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Growing list of HRT shortages exacerbating supply issues, reports show

Source: FemSeven Conti patient information leaflet, 2017
Source: FemSeven Conti patient information leaflet, 2017

The latest reports by British Menopause Society (BMS) and the NPA of the growing number of HRT products in short supply have revealed the extent of the issue.

BMS was prompted to produce guidance on the availability of hormone replacement therapy (HRT) products last week (August 9), due to a surge in reports of shortages.

"BMS has been reassured that these are temporary shortages, which pharmaceutical companies and their suppliers are trying to resolve," it said.

"Prescribers can consider equivalent preparations that provide a similar dose to what their patient is using," the charity advised.

According to the charity, the following products are in short supply:

Janssen (see the manufacturer’s response below)

  • Evorel Conti (pack of 24)
  • Evorel Conti (pack of 8)
  • Evorel Sequi (pack of 8)
  • Evorel 25mcg (pack of 8)
  • Evorel 50mcg (pack of 24)
  • Evorel 75mcg (pack of 8)
  • Evorel 100mcg (pack of 8).

Merus Labs

  • Estraderm MX 50mcg (pack of 8).

Mylan

  • Elleste Solo: 2mg oestradiol
  • Elleste Duet 1mg oestradiol and 1mg norethisterone acetate
  • Elleste Duet Conti 2mg oestradiol and 1mg norethisterone
  • Femoston 1mg oestradiol and 10mg dydrogesterone
  • Zumenon 1mg oestradiol and 2mg oestradiol
  • Elleste Solo MX 40mcg transdermal oestradiol – likely to be available later this month
  • Elleste Solo MX 80mcg transdermal oestradiol – likely to be available later this month.
NPA adds to BMS list

The National Pharmacy Association (NPA) provided C+D with an update yesterday (August 14) on the HRT products it is aware are in short supply. This included additional items not in the previous list:

Merus Labs

  • Estraderm MX 50mcg (pack of 24)
  • Estraderm MX 75mcg (pack of 24).

Theramex

  • FemSeven Conti (packs of 4 and 12)
  • FemSeven Sequi (packs of 4 and 12).

The availability of these products can change rapidly and the information it provides members is not exhaustive, the NPA stressed.

Theramex said in April that its HRT patches FemSeven Conti and FemSeven Sequi are not expected to reenter the supply chain until early 2020. C+D has asked the manufacturer for an update on the supply situation.

Shortages prompts more issues

Manufacturer Janssen, which produces the Everol range of oestrogen-only HRT patches, told C+D it expects its stocks to run out "at the end of October", if not sooner.

This shortage is due to "an unusual increase in demand" over recent months, and a "lack of availability of alternative HRT products not produced by Janssen".

"It will not be possible to resupply countries, including the UK, within the timeframe required to prevent an interruption," it warned.

RPS: Pharmacies have been struggling for months

Despite HRT supply issues only recently making national media headlines, pharmacy teams have been struggling for a while to obtain these products, Royal Pharmaceutical Society (RPS) president Sandra Gidley told C+D on Tuesday (August 13).

Ms Gidley – who is also a locum pharmacist – said pharmacy teams do not necessarily know why products are in short supply, and not being able explain this to patients can be frustrating.

Knowing the source of the problem "doesn't necessarily help the patient, but at least [pharmacists] can attempt to explain it and it doesn't look as though you're being completely inefficient", she said.

Can you recognise if HRT is appropriate for a patient in this clinical scenario?

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13 Comments
Question: 
Have you experienced a shortage of any HRTs?

A LOCUM, Community pharmacist

i'm sick of women abusing me because they have to pay multiple charges for these

*This comment has been edited to comply with C+D's community principles*

david williams, Community pharmacist

No-one has still explained WHY it is short. Is it short due to ingredients?, Is it short due to supply to a more lucrative market? Is it a manufacturing issu. Is it a lisenceing issue?

I am interested as to why all manufacturers are struggling?

ABC DEF, Primary care pharmacist

Nah it's all down to Brexit.

Don't worry they will all go oos after no deal kicks in. 

 

Lucky Ex-Locum, Superintendent Pharmacist

Absolute rubbish. If it's to do with Brexit, then we are being punished for daring to break from the corrupt Firm. Just remember - we are still IN EUROPE.

ABC DEF, Primary care pharmacist

It has been such a pain having scripts bouncing back and forth between pharmacies and surgery. I feel for the patients but I feel for the pharmacy teams even more as they are the ones end up taking the blame for being ''incompetent'' and ''useless'' for something out of their control. 

Joan Richardson, Locum pharmacist

My team and I have been called all kinds of things along the lines of "too stupid to order stock", "incompetent" and "incapable of checking our stock levels" and so on.  It is not just the shortage of HRT but the numerous other lines as well. 

I was actually reduced to tears one morning after several confrontations with patients over lack of stock.  I fully appreciate their frustration but taking it out on me does not magically produce stock.  It is as if the patients think that we have a secret stash of medication and are witholding it just for the sake of it.

 

Michael Achiampong, Community pharmacist

I am sad to read of your situation Joan. I'm sure you and your pharmacy teams have done your best to explain the medication shortages to patients. However, there is no reason for patients to become abusive. Talk to your superintendent pharmacist your about displaying a zero tolerance policy for abusive behaviour in the pharmacy. We also need more back up from the RPS and GPhC [perhaps as targeted media releases] because this situation is becoming more common place on a daily basis. Many other pharmacy teams that I have been locuming with this summer are going through similar confrontations and so sadly, you're not alone, Joan.

Lucky Ex-Locum, Superintendent Pharmacist

Just remember the demographic that needs HRT. Us blokes of a certain age have been putting up with unreasonableness for years. Just sayin.....

ABC DEF, Primary care pharmacist

Main reason why I left the sector. The abuse and pressure is endless that it gets to a point you decide "Enough is enough". You literally get way way more respect seeing patients in a consulting room in a surgery. 

C A, Community pharmacist

Sorry to hear that patients have been abusing you. The worst I have gotten from HRT shortage is "but I need it", despite our best attempts to explain the situation and get replacement scripts from GPs.

Michael Achiampong, Community pharmacist

You're not alone in this challenging sitaution CA. EWe#re all pressed for time, however, time permitting, I'd recommend the (HRT) patients the product manufacturers' contact details so that they can hear the situation "from the horses' mouth".

Ranjeev Patel, Non Pharmacist Branch Manager

I've had that several times. I tell them we have no stock and cannot procure any due a manufacturer's shortage - "but I really need it!". I always used to think I'd love to reply with "oh, well seeing as you really need it, I can get some from our magic box in the back, where we keep stuff that people really need".

Leon The Apothecary, Student

Everyone has an exit strategy.

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