynaecology and urinary tract disorders ...................................................................................................................................... 18
BNF Chapter 8 – Immune system and malignant disease .......................................................................................................................................................... 21
BNF Chapter 9 – Nutrition and Blood ......................................................................................................................................................................................... 22
BNF Chapter 10 – Musculoskeletal and Joint Diseases ............................................................................................................................................................... 23
BNF Chapter 11 – Eye .................................................................................................................................................................................................................. 24
Royal College of Ophthalmologists and the UK Ophthalmic Pharmacy Group maintain a shortages page. .............................................................................. 24
Additional local advice is included below. .................................................................................................................................................................................. 24
BNF Chapter 12 – Ear, Nose and Oropharynx ............................................................................................................................................................................. 26
BNF Chapter 13 – Skin ................................................................................................................................................................................................................. 27
BNF Chapter 14 – Immunological products and vaccines ........................................................................................................................................................... 28
BNF Chapter 15 – Anaesthesia .................................................................................................................................................................................................... 29
Other ........................................................................................................................................................................................................................................... 30
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 1 – Gastro-intestinal System
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last
Checked
Ranitidine –Tablets, Effervescent Tablets and
Oral Solutions
All oral formulations of ranitidine are anticipated to be out of stock,
with no date for resupply until further notice
A Supply Alert Notice has been issued by the Scottish Government. The main points are below. See the Supply Alert Notice for full information. All oral formulations are expected to be out of stock, although very limited supplies of unaffected oral ranitidine products may remain available. These should be reserved for those patients in whom alternatives are not clinically appropriate.
Review patient to determine if medication still required
Consider Peptac for patients who do not require GI protection
For patients requiring GI protection or patients whose symptoms are not adequately controlled omeprazole is the first-choice proton pump inhibitor (PPI) where clinically appropriate, lansoprazole is the alternative PPI;
Patients should not be 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;
For specialist indications GPs should consult with specialist clinicians to identify circumstances when ranitidine cannot be substituted with clinical alternatives; and
17/10/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last
Checked
Any remaining supplies of oral ranitidine are reserved for circumstances where specialists consider there are no clinically appropriate alternatives.
See below for paediatric patients
Paediatric patients
Check if patient still symptomatic and switch to omeprazole dispersible tablets / MUPS if required.
For patients requiring a 5mg dose of omeprazole –
Omeprazole (Losec) MUPS tablets can be halved (and no more), where appropriate, and dispersed in 5ml or 10ml of tap water/boiled and cooled water, for 5mg or 10mg dose respectively. Do not crush the tablet. Doses must be rounded to the nearest 5mg as otherwise dose accuracy cannot be guaranteed.
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 2 – Cardiovascular System
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Bumetanide 5mg tablets Unavailable until early Sept 2019 Bumetanide 1mg tablets are available. 9/8/2019
Cardura (doxazosin) XL 4mg and 8mg
Out of stock until mid-August 2019
Standard release generic doxazosin tablets are available and are the preferred formulation of doxazosin. An advice
document on switching from XL to standard release is available from UKMI.
Generic versions of XL formulations also remain available from other manufacturers.
9/8/2019
Disopyramide 100mg tablets
Unavailable until end Aug 2019
A supply disruption alert has been issued via MHRA’s CAS, which includes information on the issue and actions to be
taken. Please see link below:
9/8/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Emerade (adrenaline) 500 and 3000 microgram
500 microgram expected available from 18th Oct
300 microgram expected available w/c 14th Oct
A supply alert has been issued with advice. Emerade 150 microgram adrenaline autoinjectors remain available.
See alert notice for availability.
Epipen 300microgram remains available and and Jext 300microgram available from w/c 14th Oct– patients will
require advice as per the supply alert. The process for Pharmacies to obtain Epipen is available via
the alert. Expiry dates of specific batches of Epipen 300 and Jext 150 and 300 have been extended by 4 months –
see the alert notice for details. If patients have a pen from one of the listed bacthes, further supplies can be delayed
as per the advice in the alert notice.
Available adrenaline autoinjectors should only be prescribed and dispensed to those who truly need them,
as any additional issuing to patients with sufficient supplies who are worried about the shortages could
exacerbate the overall supply situation.
It is essential that all patients have 2 adrenaline autoinjectors available at all times.
15/10/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Prazosin (Hypovase) Tablets
1mg and 500 microgram Resolved – Now Available
13/8/2019
Bile Acid Sequestrants: Questran/Colestyramine Oral Powder Sachets and
Colestipol
Colestyramine and Questran Light (Colestyramine sugar-free) -
ongoing supply issues not expected to be resolved until mid-
2020
Colestipol is unavailable until mid-October
Information and advice is available from the UKMI/SPS: https://www.sps.nhs.uk/articles/shortage-of-bile-acid-sequestrants/
7/10/2019
Metoprolol Tablets (50mg and 100mg)
Supply is likely to be intermittent for a number of months. If
patients are having difficulty obtaining
metoprolol, they may need to be switched to an appropriate
alternative treatment.
