Drug Shortage Causes and Coping Strategies for people with Addison's Disease

Confused or worried about drug shortages? Here’s our ADSHG Guide to causes and coping strategies.

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.

How to manage your Addison’s Disease during a shortage:

Stock Piling

It is usual advice for steroid-dependent people to keep at least one month’s supply of extra medication above and beyond your expected daily requirement to allow for up-dosing in the case of any intercurrent illness. Make sure you have at least one month of extra medication available at all times.

Our Medical Advisory Panel recommends that people with Addison's request six-monthly prescriptions. Those requesting six-monthly prescriptions are not asking for extra, just what they would ordinarily be prescribed in six months, in advance. Those people must ensure they request their next set when they have AT LEAST one month's tablets left which, due to any updosing, maybe after only 4-5 months. It's important to always keep at least a month in hand.

Dept. of Health advice is that individuals should not try to stockpile a year of medication for personal use. If everyone does this, then there will be a surge in demand and some people will be left without any.

Trying 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.

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 Solu-Cortef which is a dried form of hydrocortisone that is mixed with a water vial before injections.

Advice on using the 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.

Solu-Cortef Injection

In the event of being unable to access 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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Last updated: 14/10/2021

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