It’s me, talking about shortages – again. Sorry. One of these days I’ll find something original to write about.
The latest instalment in the medicine shortages box set is ranitidine. If I’m being honest, it’s not a medicine that I usually give much thought to. Ranitidine is useful for those with reflux and gastritis, and it’s cheap and well tolerated. It isn’t something that has given us much hassle. Until now.
The headlines started to hit in early October, when a Medicines and Healthcare products Regulatory Agency recall was issued for certain batches of ranitidine-containing medicine due to possible contamination with carcinogen N-nitrosodimethylamine (NDMA).
Initially, this only affected Zantac. But it was shortly followed by an alert that all oral preparations of ranitidine were out of stock, with no date for resumption of supply. This action was taken even though, according to the U.S. Food and Drug Administration, the levels of NDMA in ranitidine barely exceed that found in many foods. Perhaps we should also ban bacon and whisky.
This shortage seems to be different from some of the previous ones. So far, shortages have been caused by different brands of a medicine going in and out of stock, so prescribers have to fiddle around changing allergic patients from Jext to Emerade and back again, or our patients taking hormone replacement therapy products from a patch to a gel and then to a tablet.
This is the first time that an entire class of medicine has effectively gone out of stock, as there are few other H2 antagonists on the market. Those that are available are also in short supply, so much so that we have been asked not to switch to them for fear of exacerbating those shortages.
From adversity comes opportunity though, and this is at least a trigger for GPs and pharmacists to work together in a way that will hopefully become more common in the future. Increasing numbers of practices have pharmacists who conduct medication reviews and other tasks previously given to GPs. Managing patients on ranitidine seems to be a good use of their skills.
Pharmacists have the knowledge to review the notes for the indication and then speak to the patient. Some patients been taking it for years after a short episode of reflux and don’t need it anymore. Others will need switching to omeprazole or Gaviscon.
The occasional patient might need to be discussed with gastroenterology or paediatrics. Drug shortages are a pain in the posterior, but if they improve GP-pharmacist communication and multi professional working then at least some good will have come out of the situation.
Toni Hazell is a GP based in a practice in London