If patients are having difficulty obtaining metoprolol, they may need to be switched to an appropriate
alternative treatment. Scottish Govt have produced an advice document.
31/5/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Nifedipine 5mg Capsules and
the Adalat Range
Bayer will be discontinuing the 5mg and 10mg capsules after
March 2019.
Adalat LA is unavailable in all strengths until 2021
Adalat Retard has been discontinued
Bayer have issued a HCP letter advising on availability and discontinuations affecting the product range
(available here). UKMI have issued a memo with general advice on
alternatives – available here: https://www.sps.nhs.uk/articles/shortage-of-adalat-
nifedipine-products Amlodipine and Felodipine are FV 1st and 2nd line
choice for calcium channel blockers and further formulary choices are available where pharmacies are unable to
source (NB unlicensed for Raynauds).
21/5/2019
Valsartan
Intermittent issues with some strengths - 40mg caps and tabs are available from some wholesalers. 80mg and 160mg from Teva are
MCS until November 2019
Some residual stock may be available in pharmacies. Where pharmacies are unable to obtain stock from alternative suppliers or other pharmacies, or other
strengths or formulations (tabs/caps) may be available as per the Supply Issues Flowchart.
In the event that an alternative agent is required, UKMI have previously provided advice and approximate dose
conversions: https://www.sps.nhs.uk/articles/shortage-of-valsartan/
13/8/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 3 – Respiratory System
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Phyllocontin and Phyllocontin Forte
(Aminophylline) Resolved
12/6/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 4 – Central Nervous System
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Capsaicin Cream (Axsain 0.075%; Zacin 0.025%)
Both products unavailable until December 2019
No directly equivalent alternative available. Patients will require individual review for suitable alternative. Options for consideration would include:
topical NSAID (ibuprofen 5% gel is first-line formulary choice)
oral NSAID or regular paracetamol if appropriate (reduced dose of paracetamol if patient <50kg)
Optimisation of the dose of any existing medication for nerve pain if possible
Heat or cold if this helps patient’s symptoms. TENS machine trial
SIGN 136 provides detail of various treatment option for treatment of chronic pain.
18/7/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Carbagen (carbamazepine) 200mg and 400mg
(immediate- release and Modified
Release)
Carbagen 200mg and
400mg Immediate Release Tablets –
unavailable until late 2019
Carbagen 200mg and 400mg Modified Release Tablets – unavailable until
late 2019
The preferred brand of carbamazepine (in epilepsy) is Tegretol for both immediate and modified-release
versions, prescribed by BRAND name for epilepsy patients. Epilepsy patients should be switched to Tegretol products
by BRAND name and monitor for any side-effects or change in seizure control. The Neurologists and Epilepsy Specialist Nurse wish to be advised of any patient where
the brand is changed.
The Specialist Pharmacy Service in England have produced a more detailed advice document.
9/8/2019
Epanutin (phenytoin) 30mg/5ml oral suspension
Current Supply Issues See associated CAS alert 9/8/2019
Epanutin (phenytoin) 50mg Chewable Infatabs
Supply Problems expected until Nov 2019
Imported Canadian product (Dilantin) is available as an interim measure. A PIL and Information Letter are
available. Pharmacies will require to follow the Specials Authorisation process before obtaining. Patients should
not be switched to Epanutin Oral Suspension as this product is also experiencing supply problems (see above).
9/8/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Fluoxetine 10mg caps, 30mg caps and 40mg caps
Unavailable until early Nov 2019
20mg capsules and 20mg/5ml oral solution remain available. 10mg tablets also remain available.
When prescriptions are presented for dispensing – if the patient has sufficient supplies to last them until early November, the prescriptions should not be dispensed during this period.
For patients who do not have sufficient supplies for the duration of the expected out of stock period, Community Pharmacists should consider the substitutions mentioned on page 4 of the Supply Alert (using the available licensed products), which can be undertaken using appropriate endorsement, without the need for a new prescription. NB: the use of unlicensed 10mg capsules is NOT supported.
Advice on the appropriate process and endorsements is available in the FV Flowchart and CPS Advice Document available here.
24/9/2019
Imigran (sumatriptan) Injection
Resolved
22/5/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Lofepramine tablets 70mg Limited supplies available
Some supplies available.
FV Depression guidance has information on formulary choices and advice on how to switch between different
agents.
