HRT Issues

27th September 2019 - Source: Amanda Chell

Hormone replacement therapy (HRT) supply issues

• The Department of Health and Social Care (DHSC) are aware of the ongoing manufacturing issues that have affected the supply of some hormone replacement therapy (HRT) products throughout 2019.
• Please see Table 1, which provides the latest update on the availability of all HRT products marketed in the UK and the known resupply date for products that’s are currently experiencing supply issues.
• This table also provides an update of all HRT preparations that remain available. Clinicians may be required to switch patients to alternative HRT products that contain the same active ingredients for a temporary period.
• Prescribing information regarding HRT equivalence to support local decision making is available through various sources such as the British National Formulary, Summary of Product Characteristics (SPC), The Monthly Index of Medical Specialities (MIMS), and other sources including local Medicines Information Centres.
• Clinicians are advised to work closely with community pharmacies to understand local availability of HRT products and use the table below to help make decision about appropriative HRT products for patients who are affected by the supply issues.
• DHSC will continue to provide updates on HRT availability in the monthly supply report, which is uploaded to the Specialist Pharmacist Services website. All registered user can access this update via this following link: https://www.sps.nhs.uk/articles/department-of-health-and-pharmaceutical-market-strategy-group-pmsg-supply-updates/
• Please share this information with relevant networks locally including GP practices and community pharmacies.

Table 1. HRT Availability

*Elleste HRT Range:

• Mylan have recently advised that supplies of all the Elleste Range (Elleste Duet Conti, Elleste Duet 2mg tablets, Elleste solo 1mg and 2mg tablets, Elleste Duet 1mg and 2mg and Elleste MX 40 and 80micrograms patches) have been replenished and are now available.
• However, Mylan have advised they are still experiencing on going manufacturing problems, therefore, currently they do not have visibility on future supplies.
• DHSC are working with Mylan and awaiting further information to understand the long-term implications of this.

**Evorel HRT transdermal patch range:

• Janssen-Cilag, the manufacturer of the Evorel HRT transdermal patch range (Evorel; Evorel Conti; Evorel Sequi) have notified the DHSC that due to manufacturing constrictions, the whole range will be out of stock from October 2019 for most presentations and others are expected to last until early 2020. Current forecasted stock out dates for specific Evorel products are listed in Table 1.
• Currently, Janssen-Cilag are unable to give an exact resupply date beyond mid-2020.
• UK Medicine Information have published guidance to advise on suitable alternatives. This provides a range of alternative options and highlights  the need for prescribers to seek specialist advice for more complex patients and consider prioritising the use of transdermal HRT therapy for  women at increased risk of venous thrombosis  https://www.sps.nhs.uk/articles/shortage-of-evorel-hormone-replacement-therapy-hrt-patch-range/