Supply Issues

Supply issues occur from time to time for a variety of reasons, including interruption to supply lines, problems in manufacturing, and complications in sourcing ingredients. We know it can be disruptive and time-consuming to source stock and/or alternatives, so for your ease, this new section of our website will keep you updated on recent supply issues, and where applicable what the alternative supply arrangements are.

If you have any questions, please contact either Stephanie Menzies or Emma Taylor in Pharmacy Services by email or on 0131 466 3540.

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Nardil 15mg tablets are anticipated to be out-of-stock until the end of November 2019, however unlicensed generic versions are available.

You should follow the normal specials authorisation process as outlined in Circular PCA(P)(2015)17 and make sure to claim any additional endorsements on both paper and electronic forms to ensure accurate reimbursement.

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There are current manufacturing issues with several HRT products, which have been ongoing throughout the year. Some products have been long-term issues with no stock available, others have been intermittently available. We appreciate this can be difficult to keep track of in a busy pharmacy environment, so for quick reference, please use the table in circular PCA(P)(2019)18 collated by the Department of Health and Social Care which advises of the availability or anticipated restock date of products with known issues.

Where you receive a prescription for unavailable HRT products, an equivalent available alternative should be requested from the prescriber. If you encounter, any supply issues out-with the ones in the table, please report it via our Shortage Reporter App.

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There are current short-term supply issues with the following Juvela products:

  • Gluten Free Pizza Bases
  • Gluten Free Oats

The oats are anticipated to come back into supply in September 2019, and there is no anticipated date for return of supply of the pizza bases as of yet.

Please advise patients of these delays when managing orders for the above products through the Gluten Free Food Service.

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The manufacturer Mylan are currently experiencing production difficulties leading to disruptions in the supply of EpiPen 0.3mg adrenaline auto-injectors.

As a result, Mylan are managing stock supply through a prescription-only process, allowing a supply of a maximum of two EpiPen 0.3mg AAIs per prescription.

Where you are presented with a prescription for EpiPen 0.3mg AAI, to order stock you should fax anonymised prescriptions to Alliance Healthcare’s prescription validation service on 0330 332 8126 or email them to scriptvalidation@alliance-healthcare.co.uk quoting your account number.

Please note that this process only applies to the EpiPen 0.3mg AAIs and orders for 0.15mg auto-injectors should be placed as normal.

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The Department of Health and Social Care (DHSC) has advised that SOBI, sole distributors of Megestrol in the UK have a very limited supply of Megestrol 160mg tablets for those patients for whom an alternative option as detailed below is unsuitable.

National Clinical experts have confirmed there are several other products available to treat the licensed indication but, if appropriate, unlicensed supplies of Megestrol can be used.

Unlicensed Megestrol 160mg tablets are available from some specialist importers although lead times vary. There are also unlicensed Megestrol 40mg tablets obtainable as an import with several importers currently holding stock.

 

 

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Sanofi and Mylan are currently experiencing temporary disruptions to supply of Disopyramide 100mg and 150mg caps. The 100mg from both manufacturers will be out of stock from approximately mid-June to late-July 2019.

The 150mg capsules from Mylan will be out of stock from approximately mid-August to mid-September 2019.

As these items are in Part 7 and if you are unable to obtain stock you will need to speak with the prescriber for an acceptable licensed alternative or seek authorisation for an unlicensed product. In each instance a new prescription would be required.

We ask you to please report via the Shortage Reporter any supply issues that you experience to support us in monitoring the impact of this disruption.

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Permission has been granted to supply an imported version.  Dilantin 50mg Chewable tablets have been added to Part 7U of the Drug Tariff, therefore, will not require Health Board authorisation and will be reimbursed at the listed price. If you have any issues obtaining Dilantin at tariff price, please report via the Shortage Reporter.

As Phenytoin is classed as Category 1 Anti-Epileptic drug, any change in brand supplied to patients should be discussed with prescribers as per this letter from Pfizer.  Once stocks of the licenced UK product out, pharmacy teams must not fulfil prescriptions with the imported Dilantin until they have contacted the prescriber to agree that this is appropriate.  There may be differences in bioequivalence between Dilantin and the Infatabs, so any change of brand should be managed carefully – particularly as most patients are children.

The supply issue is anticipated to continue until mid-November.

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The Department of Health and Social Care (DHSC) has advised that Pfizer expect that Epanutin (Phenytoin) 30mg/5ml oral suspension will be out of stock from week commencing 10th June. 

The Canadian brand of Epanutin® ‘Dilantin-30’ is equivalent to Epanutin 30mg/5ml oral suspension and supplies are available on an unlicensed basis.

Different formulations of Phenytoin (other than Dilantin 30mg/5ml oral suspension) are not interchangeable and if patients are switched to anything other than ‘Dilantin (Phenytoin) 30mg/5ml oral suspension’, careful management of switching and monitoring is required. 

Further details of the supply disruption and actions to be taken can be found here.

More information:

Letter from Pfizer 
Epanutin PIL and SPC
Dilantin PIL and Monograph 
Shortages

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