For patient-specific advice the FV Mental Health Pharmacy Team are able to provide patient-specific advice.
(01324 567616/566728/566729 or email [email protected])
30/05/2019
Migraleve Tablets Pink (Co-codamol 8/500
plus Buclizine combination)
Unavailable – Manufacturer
Cannot Supply. No date of resolution.
Suitable alternative analgesic and anti-emetic can be prescribed as separate products.
Prescribe alternatives by generic name. 22/5/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Migraleve Tablets Yellow (Co-codamol 8/500)
Unavailable - Manufacturer Cannot Supply. No date.
Generic co-codamol 8/500 tablets are available and more cost-effective.
22/5/2019
Nardil (Phenelzine) tablets Unavailable until March 2020
Given the difficulties in withdrawing treatment and initiating new treatments in patients stabilized on
phenelzine – patients should be maintained on phenelzine using unlicensed imports where supply is required while UK product is unavailable. Community Pharmacies will
require to follow the unlicensed Specials process – obtaining authorisation for the unlicensed Special. The
UKMI Specialist Pharmacy Service have produced an advisory memo. A Supply Alert Notice was issued in Oct
2019.
15/10/2019
Ongentys® (opicapone) 50mg capsules
Supply Problem expected until mid-January 2020
A Medicines Supply Alert Notice (MSAN (2019)8) has been issued by the Scottish Govt.
Patients have been identified and the Practices notified for appropriate action. See MSAN for further information.
28/10/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Risperidone Tablets (standard generic tablets,
various strengths) Resolved 22/5/2019
Seroxat (Paroxetine) 20mg/10ml oral solution
Out of stock until Jan 2020
A Medicines Supply Alert Notice (MSAN (2019)9) has been issued by the Scottish Govt. Tablets remain available – Consider tablet formulation if appropriate dose available. Patients with swallowing difficulties/young children - UKMi has advised that tablets can be crushed and mixed with water for administration (off-label use). The crushed tablets are bitter and have a slight local anaesthetic effect.
See MSAN for further information Alternative SSRIs may be an option after patient review depending on patient history and requirements.
28/10/2019
Sinemet (co-careldopa) 10/100mg tablets are out of
stock from 1st August 2019 until end of Aug 2019.
Generic co-careldopa supplies in these strengths will be available to support where Sinemet unavailable.
Information for Pharmacies trying to source branded product is available in an HCP Letter.
MSD have indicated that some of their Sinemet tablet range will have a change in appearance. Information is available here.
13/8/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 5 – Infections
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Cefuroxime 125mg/5ml suspension (Zinnat)
Out of stock until end August 2019
Cefuroxime 125mg tablets remain available UKMI have advised that tablets can be crushed and dispersed for oral administration. However, please note that doing so is considered off-label use.
9/8/2019
Tobi (Tobramycin) Podhaler Phoned orders required
The manufacture of this product is in the process of switching suppliers. Currently it is not listed as a standard item by wholesalers but is available via wholesaler special order processes via the usual wholesaler processes.
24/9/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 6 – Endocrine System
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
HRT Products
Supply Issues with various HRT products
Further information is available via this link. 26/8/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 7 – Obstetrics, gynaecology and urinary tract disorders
Product
Current Supply Problem /
Date of Resolution
Impact and Advice Date
Information Last Checked
Cilest (norgestimate 250mcg and ethinylestradiol 35mcg)
Discontinued with stocks expected
to be exhauseted by end July 2019
The formulary preferred equivalent is Cilique, prescribed by brand name. 13/8/2019
Loestrin 20 and 30 Unavailable – no
date of resolution
Products with the same ingredients but different strengths are Brevinor and Norimin - see BNF for further info.
Alternative Formulary products contain different Progestogen components, and will require to be selected on an individual basis:
Formulary COCs - the differing progestogen component as stated:
Millinette: Progestogen component=Gestodene
Rigevidon: '30' strength only. Progestogen component = Levonorgestrel
Gedarel: Progestogen component = Desogestrel
13/8/2019
Noriday (norethisterone) 350 micrograms tablets
Out of stock until end Sept 2019
UKMI have advised that there are no exact equivalent preparations in the UK market and clinicians should refer to CKS guidance for advice on alternative POPs:
https://cks.nice.org.uk/contraception-progestogen-only-methods#!scenario:
13/8/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product
Current Supply Problem /
Date of Resolution
Impact and Advice Date
Information Last Checked
Microgynon 30 (ethinylestradiol
30 mcg, levonorgestrel 150 mcg)
Appears to be resolved
Microgynon 30 is non-formulary – the preferred formulary equivalent product is Rigevidon.
