Written by Carla Scuderi, Pharmacist Advanced - Royal Brisbane and Women's Hospital
Many of us recently, either as a physician, pharmacist or other health care professional, would have experienced constrained supply or unavailability of certain prescription medications. Pharmaceutical supply chain disruptions have been due to Covid 19, demand outstripping supply and other global events. Sometimes medicines shortages occur due to disruption in manufacturing plants or access to the raw material from which the medicine is made.
Medicines are considered in 'short supply' is there is not enough to meet the normal demand. In Australia the TGA or Therapeutic Goods Administration is the governing body which regulates licensing of medicine defines a medicine shortage as follows: "There is a shortage of a medicine in Australia at a particular time if, at any time in the 6 months after that particular time, the supply of that medicine in Australia will not, or will not be likely to, meet the demand for the medicine for all of the patients in Australia who take, or who may need to take, the medicine."
The TGA requires that medicines sponsors (manufacturers) notify the TGA when they predict there will not be enough medicine available to supply the
next 6 months. At present there are a number of very commonly used diabetes medicines and even very common antibiotics which are in short supply.
How as a front-line clinician are you able to stay abreast of the changing situation with medicine shortages? Firstly, keep in contact with your local pharmacists. Local pharmacies may be able to source stock from other branches or wholesalers or have alternate strengths or drugs within a class which can be considered.
Sometimes there is the ability to access an imported product that is registered in another country through what is called Section 19a or Special Access scheme. Larger hospital pharmacies with purchasing teams may have larger stock holdings or be able to access medicines from multiple suppliers providing some support for critically unwell patients. Ultimately though in some instances (e.g., Tenectaplase and GLP1 agonists at present) there is just not enough drug available to meet current demands and alternate treatment decisions need to be made.
The TGA offers a subscription service for medicine shortage alerts and also publishes a medicines shortages database. Shortages | Therapeutic Goods Administration (TGA)
Australia is not alone in the struggle with medication shortages. The International Pharmaceutical Federation (FIP) has published guidelines in conjunction with the WHO on management of drug shortages at a health system level. fip-summit-on-medicines-shortage.pdf
Awareness of current medication shortages and adaptability will assist in preventing poor patient outcomes such as patients having delayed or no treatment.
Carla Scuderi
a/Assistant Director of Pharmacy (clinical)
Royal Brisbane and Women's Hospital