To send or not to send..?

[Band6]

..That is the question...

I am currently working in a small district hospital. The Trust I work for has a wholesalers licence. Recently, a community pharmacy has been asking me for pilocarpine 4% eye-drops, whose manufacture is stopping. I am now down to 4 bottles. We don't use this very often, but do use it for reduction of acutely very high intra-ocular pressure (we have an opthalmology clinic twice a week). Should I allow the stock be used in the community, or do I reserve it for hospital patients while the opthalmologists get their act together? I would be interested to hear your opinions, especially from colleagues in the community.

Band6

[Jeff]

Re: To send or not to send..?

..That is the question...

I am currently working in a small district hospital. The Trust I work for has a wholesalers licence. Recently, a community pharmacy has been asking me for pilocarpine 4% eye-drops, whose manufacture is stopping. I am now down to 4 bottles. We don't use this very often, but do use it for reduction of acutely very high intra-ocular pressure (we have an opthalmology clinic twice a week). Should I allow the stock be used in the community, or do I reserve it for hospital patients while the opthalmologists get their act together? I would be interested to hear your opinions, especially from colleagues in the community.

Band6

If necessary it can always be made as an unlicensed special at an exorbitant price.

I'd suggest that the patient might need to be re-assessed - why do you think it's being used in the community other than on an historical basis?

Jeff

[Band6]

Re: To send or not to send..?

I'd suggest that the patient might need to be re-assessed - why do you think it's being used in the community other than on an historical basis?

Jeff

Hmm - thats a good point. I'll suggest that the pharmacist in question contact the prescriber. I'll reserve the rest of the stock for hospital patients for now.

Cheers,

Band6

[mr_colt]

Re: To send or not to send..?

Couldn't you send a memo to the Consultant Oplathalmologists explaining that the product will shortly cease to be manufactured. Ask them if there is a suitable licensed alternative available that they would be willing to switch to using in such cases?

If they kick up a fuss; ask them in future which dept should invoiced for the costs of making up a special?

Obviously sometimes there may not be a suitable replacement drug/preparation but; you can't influence the manufacturers decision anymore than the rest of us. Hopefully there might be a suitable replacement they can switch the habit of scripting to instead.

mr_colt.

[Band6]

Re: To send or not to send..?

We're waiting on that now - pilocarpine 3% more often? Or even atropine?! Answers on a postcard please...

[SolomonQ]

Re: To send or not to send..?

similar "manufacturer" problems with predsol and betnesol drops,these are used for ears as well as eyes so is maxidex (betamethsone) drops a suitable alternative to use in ear, even though i think theyre only licensed for use in eyes? or is they're a better alternative?

thanks

[paul2008]

Re: To send or not to send..?

similar "manufacturer" problems with predsol and betnesol drops,these are used for ears as well as eyes so is maxidex (betamethsone) drops a suitable alternative to use in ear, even though i think theyre only licensed for use in eyes? or is they're a better alternative?

thanks

Is maxidex not dexamethasone 1% ?

[johnep]

Re: To send or not to send..?

Had a hospital script asking for ciproxin ear drops. Supplied eye drops aftter 'phoning hospital and someone here provided advice to pts leaflet from manchester.
johnep

[lamzee]

Re: To send or not to send..?

I've seen that with ciproxin before as well.

[the old merlin]

Re: To send or not to send..?

I've seen that with ciproxin before as well.

Used to do that regularly when I worked in hospital. Getting to be a while ago now, admittedly.

[SolomonQ]

Re: To send or not to send..?

Is maxidex not dexamethasone 1% ?

yes i know but is it licensed for use in ears?

[paul2008]

Re: To send or not to send..?

yes i know but is it licensed for use in ears?

No is not licenced for ears (surely you know how to check this..... )but my point was maxidex does not contain betamethasone as you bracket suggests.

I have been lead to believe that attention to detail is a key characteristic of a pharmacist. Don't know if it is true or not but am trying to get back into the habit of attending to details.

[Pharmanaut]

Re: To send or not to send..?

No is not licenced for ears (surely you know how to check this..... )but my point was maxidex does not contain betamethasone as you bracket suggests.

I have been lead to believe that attention to detail is a key characteristic of a pharmacist. Don't know if it is true or not but am trying to get back into the habit of attending to details.

Oddly, some GP computers print out generic scripts for maxidex as Dexamethasone 0.1% and Hypromellose 0.5% Eye drops.

On the SPC the Hypromellose is in the 'other ingredients' at the end.

The DM+D just call it Dexamethasone 0.1% Eye Drops.

[pharmatron]

Re: To send or not to send..?

We're waiting on that now - pilocarpine 3% more often? Or even atropine?! Answers on a postcard please...

Certainly not atropine as an alternative. It's a while since I've had to think about pharmacology of autonomic nervous system but if I remember correctly atropine and derivatives (like tropicamide) are cholinergic antagonists used in iritis as mydriatic agents, thereby preventing adhesions between the iris and cornea. Whereas pilocarpine is a direct muscarinic agonist applied topically to cause pupillary constriction (miosis) in the treatment of glaucoma. Thus the two have opposing effects.

[Titch]

Re: To send or not to send..?

Isn't atropine subject to a similar stock problem at present anyway?