Medication Supply Issues


Medications with reported supply issues

Testosterone Gel (2022)
Ozempic and other GLP-Inhibitors (2023)
Tresiba Flexpen (2023)

Replens vaginal Moisturiser

Alternative: Yes VM vaginal moisturiser

Estring vaginal delivery system

Updated Dec 2023 - Estring® 7.5micrograms/24hours vaginal delivery system is out of stock until February 2024, with intermittent availability expected until November 2024. • 

Alternative estradiol or estriol preparations Active Ingerdient Dose
Vagirux vaginal tablet Estradiol 10 mcg One vaginal tablet daily for 2 weeks followed by maintenance dose of 1 vaginal tablet twice weekly
2 weeks followed by
maintenance dose of
One vaginal tablet twice a
Vagifen vaginal tablet
Estradiol vaginal tablet 10mcg
Imvaggis pessary Estriol 30mcg 1 pessary daily for the first three weeks then 1 pessary twice weekly
Estriol cream 0.01% Estriol 100mcg/g 1 applicator per day until restoration of vaginal mucosa has been achieved then maintenance dose of one applicator full twice a week 
Estriol cream 0.1%  Estriol 1000mcg/g 1 appliation per day for first weeks (max 4 weeks) followed by a graual reduction based on relief of symptoms until 1 application twice weekly

Testosterone gel/sachet

Tostran gel pump   Testogel pump   Testim gel (discontinued Dec 2023)   Testogel sachets
20mg/g (2%)   16.2mg/g   50mg/tube   50mg/sachet
10mg 1 pump                  
20mg    2 pumps   20.25mg  1 pump            
30mg 3 pumps         25mg 0.5 tube   25mg 0.5 sachet
40mg 4 pumps   40.5mg 2 pumps            
50mg   5 pumps         50mg/tube 1 tube   50mg 1 sachet
60mg 6 pumps   60.75mg 3 pumps            
70mg   7 pumps         75mg 1.5 tubes   75mg 1.5 sachets
      81mg 4 pumps            
                  100mg 2 sachets

The GLP1-RA Problem:

There is an ongoing national shortage of glucagon like peptde-1 receptor agonists (GLP-1 RAs) used in the management of Type 2 Diabetes (T2DM). This situation is not expected to resolve until mid2024. Supplies of some GLP-1 RA preparations may be intermittent or exhausted within this timeframe. Although other GLP-1 RA therapies may be available, it is possible there will be insufficient additional capacity to accommodate switching everyone with T2DM currently prescribed an affected GLP-1 RA to an alternative brand.

 The following advice has been issued from DHSC for the period:

What are the medications involved: 
Semagutide (Ozempic)
Exenatide (Bydureon)
Dulaglutide (Trulicity)
Liraglutide (Victoza)

  • Avoid initiating people with Type 2 Diabetes on GLP-1 RAs for the duration of the GLP-1 RA national shortage.
  • Review the need for prescribing a GLP-1 RA agent and stop treatment if no longer required due to not achieving desired clinical effects as per NICE NG28.
  • Avoid switching between brands of GLP-1 RAs, including between injectable and oral forms.
  • Where a higher-dose preparation of GLP-1 RA is not available, do not substitute by doubling up a lower-dose preparation.
  • Proactively identify patients established on the affected preparation and consider prioritising for review based on the criteria below.
  • Where an alternative glucose-lowering therapy needs to be considered, use the principles of shared decision making as per NICE guidelines in conjunction with the Supporting information below.
  • Support people with Type 2 Diabetes to access structured education and weight management programmes where available.
  • Order stocks sensibly in line with demand during this time, limiting prescribing to minimise risk to the supply chain whilst acknowledging the needs of the patient.
  • Offer lifestyle advice
  • Review patients on GLP-1RA and stop if not achieving effects or not diagnosed.

The solution - At our practice we are doing the following:

We have been informed that the following will be able to deal with the expected increased demand:

  • Intermediate - HumulinI KwikPen
  • Basal Toujou U300 Solostar pen
  • Mixed Insulin Humulin M3 Kwik pen

 This is the leaflet we are sharing with our patients: 


Tresiba Flexpen

Tresiba® (insulin degludec) FlexTouch® 100units/ml solution for injection 3ml pre-filled pens will be inshortage with an anticipated re-supply date of January 2024. 

  • Do NOT initiate new patients with Tresiba® FlexTouch 100 units/ml pre-filled pens.
  • Switch patients to Tresiba® PENFILL 3ml cartridges and prescribe a compatible reusable pen device (NovoPen® 6 or NovoPen Echo Plus®) OR
  • Switch from Tresiba 100 units FlexTouch pre-filled PEN to Tresiba 200 units FlexTouch pre-filled PEN -  DO NOT advise the patient to half the dose - the Tresiba® 200 units FlexTouch® pre-filled pen dials the dose in 2 unit increments instead of 1 unit increments. Note, the dose window shows the number of insulin units to be delivered and so no dose conversion is needed regardless of the strength of the Tresiba® FlexTouch pre-filled pen.



Permethrin 5% w/w cream

  • Clinicians in primary and secondary care should refer to UKHSA guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings including the appropriate infection prevention and control measures with advice on cleaning of clothing and bedding.
  • Where scabies has been diagnosed and where individuals have been confirmed as contactsb , UKHSA has advised that existing stock of permethrin 5% cream should be reserved for these patients.
  • If licensed permethrin 5% cream is unavailable, prescribe unlicensed permethrin 5 % cream.
  • Where permethrin 5% cream is unavailable, consider prescribing unlicensed special-order benzyl benzoate 25% emulsion if locally available.
  • If both alternatives are unavailable, consider prescribing unlicensed ivermectin 3mg tablets. Ivermectin tablets are now a licensed product, although sources like the BNF, CKS, and UKHSA guidance have yet to update to reflect this, and still describe oral ivermectin as an unlicensed product.
Pharmacist Shilpa Patel

Shilpa Patel

Lead Presscribing Pharmacist and GP partner at WellBN

Creator of, I also write for the Chemist & Druggist and EmpowHER and am passionate about inspiring and encouraging pharmacists to explore new avenues and promoting excellence in the field. I have over 17 years of experience in community pharmacy and 8 years as a clinical pharmacist. Through my work, I have gained a deep understanding of general practice by creating and supervising a team of nine pharmacists and training them in their individual roles. I have also led on a GP merger and successfully run a benzodiazepine detox clinic. Additionally, I have been the medication lead for a primary care organization.
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Reviewed By: Ask Shilpa Author
Reviewed Date: 2023-07-25

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