stephensons wrote:
I've had Sky news on for a couple of hours now and still 'zilch' on the flu situation here. I believe the Royal College of Practioners report is due out today for the numbers of cases etc. All this silence makes it more unerving.
The commented on antivirals:
http://www.rcgp.org.uk/pdf/Seasonal_Inf ... 2_2010.pdfDr Keith Ridge
Chief Pharmaceutical Officer
Room 406A Skipton House
80 London Road
London
SE1 6LH
Tel: 020 7972 2000
Gateway Reference: 15366
To: Medical Directors of Acute Trusts
Chief Pharmacists of Acute Trusts
Pharmaceutical Advisers of PCTs
Immunisation and Flu Co-ordinators
SHA Medical Directors
SHA Pharmacy/Prescribing Leads
Copy: General Practitioners
Community Pharmacists 23rd December 2010
Dear colleague
2010/11 Seasonal Influenza: supply and availability of antivirals
Following on from the Chief Medical Officer’s communication of 21st December on the prescribing of antivirals1, I thought it would be helpful if I provided you with an overview of action underway at national level in relation to the supply and availability of antivirals to pharmacies, and arrangements for the holiday period.
Following increased demand for antivirals, there have been reports of localised shortages at both pharmacies and wholesalers. DH has taken a series of steps to support the normal medicines supply chain including:
a) So far, transferring two batches from the national antiviral stockpiles ( a total of 36,960 packs of 75mg capsules of oseltamivir, 12,228 packs of both 45mg and 30mg oseltamivir capsules, 7,360 bottles of oseltamivir suspension, and 1,680 packs of zanamivir ) to manufacturers for onward supply to wholesalers and then to pharmacies (i.e. the normal supply chain). A further significant release of oseltamivir from the national stockpile is likely to go ahead shortly;
b) Checking that manufacturers have in place sufficient and timely ordering of stock from their normal routes;
1
http://www.dh.gov.uk/en/Publicationsand ... /DH_1230961
c) Checking that manufacturers and wholesalers have in place arrangements for urgent courier supplies to pharmacies, if absolutely necessary;
d) At least daily teleconference calls with manufacturers and wholesalers, as well as regular contact with key pharmacy contacts, to assess stockholding and action required.
It takes around 24 hours for stocks to reach manufacturers from the national stockpile and then onto wholesalers. Wholesalers have placed significant orders for antivirals and the latest delivery will be at wholesaler depots later today. These amounts will be sufficient to fill back orders to wholesalers, whilst also retaining a buffer. Through the regular monitoring set out above DH will determine whether there is a need to release more of the national stockpile.
You will also be aware that following increased case severity and hospitalisation, the Chief Medical Officer has recommended that the current antiviral prescribing restrictions should be amended to allow general practitioners (and other prescribers) to exercise their clinical discretion so that any patient who their GP feels is at serious risk of developing complications from influenza may receive these treatments on the NHS. This is consistent with guidance from NICE which informs the existing statutory restrictions, but which envisages that prescribers may exercise their clinical discretion in individual cases1.
I expect there to be an increased demand for antivirals as a result, the level of which is difficult to predict.
There are a number of important actions for SHAs, PCTs, pharmacists and prescribers during this period. Some PCTs have chosen to identify selected community pharmacies as locations to receive and dispense antivirals. PCTs may want to target specific community pharmacies, which are open over the holiday period. The wholesalers are tending to put a limit on the number of packs that they issue to community pharmacies in any single order to ensure that all pharmacies are able to get supplies if they need them. PCTs may want to contact the wholesalers to inform them of pharmacies who will be open over the holiday period so that wholesalers can supply the appropriate number of packs, given these pharmacies will be open for longer periods. The Medicines and Healthcare Products Regulatory Agency are content with this approach in these circumstances.
Email boxes for PCTs to notify wholesalers of key pharmacies:
pctstockrationing@alliance-healthcare.co.ukantiviralstockqueries@aah.co.ukIdeally, PCTs should provide the postcode and wholesaler account number for those pharmacies. Those pharmacies should place their orders with wholesalers as soon as possible.
Community pharmacies will already be aware of the emergency contact details for wholesalers.
It remains important that hospital and community pharmacies and prescribers do not over order or stockpile antivirals as such activity will lead to further shortages.
2
However, there also needs to be rapid or immediate access to the medicine when and where it is needed (bearing in mind it has to be given within 12 – 48 hours of onset of symptoms). I know many community pharmacies do not routinely stock antivirals, but rely on the ability to obtain them quickly from normal routes when a prescription arrives. This is an important balance to achieve and will need collaboration between GPs and pharmacists. Pharmacists and GPs should bear in mind that hospitals may offer an alternative source in exceptional circumstances.
Antivirals for Children
DH has made available stocks of Tamiflu suspension to the manufacturers, who will respond to orders from wholesalers and hospital and community pharmacies for requests accordingly. Should supplies of Tamiflu suspension be depleted, the marketing authorisation for Tamiflu now includes the emptying of capsules into a suitable diluent, with the appropriate volume being administered to the child, based on age and weight. The patient information leaflet for Tamiflu capsules contains detailed directions about making up a solution in a suitable diluent. The suspension should be used for children under 1 year of age. For older children, who cannot swallow capsules, the contents of the capsules should be emptied and added to a sugary diluent as recommended in the Patient Information Leaflet.
Tamiflu is not licensed for use in children under the age of one year for seasonal influenza. Prescribing of Tamiflu in this age group should be based upon the judgement of the clinician, after considering the potential benefit of treatment and any potential risk to the child.
Contacts over the holiday period
We will be holding regular telecons with manufacturers and wholesalers across the holiday period, as well as keeping in touch with front line pharmacy through the relevant pharmacy organisations. Therefore any feedback from yourselves to help inform those discussions will be most welcome. This needs to be sent to the following email address:
Brandedmedicineshortages@dh.gsi.gov.ukI hope this information is helpful.
Yours faithfully
Dr Keith Ridge
BPharm MSc PhD DSc(Hon) FRPharmS
Chief Pharmaceutical Officer
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