GPs have been asked to identify patients taking a certain anti-epileptic drug amidst supply shortages.
Some forms of Trileptal – a branded version of oxcarbazepine – will be out of stock until mid-July, the Department of Health and Social Care has warned.
The 300mg tablets will be going out of stock from late June and the 600mg tablets are already out of stock, the medicines supply notice said.
Trileptal 150mg tablets and 60mg/ml oral suspension remains available ‘but cannot meet an increase in demand’, it added.
Primary care teams have been asked to identify and prioritise patients taking Trileptal – manufactured by Novartis – who might not have enough supply to last until stocks come back in.
Patients taking the medication for trigeminal neuralgia should be moved to the generic version of the drug to reserve supplies for patients with epilepsy, the notice said.
And any patients with epilepsy who need to be switched to the generic drug, should be monitored for adverse effects and worsening seizure control.
Those who have to be switched to the generic as a result of the supply issues should be reassured they are receiving the same drug at the same dose, and to report any side effects or loss of seizure control, DHSC said.
Where generic alternatives are not appropriate, advice should be sought from specialists on management options, the notice added.
Secondary care teams have been asked to start no new patients on Trileptal branded tablets until the medicines shortage has been resolved.
Epilepsy Action noted there had been fluctuating supply problems since April with different doses or formulations unavailable at different times.
David Thornton, advice team leader at Epilepsy Action, said: ‘It’s concerning to see that multiple formulations of Trileptal have been unavailable.
‘Oxcarbazepine is a category 2 medicine, so for many people it will have been decided by them and their doctor that they should stay on Trileptal where possible.
‘If anyone has concerns about supply of their medicine or taking a different version, they can speak to their doctor or pharmacist for advice.
‘While not ideal, for most people it’s safer to take a different version of their medicine than to run out and stop taking medicine completely.’
Professor Azeem Majeed, GP and professor of primary care and public health at Imperial College London said for people with epilepsy, using the same brand of medication was important for reasons such as consistency and bioavailability of active ingredients, and to maintain good seizure control.
‘For this particular drug, the number of patients using Trileptal in a typical practice may not be high but whenever there is a shortage of a drug, this adds to the workload of primary care teams (both general practices and pharmacies), as well being frustrating and stressful for patients.’
He added that ongoing shortages of common drugs in recent years – which has included HRT among other products – had lead to considerable extra workload for general practices and pharmacies.
‘We do need a more active approach from the Government which needs to work with manufacturers, importers and wholesalers of drugs to ensure that the NHS has a consistent supply of drugs.’
There are some drugs where generic prescribing is not appropriate, and the foremost of these is anticonvulsants, for reasons of variation in availability and pharmacodynamics between different branded preparations.
Changing brand is a highly complex and specialist process, which Secindary Care should be doing. How can GPs be expected to accurately provide fully informed consent to patients when we do not know the risks?
Government should not have allowed this situation to arise. Anticonvulsants should be manufactured within Britain, so that they cannot fall off cargo ships in transit and get lost.
I have had a patient who had a seizure because normal medication was not available at the right time, and therefore lost her driving license, and the effects were drastic. Out of work, unable to obtain groceries, transport for disabled husband, safeguard for epileptic daughter, and her young family, and unable to access GP care.
How can GPs be expected to provide fully informed accurate risk assessments and safeguard patients from this negligent, and short-notice, privatised drug company error?
Anyway, best way to identify them is to advertise it on the TV, radio and social media, and ask them to come forward to their MP and Specilaist (but not their GP, thankyou).
I have identified all of them. Deal with it.
It my is *a* problem but not *our* problem. There are a number of possible ways to fix it in primary or secondary care.
It seems to me that there are therefore two correct responses by GPs to this:
1. We have capacity to do this, but the work is not GMS and will require funding from the ICB or NHSE.
Or
2. We do not have capacity to do this ourselves, but if the ICB wish to send someone out to access the records in order to fix it then we will make them welcome (but we will not be doing the work itself).