Pharmacists and GPs alike must stop simply accepting excuses from manufacturers when commonly prescribed drugs are in short supply, says The Pharmacist’s GP blogger Dr Livingstone
It’s a sign of our collective ability to adapt/demoralised passivity that, these days, we just meekly accept drug ‘manufacturing problems’ to explain away medicines shortages. They’re simply irritations we’ve become immune to, like traffic, frozen computers and the ad-breaks in The Great British Bake Off.
But then a new medication shortage smacks you in the face with such force that you suddenly wake up, once more, to the absurdity of the situation. And so it is with glipizide.
As usual, the first we heard of the great glipizide shortage was when a diabetic patient turned up in the middle of morning emergency surgery because, apparently, ‘The pharmacist said you’ll have to prescribe an alternative.’
Later, during repeat-script signing, there was a note from another pharmacy attached to a glipizide request stating, ‘Unavailable – suggest glibenclamide’.
Which told us three things. First, that there really was a problem.
Second, that the pharmacist was at least adopting our longstanding request of suggesting an available alternative rather than relying on our guesswork.
And third, that this isn’t a fool-proof system, given that glibenclamide is not an ideal replacement, unless you want to practice resuscitating a hypoglycaemic patient.
There are those who think GPs and pharmacist gripe too much about drug shortages, but that’s clearly because they know sod all about primary care.
A manufacturing issue involving an incredibly common drug creates massive problems and endless questions.
Is it affecting all pharmacies? How long will it go on for? What’s the nearest equivalent? Is that about to run out, too? Do we proactively contact the patients or wait until they encounter a problem? How do we communicate the switch to them? How do we allay the anxiety it will cause? Do we need to redo all the repeat templates? And so on and so forth.
And glipizide-deficiency is a prime example: work for us all, concern and confusion for the patient and the very real possibility of adverse outcomes.
I genuinely have no idea what’s really behind these drug shortages, but I do wish that someone, somewhere, could get hold of the problem and sort it out. Not least because I wonder where it might end: maybe next it’ll be the unavailability of insulin, or a shortage of antibiotics.
Or it could even be that, one day soon, I’ll come into work to be confronted by a message from the local pharmacist stating, ‘There are no drugs of any sort available whatsoever anywhere.’ And, yes, ‘Can you prescribe an alternative?’