After high profile shortages of HRT and antibiotics, Britain’s pharmacists warn that supplies of sleeping pills and antidepressants are also running short, so can you safely swap to another drug?
- Drug suppliers have warned of critical shortages of vital and common medicines
- Doctors are concerned that patients will suffer without the correct medication
Britain’s medicines shortage crisis is deepening, with an unprecedented 70 commonly taken drugs now out of stock, according to the latest data.
Over the past 12 months, supply problems have hit crucial antibiotics, hormone replacement therapy (HRT) drugs, painkillers and over-the-counter cold and flu remedies – but now certain antidepressants, stop-smoking pills and a sleeping tablet taken by millions have been added to the list.
Doctors and pharmacists have raised the alarm after becoming concerned that patients will be forced to suddenly stop taking prescribed treatments, risking worsening or the return of illnesses, withdrawal symptoms or other complications.
In a bulletin from Alliance Healthcare, one of the UK’s largest medicines suppliers, everyday drugs such as Gaviscon, Benylin, codeine, and even certain types of asthma inhalers are also said to be unavailable or in limited supply.
Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said: ‘Time and time again we’re seeing pharmacists being forced to turn patients away who are trying to get hold some of the most common and important medicines.
Pharmacists have been warned about critical shortages in vital drugs including common medicines which have been widely prescribed by GPs
There has been an ongoing high-profile shortage of HRT drugs, leading to increased stress to women relying on the medication
‘Manufacturers are telling us that this year these shortages will get even more common.’
According to Mark Samuels, who heads industry body the British Generic Manufacturers Association, the situation is ‘worse than at any time I’ve experienced during my career’.
One of the more worrying examples of pills that are hard to come by is low-dose formulations of the antidepressant fluoxetine, also known as Prozac.
These are prescribed by psychiatrists to more than a million children and young people aged five to 18 suffering from mental health problems such as depression.
New stocks are not expected until March, according to Government document The Serious Shortage Protocol List.
While adult patients on low doses may be able to take a different antidepressant, GP Dr Philippa Kaye warns: ‘Fluoxetine is the only antidepressant licensed for children – finding alternatives might be difficult.
‘Stopping antidepressants suddenly isn’t advised. It can trigger discontinuation symptoms such as extreme anxiety and trouble sleeping which last for a while.’
And also in short supply, according to Alliance Healthcare’s Out of Stock Bulletin, is sleeping tablet zopiclone, one of two insomnia drugs that are collectively prescribed more than ten million times a year in the UK. If patients who have taken the pills for more than a few months stop suddenly, they can suffer withdrawal symptoms including anxiety, tremor and digestive problems, or a return of sleeplessness.
Medication for treating depression has also been marked as being in short supply
One of the more worrying examples of pills that are hard to come by is low-dose formulations of the antidepressant fluoxetine, also known as Prozac
‘It’s been impossible to get hold of zopiclone for close to two months,’ says Mitesh Desai of Landys Chemist in London.
Dr Kaye adds: ‘These aren’t drugs that patients should be stopping instantly without swapping them for something else or tapering off, if they’ve been taking them for a prolonged period of time.
‘Patients need to see their GP about how to gradually come off sleeping pills if they are running out – you shouldn’t be on them for a long period anyway, due to a risk of addiction, but we know many patients are.’
Also on the list is bupropion, a pill given to people who want to stop smoking. It is the only treatment other than nicotine replacement therapy, such as gum, patches and inhalers.
‘Nicotine gum and suchlike double your chances of quitting but don’t work for everyone, and bupropion is very effective as an alternative,’ says Dr Kaye.
‘We’re in a situation where we can’t start patients on it, which means they might want to quit but are unable to.’
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Bupropion is also prescribed as an antidepressant in adults who have failed to respond to other medications. ‘It’s likely these patients have tried a few other antidepressants and not improved, or suffered side effects, so there may not be many other options a GP can offer without the advice of a psychiatrist,’ says Dr Kaye.
The Out of Stock Bulletin lists some over-the-counter medicines as unavailable, including children’s paracetamol product Calpol, along with cold and flu medicines Day Nurse and Night Nurse. ‘We saw sales of Calpol shoot up at the end of last year because of a spike in winter bugs,’ says Mr Desai. ‘We haven’t been able to get any more for nearly a month, and we’ve had no information about when it will get sorted.’
The sudden shortages of these products come amid the ongoing problems with access to HRT, taken by women to help with symptoms of the menopause. This has largely been put down to an unprecedented rise in demand for the medications.
Supply issues with HRT followed public awareness campaigns and a spike in demand, with a 35 per cent increase in prescriptions last year alone. In response to the increased popularity of the drugs, the Government created an HRT supply taskforce to help alleviate the problems. Last week, Health Minister Maria Caulfield tweeted that the UK had a ‘full stock’ of Evorel patches, which contain oestrogen and are used in HRT treatment, but GPs report that many patients can’t get hold of it and there are shortages of other HRT drugs.
Staffordshire-based GP Dr Cat Anderson said: ‘I’ve had patients in floods of tears because they can’t get hold of their HRT, and suddenly they can’t sleep or focus at work.’
