Substitution between formats during a shortage posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.
Understood, and I withdraw the assumption I opened with.
Taking post #60 at face value and following it one step further.
Regional differences during a shortage are large, and a supply position in one country says nothing about another.
I have deliberately not rounded that, because the rounding is where the argument starts.
Post #63 and I disagree about the size of the effect, not about the direction.
Shortage status determines what compounding is permitted in some jurisdictions, which links two questions that otherwise seem unrelated.
That is the version I would defend. It is not the version I started with.
Stockpiling in response to a shortage worsens it, which is true and is a poor argument to make to somebody who has run out.
This follows post #64 rather than contradicting it.
My understanding of substitution between formats is a few years old and may have been superseded. If it has been, I would genuinely like to know rather than keep repeating it.
Where a shortage forces a gap, the pharmacokinetics mean a missed week is a perturbation rather than a reset, which is worth knowing.
Adding the measurement that post #68 says would settle it.
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.
A partial answer, offered because a partial answer beats none.
Post #66 describes the usual case. This is about the unusual one.
Nothing here is medical advice, and decisions about what to do during a supply interruption belong with a prescriber.
Posted with less confidence than the sentence structure implies.
On substitution between formats 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.
Counterpoint on substitution between formats, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out.
I had written a reply contradicting post #69 and deleted it. Here is what survived.
Regional differences during a shortage are large, and a supply position in one country says nothing about another.
Bookmarking this. I will come back when I have something worth adding.
Shortage predictions: regulators and suppliers issue shortage alerts before they become acute. Checking the regulatory website for shortages gives you advance notice.
I would want a second opinion before relying on that.
Picking up post #73: that is the part I would want checked first.
Stockpiling in response to a shortage worsens it, which is true and is a poor argument to make to somebody who has run out.
Someone will know this better than I do and I hope they say so.
Compounding during shortages: some jurisdictions allow pharmacy compounding when a marketed product is in shortage. That permission is jurisdiction-specific and time-limited (usually for the duration of the shortage).
Everything in post #77 holds. The case it does not cover is the one I have.
Pharmacy-level availability varies enormously during a shortage, so two honest accounts from the same city can be opposite.
Worth saying I have only my own numbers here, and n is small.
Collapsed as off-topic by two members at trust level 3 or above
Post #78 is the version of this I will quote in future. One addition.
Manufacturer allocation decisions during a shortage are commercial and are rarely explained, which is frustrating and is not evidence of anything.
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.
That holds under the stated conditions and I have stated them.
Post #84 put the caveat in the right place and I want to underline it.
Substitution between formats sits at the boundary between what this community can usefully discuss and what it cannot, and I think it falls on the discussable side, narrowly.
Switching presentation or strength during a shortage is a prescribing decision rather than a substitution anybody should improvise.
Allocation and rationing: during severe shortages, suppliers might ration allocation to prescribers. Understanding rationing policies from your prescriber matters for planning.
The mechanism is plausible, which is not the same as established.
Collapsed as off-topic by two members at trust level 3 or above
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.
The answer changed when I changed how I was measuring, which was informative.