National Patient Safety Alert: Shortage of pyridostigmine 60mg tablets

National Patient Safety Alert Reference Number: NatPSA/2023/008/DHSC

Date issued: 18th July 2023

Brief description of the problem

There are very limited, intermittent supplies of all glucagon-like peptide-1 receptor agonists (GLP-1 RAs).

Supplies are not expected to stabilise to meet full market demand until at least mid-2024. 
The supply issues have been caused by an increase in demand for these products for licensed and off-label indications.
The off-label use of these agents for the management of obesity is strongly discouraged. Existing stock must be conserved for use in patients with diabetes. These shortages have serious clinical implications in the management of patients with type 2 diabetes. 
Please also see the Medicine Supply Notification for further information or the resources on the Specialist Pharmacy Service (SPS) website.

Actions required

Actions to be completed by 18th October 2023:

Actions for clinicians and prescribers of GLP-1 RAs until supply issues have resolved

Only prescribe GLP-1 RAs for their licensed indications.
Do not initiate new patients on GLP-1 RAs for the duration of the shortage.
Proactively identify patients established on affected GLP-1 RAs and consider prioritising for review based on the criteria set out in the clinical guidance and:
i. discuss stopping treatment with patients who have not achieved treatment targets as per NICE CG28 or NICE CG189
ii. do not switch between brands of GLP-1 RAs, including between injectable and oral forms.
iii. do not double up a lower dose preparation where a higher dose preparation of GLP-1 RA is not available.
iv. do not prescribe excessive quantities; limit prescribing to minimise risk to the supply chain whilst acknowledging the needs of the patient.
Use the principles of shared decision making where an alternative agent needs to be considered, as per NICE guidelines and in conjunction with the clinical guidance.
Support patients to access structured education and weight management programmes where available.
For type 2 diabetics; If switching a patient on to insulin, please ensure an insulin is chosen as per information on the SPS page on prescribing available insulins as not all suppliers are able to manage an uplift in demand.

Please see full guidance in the alert.

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