If you've been told by your pharmacist that there is an issue filling your prescription, this can be due to temporary local issues. This does not necessarily mean there is a national shortage or drug supply problem. The majority of enquiries we receive from our community on this topic, are resolved at a local level within a couple of days when the correct questions have been asked, so please be reassured there is a solution to help you. 

Please read on for next steps on what to do if you find yourself in this situation, and how we can support you.

Why do drug supply problems happen?

Often it’s about getting the medication out to Pharmacists

In the UK there are only a couple of medication wholesalers and less than 40 warehouses serving the whole country. When your pharmacist says they are unable to order items it’s understandable to assume there is a shortage. Usually, however it is the local depot that has run out – there could still be a supply somewhere else in the supply system. Your pharmacist won’t stockpile items, and will most likely order items frequently instead. Often it’s only when the pharmacy puts in an order that they discover there is a supply problem.

Sometimes there’s a surge in demand

When other medications are in short supply, alternatives are highly sort after. This can lead to knock-on shortages of alternatives.

Occasionally it’s about issues with manufacturing the medication

There are many reasons that manufacturers might stop making a medication, temporarily or otherwise. Ingredients may be in short supply or suddenly too expensive. Legal or licensing problems may also halt production. India and China are the main countries supplying raw pharmaceutical materials.

What to do if you've been told there's an issue supplying your medication

Double-check with the Pharmacy

If your pharmacy says they are currently unable to fulfil the prescription please ask why this is - this will significantly speed up the charity then investigating why there may be an issue.

The pharmacy may be unable to fulfil the prescription due to an issue with the wholesaler having difficulty getting hold of the medication, or a temporary local short supply issue due to a surge in demand. Most commonly we find issues are temporary local issues.

Asking your pharmacist for the exact reason, rather than a general "we can't get hold of it at the moment", allows the ADSHG to give the pharmaceutical companies the information they require to look into why a certain wholesaler is unable to supply a pharmacy at that moment in time. 

We have found that when members ask these further questions to the pharmacist, this then prompts the pharmacist to look further into it and will often resolve it with you directly. 

If you are still unable to get hold of the issue please get in touch with the following information: your pharmacy location, the detailers of the wholesaler your pharmacy has been unable to get the medication from and the type of medication. It is vital we have this information, otherwise we will be unable to look into the issue.

This can be a draining, stressful experience. If this impacts your mental health and well-being, please read our stress article for further emotional support or reach out on our online forum.

Try another Pharmacy

Remember that your green (FP10) prescription is your property. If a pharmacy cannot fulfil your prescription, ask for the prescription back and take it to another pharmacy. Generally, try a bigger pharmacy, but don’t ignore that some smaller or independent pharmacies with knowledgeable pharmacists may have good stocks.

How to manage your Addison’s or adrenal insufficiency during a supply issue

3 months reserve supply of essential steroid medicine

Due to the Sick Day Rules it is necessary to always have 3 months reserve supply of your essential steroid medicine available. This is to ensure you have enough to keep you safe through an episode of illness which requires increased dosing, or to cover if there is a shortage of your medicine. Make sure you have at least one month of extra medication available at all times.

If you need to discuss with your GP adjusting your repeat prescription length, you may find it helpful to give them the following information: 
  1. The ADSHG GP Care leaflet to emphasise that this is the recommended clinical practice for essential replacement steroid therapy.
  2. The 'Treatment' section of the NHS website for Addison's, where this is the advice given under the 'Sick Day Rules' header.
  3. The RCGP eModule "Adrenal insufficiency with a focus on Addison's disease” 
  4. The advice from the Society for Endocrinologists for people with adrenal insufficiency

3 months provision of essential steroid medication is standard practice and is the advice given by the ADSHG Clinical Advisory PanelSociety for Endocrinology, and on the NHS page for Addison's disease.

Here is some guidance on next steps, if your GP refuses to increase your prescription:

Write or Email: If your GP does not wish to extend your prescription to provide the above cover, please put your request in writing, including the information on this page which confirms this is standard practice for your safety. Ask them to read through and then politely request again that you are provided with 3 months provision of your essential steroid medication.

Due to Addison's and adrenal insufficiency being a rare disease, medical professionals don't always have the information they need to make certain decisions. With over 7,000 rare diseases, it isn't possible for your GP to be an expert on your condition. Providing them with the information linked above and working with them, means they have the medical evidence they need to adjust your prescription.

Next steps inc PALs: After sending this email/letter, if your GP still refuses - ask them to answer why they are going against the expert advice and guidance of the Addison's Clinical Advisory Panel (CAP). This is so you have their response in writing and helps provide clarity. Let your GP know it is your intention to include their answer when writing formally to PALs about their unsafe management of your Addison’s or adrenal insufficiency. 

Alternative medication

Hydrocortisone

In the event of being unable to access hydrocortisone tablets, patients with steroid dependency should be able to swap temporarily to prednisolone tablets. The conversion ratio is 4 to 1, meaning 20mg of hydrocortisone has the same strength as 5mg of prednisolone. Prednisolone has a longer half-life in your body than hydrocortisone, and many people with steroid-dependency will be able to stay well just taking one morning dose of Prednisolone. Typical daily doses of prednisolone are 3, 4, 5 or 6mg; approximately equivalent to 12, 16, 20 or 24mg of hydrocortisone.

Fludrocortisone

In the event of a temporary interruption to the fludrocortisone supply, you should immediately start to take extra salt (normal table salt, sodium chloride) in your diet. If you start to feel weak, dizzy or lightheaded increase your hydrocortisone dose to 40 or 50mg in the day.

To learn more about fludrocortisone, read our article by Professor Simon Pearce on our blog.

Liquid Hydrocortisone Injection

In the event of being unable to access Hydrocortisone sodium phosphate (ex-Efcortesol) you should swap temporarily to 'Hydrocortisone 100mg Powder for Solution' (ex Solu-Cortef), which is a dried form of hydrocortisone that is mixed with a water vial before injections.

Advice on using the Powder for Solution (ex Solu-Cortef) injection.

Some people have experienced issues getting their Hydrocortisone Sodium Phosphate due to a recent change by the pharmaceutical company producing the medicine. If your pharmacist has been unable to get hold of the medication for you, please check with your pharmacist the PIP code (that is a recognised identifier) they are using is PIP code: 1200286, supplied by Advanz Pharma. Our members have let us know when they have advised their pharmacist of this information, it has resolved the issue. Find out more about PIP Codes.

Hydrocortisone 100mg Powder for Solution (ex Solu-Cortef) Injection

In the event of being unable to access 'Hydrocortisone 100mg Powder for Solution' (previously known as Solu-Cortef), you should swap temporarily to Hydrocortisone sodium phosphate (ex-Efcortesol) which is a pre-mixed liquid form of hydrocortisone.

Advice on using the Liquid Hydrocortisone injection

Visit our Online Forum

On our forum, we have a dedicated section called "Medication supply and availability issues" where members can report any issues they face about shortages of any of the pharmaceuticals and supplies they need to manage their Addison’s and adrenal insufficiency. Please visit our forum if you have any issues as often this can supply you with an instant solution, advice or reassuring information.

Visit the Online Forum

Please stay in contact and let us know if you need additional advice or if you find medication shortages in your area.

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