The new dosages of Aristo Vencamil are reportedly coming through to pharmacies now. These are 25, 50 and 75 micrograms.
However, GP computer systems might still not find them listed - they can take months to update - despite Aristo ensuring they were on NHS systems well ahead of release.
1st October 2024
I don't often post blog entries.
What I tend to do is post pages which are meant to be for reference - rather than the frequent blogs. Most blogs are intended to promote something or other. (And that is not in itself a criticism.) Or to provide an ongoing narrative.
Whereas my main aim is to maintain what could be pages on a website.
You can see the index to all my blog pages here:
https://helvella.blogspot.com/p/helvella-index-of-blog-pages.html
There are ordered alphabetically by title - within sections. And I regularly update them.
If you find anything wrong or out of date - please let me know!
This might be the first time you have ever seen my blog. In which case, just welcome. For returnees, welcome again.
I keep adding pages to the main content of my blog - the numerous pages indexed here:
https://helvella.blogspot.com/p/helvella-index-of-blog-pages.html
Recently added page identify what tests might be included in an Iron Panel or a Thyroid Panel. While the phraseology of "ordering a panel" sounds very American, it has become ever so common. Yet the simplest level of know what that means is rarely explained.
And I keep adjusting the phrasing, adding some words, correcting typos, etc.
This sort of information is locked away by the USP so that we patients cannot access it!
However, searching found what claims to be a copy of the USP document and that says:
It may contain a suitable diluent such as Lactose, Sodium Chloride, Starch, Sucrose, or Dextrose.
My memory is claiming there might be one or two other substances are specifically permitted but I cannot find confirmation. I'll update if I can find out more. But as written, it seems to allow anything that is considered "suitable" without definition of that.
In an attempt to clear up widespread confusion:
★ Mercury Pharma is a company/brand owned by Advanz Pharma.
★ Mercury Pharma have two product lines - Mercury Pharma levothyroxine and Mercury Pharma Eltroxin.
★ These products are absolutely 100% identical - only the packaging is slightly different.
Sometimes prescribers and pharmacists do not appreciate all of this.
Also, it appears that the company might only be producing Eltroxin at present.
● If they look up Mercury Pharma but it is listed under Advanz Pharma on their system, they might miss it.
● If they look up Advanz Pharma but it is listed under Mercury Pharma on their system, they might miss it.
● If they look up Eltroxin but it is currently only available as levothyroxine, they might miss it.
● If they look up levothyroxine but it is currently only available as Eltroxin, they might miss it.
In other words, a bit of a mess from our point of view.
However, if you explain this, they might find they do actually have what you want, or can get hold of it.
(The brand name Eltroxin is for the UK only. Elsewhere in the world, it is a completely different product owned by a different company.)
More details about thyroid hormone medicines available on this blog:
https://helvella.blogspot.com/p/helvella-thyroid-hormone-medicines.html
This blog post is a complete copy of a page on NHS England's Specialist Pharmacy Service website.
While I have copied it here, I actually encourage visiting the actual site - where it should remain and continue to be updated. However, in the past, useful pages like this have sometimes disappeared or been replaced or become inaccessible.
Copy taken 25th March 2024.
https://www.sps.nhs.uk/articles/understanding-unlicensed-medicines/
An understanding of the different types of unlicensed medicine will help in meeting patients' special clinical needs.
Any medicine that meets the definition of a medicine but does not have a Marketing Authorisation valid in the UK, is an unlicensed medicine.
Licensed medicines undergo full evaluation by the MHRA as part of the licensing process. Pharmaceutical quality, safety and efficacy are assured. Unlicensed medicines are outside the MHRA medicines licensing process, so pharmacists and prescribers must take additional steps to assure themselves of the quality, safety and efficacy of all the unlicensed medicines that they prescribe, purchase, make and supply.
The most common types of unlicensed medicines are described below.
Specials are medicines manufactured in the UK by the holder of a “Specials” Manufacturing Authorisation (MS) licence, or imported medicines that do not have a GB Marketing Authorisation.
Specials may only be prepared and supplied (often referred to as ‘placed on the market’) under an exemption from the Human Medicines Regulations 2012 (SI 2012/1916). This is further explained in MHRA’s Guidance Note 14.
Specials may only be supplied where there is no licensed medicine available to meet the special clinical needs of individual patients. They must be supplied only in response to a bona fide unsolicited order from an authorised person.
Some patients have special clinical needs that cannot be met by the administration of medicines with a UK Marketing Authorisation.
Cost saving, convenience or operational need are not special clinical needs and Specials cannot be supplied for these reasons. Manufacturers, importers and distributors must obtain documentary evidence that there is a genuine special clinical need before they supply unlicensed medicines.
Individual patients sometimes need custom preparations, for example those with an intolerance or allergy to a particular ingredient.
