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Memo – shortage of supply
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Re: Digoxin injection
Description of products affected
Digoxin injection is licensed for the management of certain supraventricular arrhythmias, particularly chronic atrial flutter and fibrillation; and cardiac failure accompanied by atrial fibrillation. It is also licensed for the treatment of chronic cardiac failure where the dominant problem is systolic dysfunction.1
Background
There is a shortage of digoxin injection as Andipharm Mercury Company Ltd who currently holds all six contracting regions in England are out of stock with an anticipated delivery date sometime in August 2015.2 The other UK product licence holder, Aspen may have stock available from mid-April 2015.3
Alternative agents and management options
Digoxin injection is now rarely used for rapid control of heart rate4 although it is often overused (inappropriately), quite often in the emergency departments. As digoxin has good oral bioavailability, tablets are the preferred option if digoxin is considered the appropriate treatment, and the injection should be reserved for those who are nil by mouth such as patients on ITU’s, and a small number coming through the emergency departments. If there is a need for rate control then other strategies should be tried such as beta blockers, rate controlling calcium channel blockers, including verapamil (unless BP low) or oral digoxin.5 In the event that supplies of the injection are exhausted, imports are available.
References
1. Aspen. Lanoxin Injection SPC (date of revision of text: December 2013): http://www.medicines.org.uk/emc/medicine/2175
2. Andipharm Mercury Company Ltd. Personal communication, 18 March 2015.
3. Aspen. Personal communication, Medical Information, 18 March 2015.
4. BNF Sept 2014-March 2015
5. Personal communication, Paul Wright, Lead Cardiac Pharmacist, The Heart Hospital / UCLH Cardiac Services, 30 Jan, 2015
Acknowledgements
· Paul Wright, Lead Cardiac Pharmacist, The Heart Hospital / UCLH Cardiac Services
· Imran Hafiz, Principal Cardiovascular Pharmacist, Guy’s and St Thomas’ NHS Foundation Trust
· Sotiris Antoniou, Consultant Pharmacist, Cardiovascular Medicine, Barts Health NHS Trust
Original document prepared by:
Guy’s and St Thomas’ NHS Foundation Trust Medicines Information Centre
Prepared 30 Jan 2015, updated March 2015
Document modified by:
Name of individual at other centre using the product with modifications, centre, date
For all correspondence please contact:
Name of person at base hospital where memo is circulated (i.e. NOT the original author at Guy’s and St Thomas’ NHS Foundation Trust
Disclaimer: The content of some of this memo is based on consensus opinion from clinical practitioners. Users should bear this in mind in deciding whether to base their policy on this document. Individual trusts should ensure that procedures for unlicensed medicines are followed where a foreign import drug is required in the interim.