National Patient Safety Alert: Shortage of salbutamol 2.5mg/2.5ml and 5mg/2.5ml nebuliser liquid unit dose vials

National Patient Safety Alert Reference Number: NatPSA/2024/003/DHSC_MVA

Date issued: 26 February 2024

Explanation of identified safety issue

A Medicines Supply Notification (MSN) issued on 14 February 2024, detailed a shortage of salbutamol 2.5mg/2.5ml and 5mg/2.5ml nebuliser liquid. The resolution date is to be confirmed.

The supply issues have been caused by a combination of manufacturing issues resulting in increased demand on other suppliers.

Terbutaline, salbutamol with ipratropium, and ipratropium nebuliser liquids remain available, however, they cannot support an increase in demand.

Ventolin® (salbutamol) 5mg/ml nebuliser liquid (20ml) is out of stock until mid-April 2024 and cannot support an increased demand after this date.

Unlicensed imports of salbutamol nebuliser liquid can be sourced. Lead times vary. Information relating to imports was outlined in the MSN and is available on the SPS Medicines Supply Tool which also details any changes to resupply dates, updates to this communication and an up-to-date supply overview.

NOTE: Supplies of licensed salbutamol nebuliser liquid have been allocated for those ambulance services which cannot administer unlicensed medicines via PGDs

Actions required

All providers MUST:

Liaise with local pharmacy teams and place urgent orders for unlicensed imports of salbutamol nebuliser liquid – do not wait for supplies to be exhausted before placing orders for imports.
Wean all patients off nebulisers as soon as their condition has stabilised.
Consider use of high-dose salbutamol pressurised metered-dose inhaler (pMDI) via a large volume spacer in patients with mild to moderate asthma attacks or COPD (see clinical information) ensuring the patient is issued with a new inhaler to avoid risk of using a near empty device and can administer it effectively if not being administered by a healthcare professional.

Secondary care providers should:

Where a pMDI is not appropriate, prescribe salbutamol nebuliser liquids when required (PRN) rather than regularly (QDS), as early as possible during admission, if appropriate.
Prioritise supplies of salbutamol nebuliser liquids for the following indications:
a. acute, severe exacerbations of COPD and asthma
b. bronchospasm secondary to refractory anaphylaxis
c. in patients who cannot use a pMDI
d. other conditions where the use of high-dose salbutamol pMDI via a spacer is inappropriate e.g. moderate to severe hyperkalaemia

Primary care prescribers should:

Review need for home nebuliser use, and if deemed necessary, determine if the patient has sufficient supplies of nebuliser liquid at home before issuing repeat prescriptions.

Please see full guidance in the alert.

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