Further drug shortages prompt advice to consider unlicensed alternatives

A total of 103 medicines are currently unavailable, according to the MIMS drug shortages tracker, and many of these are not expected to be back in stock until next year. In a confidential 24-page document circulated by the DHSC to some doctors last week, measures recommended to tackle certain shortages include prioritising the most needy patients for treatment, switching patients to alternative (in some cases, unlicensed) medications, breaking tablets in half, or referring to secondary care specialists for advice.

Several widely prescribed HRT products remain out of stock since shortages were highlighted in July. Some contraceptives also continue to be affected since earlier reports, with new shortages reported for Synphase (ethinylestradiol/norethisterone), Noriday (norethisterone) and Evorel (estradiol). Loestrin 20 and 30 (ethinylestradiol/norethisterone) were recently discontinued following a long-term shortage. 

The MIMS tracker also lists various antidepressants as unavailable, including Seroxat (paroxetine), Nardil (phenelzine), mianserin and some presentations of fluoxetine. The government recently activated a 'serious shortage protocol' for fluoxetine, allowing pharmacists to supply an alternative strength or pharmaceutical form of the antidepressant without needing to go back to the prescriber.

Ranitidine is currently in short supply after several manufacturers recalled their products over concerns of contamination with a potential carcinogen.

Unprecedented

Other medicines reported to be affected by shortages include:

• Treatments for dementia - some presentations of galantamine and memantine
• Topical anti-inflammatories including fludroxycortide cream, Synalar C (fluocinolone/clioquinol) and Clarelux (clobetasol)
• Antihypertensives such as Trandate (labetalol), Adalat LA (nifedipine) and Accupro (quinapril)
• TB medications - isoniazid and Rifater (rifampicin/isoniazid/pyrazinamide)
• Analgesics - pethidine tablets and Instanyl (fentanyl nasal spray)

Commenting on the DHSC document, Dr Nick Mann, a GP in Hackney in London, told The Guardian: 'This situation is absolutely unprecedented. Previously we would have one or two or three drugs that would go offline for a while, but this is something on a different level. It is going to render the day-to-day treatments that doctors provide very difficult.'

As part of its efforts to tackle drug shortages, the government recently banned exporting of certain products, including HRT, adrenaline auto-injectors and hepatitis B vaccines, to safeguard stocks for patients.

MIMS lists 96 drug shortages as having been resolved since May.