There may be whole patient cohorts for which a suitable licensed formulation is not available. Examples include:
In the case of disruption to supply of a licensed medicine, there may be a temporary special clinical need. For example, a patient group whose usual licensed medicine becomes temporarily unavailable, and where there is no suitable licensed alternative.
The Medicines Supply Notifications (MSNs) published on the medicines supply tool may include information about availability of unlicensed medicines. Unless specifically stated otherwise, these have not been evaluated for pharmaceutical quality or suitability to meet patients’ needs, so organisations must follow their local unlicensed medicines policies in the usual way.
UK manufactured Specials are manufactured in the UK by the holder of a “Specials” Manufacturing Authorisation (MS) licence. UK manufactured Specials may either be supplied directly by the manufacturer or via the holder of a Wholesale Distribution Authorisation (WDA).
Although the MS holder is regulated and inspected by the MHRA, the products themselves are not independently evaluated for quality, safety and efficacy.
Our Purchasing Specials and Making unlicensed medicines pages provide more information.
Unlicensed medicines may be imported by:
Imported medicines may have a marketing authorisation from another country, or in some cases they may be unlicensed medicines in their country of manufacture.
The importer must notify the MHRA of the intention to import a medicine. The MHRA may object to any importation, for example, if there is concern it has not been manufactured following standards equivalent to Good Manufacturing Practice, or if they are not satisfied there is a genuine special clinical need. However, the lack of objection is not equivalent to approval of the medicine by the MHRA.
Our Purchasing Specials page provides more information.
Investigational Medicinal Products (IMPs) are a pharmaceutical form of an active substance or placebo being tested or used as a reference in a clinical trial. These may be novel products, or may be medicines already with a UK marketing authorisation but:
Although many IMPs are not licensed medicines they do undergo a formal assessment by the MHRA as part of their acceptance into the trial. This means that pharmaceutical quality is assured.
Our clinical trials pages provide more information.
Some medicines made by the holder of a Manufacturing Authorisation (MIA or MIA(IMP)) are made available to patients as part of the Early Access to Medicines scheme.
EAMS medicines, although not yet licensed (authorised), do undergo a formal assessment of quality, safety and efficacy by the MHRA as part of their acceptance onto the scheme. This means that pharmaceutical quality is assured.
All medicines with a current positive EAMS scientific opinion are listed on the MHRA’s website.
Regulation 174 of the Human Medicines Regulations enables the MHRA to temporarily authorise the sale or supply of a medicinal product in response to the suspected or confirmed spread of pathogenic agents, toxins, chemical agents or nuclear radiation which may cause harm to human beings. To date, the only example of this is the supply of the first COVID-19 vaccines before they were granted marketing authorisations.
Pharmacists are exempt from licensing requirements pertaining to the provision of medicines if the medicines are prepared:
Many hospital pharmacies prepare ready to administer injectable medicines for supply to their wards and clinics under Section 10 exemption from the Medicines Act 1968.
Aseptic preparation is a critical activity undertaken according to national quality standards. The governance and regulatory arrangements are explained by NHS England’s Assurance of Aseptic Preparation of Medicines
Our Making unlicensed medicines page provides more information.
Some hospital pharmacies prepare non-sterile oral and topical preparations for supply to their patients. These are commonly referred to as “Extemps”.
Our Making unlicensed medicines page provides more information.
https://www.sps.nhs.uk/articles/understanding-unlicensed-medicines/
When members post links on HealthUnlocked, the platform itself changes their colour to blue/cyan and shrinks the links. It ends up that, except for the very shortest of links, you cannot see where the link is pointing. Any characters beyond about 24 change to an ellipsis (three dots - ...)
If you post just the link, then members might have little or no idea why they should click on it.
I've produced a simple image below which shows what you can do to help members.
First example, just a few words which can provide some sort of content.
This is a link to something:
https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/
Second, a few words of context AND a title - you can often take the words form the actual page to which you are linking:
This a better link:
NHS Conditions
Overview - Underactive thyroid (hypothyroidism)
https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/
Third, the same words, but with some added formatting. In this example, I have formatted them all as italic. And then also emboldened some of them.
You can format by selecting the text you want to format and then clicking on the letters at the bottom of the post/reply box - B for bold, I for italic or U for underscore - or combine them.
.
This is an even better link:
NHS Conditions
Overview - Underactive thyroid (hypothyroidism)
https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/
 |
| The link examples as they appear when posted. In all three, the link has been truncated. |
Don't worry. Nothing awful will happen if you do not do this (or your interpretation of this). But we'd probably find more members who are interested do click on the links if they are made more obvious. And fewer who really are not interested will feel frustrated that they have clicked on another link and wasted their time and effort.
Also, you don't have to confine yourself to the heading. Sometimes it can be helpful to include the first paragraph, or the abstract, or the summary.
Once you have done this once or twice, it really shouldn't take much time or effort to add these helpful features.