Patients must be ‘urgently’ referred back to mental health specialists if drug shortages hit, SPS warns

Patients who take medication used to treat depression should be “urgently” referred back to a mental health specialist if their supply runs out, the Specialist Pharmacy Service (SPS) has warned.

NHS trusts have already been told that phenelzine 15mg tablets will be out of stock for “at least three months” from the beginning of August 2019 to the end of October 2019, because Kyowa Kirin, the sole supplier of phenelzine tablets in the UK, is experiencing temporary disruptions.

Phenelzine, a monamine-oxidase inhibitor, is licensed for the treatment of depression. It is also used in patients with generalised anxiety disorder, panic disorder and post-traumatic stress disorder. The National Institute for Health and Care Excellence supports its use for the treatment of social anxiety disorder.

Withdrawal over six months is recommended when patients have been taking it as a long-term treatment and it is advised to leave a 14-day “washout period” between stopping phenelzine and initiating new treatment.

In a memo sent out to NHS trusts on 12 July 2019, the SPS — which is responsible for medicines optimisation across the NHS — advised that, given the difficulties associated with withdrawing treatment and initiating new treatment in patients stabilised on phenelzine, they should be maintained on treatment using imported supplies if necessary.

These medicines would need to be treated as an unlicensed medicine in line with local clinical governance procedures, the memo stated.

If a patient maintained on phenelzine runs out of supply during the shortage, they should be “urgently” referred back to a mental health specialist for advice on ongoing clinical management, the SPS said.