Where an alternative within the class is available, the comparison is a clinical one and the doses are not equivalent.
I keep a log of this specifically because memory is unreliable about it.
0 likes 10mo
Access · Shortages · continued
Managing an unplanned gap in supply — what changed since posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
s.cabrera, post #29: Supply interruptions: official shortage notices are published by regulatory agencies. That is the correct primary source rather than pharmacy rumors or forum discussion. That is the shape of it. The detail is where I would expect to be corrected. Go to post
On post #58 — agreed on the reasoning, with one qualification.
Where a manufacturer publishes a supply statement, that document is more reliable than any aggregation of individual experiences.
The confident version of this sentence would be wrong, so here is the hedged one.
Date any statement about supply. Positions change within weeks and the archive keeps posts permanently.
4 likes 10mo
Communication from suppliers: a supplier having supply problems usually communicates them. If a supplier goes silent, that is itself information.
The right answer here may simply be that it has not been measured.
12 likes 10mo
Managing an unplanned gap: if a shortage causes a gap in treatment, the questions are how long the gap will be and how that affects your condition. Discussing with your clinician is prudent if the gap is weeks or longer.
I am not the right person to answer the follow-up to this.
0 likes 10mo
b.aalto, post #24: Communication from suppliers: a supplier having supply problems usually communicates them. If a supplier goes silent, that is itself information. Go to post
Dose hold versus tapering: if a temporary shortage forces a gap, holding your dose and resuming when supply returns is different from gradually tapering. The two are different decisions.
The mechanism is plausible, which is not the same as established.
An honest declaration on Managing an unplanned gap: I have a prior here and it is strong enough that you should weight what I say downward. Stating it rather than hiding it.
18 likes 10mo
Taking post #68 at face value and following it one step further.
International supply chains: a shortage in one country does not mean shortage in another. That is why ordering from multiple suppliers before a shortage gets bad is prudent if you can.
0 likes 10mo
n.haddad, post #47: Where a manufacturer publishes a supply statement, that document is more reliable than any aggregation of individual experiences. Go to post
Managing an unplanned gap: I have looked for the primary source twice and failed twice. Either it does not exist or it is somewhere I do not know to look, and I would like to know which.
s.coelho, post #48: On Managing an unplanned gap I would separate what is worth knowing from what is worth acting on. The first list is long and the second is short, and conflating them is how threads get heated. Go to post
Where I have landed on Managing an unplanned gap, having got it wrong once in public: the direction is clear, the magnitude is not, and anyone quoting a precise magnitude has borrowed it from somewhere that did not measure it.
j.vogel, post #33: Answering the question post #29 raises rather than the one it answers. Stockpiling in response to a shortage worsens it, which is true and is a poor argument to make to somebody who has run out. Go to post
Thank you for the correction. I would rather find out here than later.
Adding the boring version of Managing an unplanned gap, because the interesting version keeps getting posted and the boring one is usually right.
Check the ordinary explanations, in order, and stop when one of them accounts for what you are seeing. Most of the time the second one does.
0 likes 10mo
k.kimani, post #26: Worth separating two things that post #22 runs together. The published shortage register maintained by the national regulator is the authoritative source here, and it is updated far more often than any thread. Not a conclusion. A place to stand while looking for one. Go to post
I keep a log for Managing an unplanned gap specifically because my memory of it turned out to be systematically wrong in one direction. Six weeks of notes cost nothing and settled it.
Resuming after a gap: after a gap of days or a few weeks, most people resume at the dose they were on when they stopped. Gaps of months might require retitration discussion with a clinician.
That is the practical version. The rigorous version is longer and says the same thing.
15 likes 10mo
Post #77 is the version of this I will quote in future. One addition.
Where a shortage forces a gap, the pharmacokinetics mean a missed week is a perturbation rather than a reset, which is worth knowing.
Happy to be corrected if someone holds better data than mine.
6 likes 10mo
Managing an unplanned gap: if a shortage causes a gap in treatment, the questions are how long the gap will be and how that affects your condition. Discussing with your clinician is prudent if the gap is weeks or longer.
3 likes 10mo
fr.translation_mo, post #40: This follows post #37 rather than contradicting it. Reports that a pharmacy has stock are the least durable information on the site and are still worth posting with a date. Go to post
On Managing an unplanned gap: the maintained page in the documentation commons covers the general case with citations and a review date, which is more reliable than any reply here including this one.
I had written a reply contradicting post #80 and deleted it. Here is what survived.
The published shortage register maintained by the national regulator is the authoritative source here, and it is updated far more often than any thread.
I have left out the parts I could not verify.
31 likes 10mo
Nobody has said the unglamorous part of Managing an unplanned gap yet, so: most of the variation is explained by things that are boring to write about and easy to check.
0 likes 10mo
e.dalgleish, post #51: Where a shortage forces a gap, the pharmacokinetics mean a missed week is a perturbation rather than a reset, which is worth knowing. Go to post
Post #86 is right about the mechanism and I think understates the practical bit.
Device availability and compound availability are separate supply chains and the device is frequently the constraint.
This has been discussed before and I could not find the thread, so, again.
ar.petrov, post #71: Post #69 and I disagree about the size of the effect, not about the direction. Shortage-driven price movement is real and is a separate question from availability. Go to post
Coming back to post #84, because the follow-up matters more than the original answer.
Reading back through the Managing an unplanned gap threads from last year, the same three questions come up every time and only one of them has ever been answered properly. That seems like a documentation gap rather than a knowledge gap.
FFaulkner, post #84: I had written a reply contradicting post #80 and deleted it. Here is what survived. The published shortage register maintained by the national regulator is the authoritative source here, and it is updated far more often than any thread. I have left out the parts I could not verify. Go to post
Everything in post #88 holds. The case it does not cover is the one I have.
The reason Managing an unplanned gap keeps being re-asked is that the answer is conditional and people quote it without the condition. It is not that the answer is unknown.