A new Government policy will mean patients need to pay only a single annual prescription charge of £18.70 for HRT, reducing the cost by about £200. As a result, more women are expected to begin taking the medication.
Common over the counter drugs are also in short supply according to industry experts
Suraj Shah, drug tariff and reimbursement manager at the Pharmaceutical Services Negotiating Committee, says: ‘Manufacturers we speak to say they worry this means the HRT shortage is about to get even worse.’
Meanwhile, a surge in the bacterial infection Strep A – which caused 190 deaths, including 30 children, between September and December last year – led to pharmacists running out of one of the main treatments, penicillin.
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GPs say they’ve been informed by local health chiefs that shortages of the antibiotic are ‘being resolved’. But the Serious Shortage Protocol List still includes eight different forms of penicillin, in varying sized doses. Worryingly, experts say the problem is only going to get worse – with far more basic medications affected.
The after-effects of the pandemic – when lockdowns caused supply chain issues and drug companies diverted resources to tackling Covid – and the war in Ukraine are partly to blame for the situation. But experts say the primary problem is China.
‘It is harder than ever to get hold of the raw ingredients used in the medicines,’ says Ms Hannbeck. ‘This is in large part because of the effect of the constant lockdowns in China, which is where a lot of these materials come from.’ This has slowed the speed at which medicines can be made, creating a backlog. Mr Shah adds: ‘This means supply is going to continue to be bumpy for some time.’
Selling medicines to the NHS is also becoming increasingly unprofitable. The raw ingredients supply problems mean the cost of making drugs has risen – but there are caps on how much the NHS will pay for them, so international firms are less willing to sell to the UK. And the Government is due to raise business taxes on sales of branded drugs from 14 per cent to nearly 26.5 per cent, meaning some firms are threatening to pull out of the UK market completely, according to reports.
‘Companies don’t see it as cost effective to produce the medicines for us,’ says Ms Hannbeck.
‘We can’t go on like this. We’re stuck in this cycle where every time demand rises for a drug, we instantly see shortages.
‘The Government need to get manufacturers and pharmacists around a table and work out how to improve the situation.’
What to take if you cannot get your usual prescription
If you can’t get your regular prescription there may be another option that works just as well. Speak to your pharmacist or doctor before making a switch.
Zopiclone
What is it?
A pill taken for short-term bouts of insomnia.
Is there an alternative?
Dr Philippa Kaye says: ‘Zopiclone can be swapped for zolpidem. However, if you’ve been taking the pills for a while, you could see it as an opportunity to stop – reducing your dose with the help of your doctor.
‘There are lots of causes of insomnia, some of which can be treated. For example, if you need pain relief or if you have depression or anxiety which is affecting your sleep.’
Fluoxetine
What is it?
A selective serotonin reuptake inhibitor (SSRI) antidepressant commonly known as Prozac. It is used to treat depression, anxiety, obsessive compulsive disorders and eating disorders.
Is there an alternative?
Dr Kaye says: ‘The shortages are affecting low doses which are given to children or people trying to taper off the drugs.
‘Fluoxetine is the only SSRI licensed for children – but under certain circumstances specialists may offer another.
‘It’s important, if you think you’re going to run out, to try to get an appointment with the psychiatrist who’ll be able to advise how to safely switch.’
Bupropion
What is it?
A drug that interferes with brain signals, reducing cigarette cravings. It is also an antidepressant.
Is there an alternative?
Dr Kaye recommends nicotine replacement treatment for smoking cessation – pills, gum and patches.
She adds: ‘You could also invest in an electronic cigarette as these can help you stop smoking.’ As for those who are take bupropion for depression, she says: ‘Specialists might be able to prescribe another type of antidepressant.’
Penicillin
What is it?
An antibiotic used to treat bacterial infection such as pneumonia and Strep A.
Is there an alternative?
Penicillin can be swapped with amoxicillin, clarithromycin and azithromycin.
Dr Kaye says: ‘At the moment it’s particularly difficult to get hold of a range of antibiotics in formulations suitable for children, such as liquid medicine. If an alternative isn’t available, your pharmacist will be able to advise on whether it might be suitable to crush a tablet into a small amount of liquid or spoonful of jam.’
HRT
What is it?
Estradot is a patch containing the female hormone oestrogen and Utrogestan is a progesterone pill. Together they are known as combination hormone replacement therapy.
Is there an alternative?
Dr Kaye says: ‘There are other forms of progesterone available, such as norethisterone or Provera. Or you could get a Mirena coil fitted, which releases progesterone.
‘Estradot can be replaced with patches such as Estraderm. There are also gels and sprays like Estrogel, Sandrena and Lenzetto.
‘If one is out of stock, pharmacists are now able to switch patients over to another HRT that is in supply, without the patients having to get another prescription.’
Cold and flu remedies
What is it?
Most contain paracetamol and a decongestant.
Is there an alternative?
Dr Kaye says: ‘Paracetamol tablets and a hot drink made with honey and lemon can be just as helpful as over-the-counter flu treatments. You could also try a decongestant spray.’
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