Prescribe as Rigevidon.
4/6/2019
Norimin (ethinylestradiol/norethisterone) 0.035mg/1mg tablets
Out of Stock until end Sept 2019
No exact equivalent preparations to Norimin is available in the UK.
Other ethinylestradiol and norethisterone OCP products should be available (the Formulary choice – Loestrin is also subject to supply problems).
Clinicians are advised to refer to CKS guidance for advice COCs: https://cks.nice.org.uk/contraception-combined-hormonal-methods
13/8/2019
Ovranette
(ethinylestradiol 30 mcg, levonorgestrel 150 mcg)
Expected to be unavailable
between June-end of August
2019.
The preferred formulary equivalent product is Rigevidon.
Prescribe as Rigevidon.
4/6/2019
Provera (Medroxyprogesterone 100mg tablets)
Expected to be out of stock until week ending 8th
Nov 2019
200mg and 400mg tablets remain available.
For patients who require a 100mg dose and who do not have sufficient supplies to last for the duration of the out of stock period, consider use of an unlicensed import. Community
Pharmacists should contact the prescriber to confirm usage of the unlicensed import and will require to contact the Prescribing Support Team for authorisation (as per the local Unlicensed Specials Process). A Supply Alert has been issued by the Scottish Government with additional information.
24/9/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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Product
Current Supply Problem /
Date of Resolution
Impact and Advice Date
Information Last Checked
Detrusitol XL (Tolterodine) Caps 4mg
Unavailable until 6th Dec 2019
Other manufacturer’s versions are available. The product is in Part 7 of the Scottish Drug Tariff.
Ensure prescribed by generic name. 15/10/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 8 – Immune system and malignant disease
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Megestrol 160mg Tablets (Megace)
Resolved
13/08/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 9 – Nutrition and Blood
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 10 – Musculoskeletal and Joint Diseases
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 11 – Eye
Royal College of Ophthalmologists and the UK Ophthalmic Pharmacy Group maintain a shortages page. Additional local advice is included below.
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Betnesol Eye Ointment (betamethasone)
Discontinued. Generic replacement expected end 2019
13/08/2019
Betnesol (betamethasone) eye/ear/nose drops
Unavailable until late 2019 Vistametahsone drops are available. Prescribe by generic
name to allow available product to be supplied. 13/08/2019
Lacri-lube Ointment Remains unavailable –
no date available The Royal College of Ophthalmology
recommends Xailin Night Ointment as an alternative 22/2/2019
Timolol 0.25% and 0.5% unit dose eye drops
Discontinued March 2018
Tiopex 1mg/g (timolol) eye gel 0.4g unit dose (preservative-free) is available. NB: This is a ONCE daily
preparation. While it is a different strength, local opinion is that this can be used as a suitable alternative and is the
preferred alternative. Eysano (0.25% and 0.5%) preservative-free multi-dose eye
drops are also available. These are slightly less cost-effective than Tiopex.
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 12 – Ear, Nose and Oropharynx
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Betnesol (betamethasone) eye/ear/nose drops
Unavailable until late 2019 Vistamethasone drops are available. Prescribe by generic
name to allow available product to be supplied. 24/5/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 13 – Skin
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
Skinoren (azelaic acid) 20% cream
Unavailable until mid-Oct 2019 Please refer to local formulary or to following guidelines for alternative treatment options.
13/8/2019
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 14 – Immunological products and vaccines
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
SUPPLY ISSUES INFORMATION | NHS FORTH VALLEY 30 October 2019
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BNF Chapter 15 – Anaesthesia
Product Current Supply Problem /
Date of Resolution Impact and Advice
Date Information Last Checked
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Other
Product
Current Supply Problem /
Date of Resolution
Impact and Advice Date Information
Last Checked
Nutramigen infant
formulas
Supply Issue Resolved
The manufacturers have limited supplies of Nutramigen 2 (for babies over 6 months)
and they will issue 2 tins per prescription.
Advice for patients prescribed Nutramigen products is as follows: If prescribed Nutramigen 1, 2 or 3 and baby is: Under 6 months of age –
Parents should be advised to contact their dietitian for advice. If urgent they can be prescribed Aptamil Pepti 1 or SMA Althera.
Note that these contain lactose and transition should be gradual to ensure tolerated.
6-12 months of age– If prescribed Nutramigen 1 then change to Nutramigen 2. If stocks of Nutramigen 2 have been exhausted contact their dietitian for advice
Over 12 months of age – Change to appropriate OTC milk e.g. oat or soya milk as
tolerated; if unable to then contact dietitian for advice.
If prescribed Nutramigen Pureamino this can be changed over to Neocate LCP.
4/6/2019