Sorry to post this - could it happen? - BEWARE: “We can’t find any T3 so you’ve got Levothyroxine, it does the same thing” ?

[Aurealis]

Article in the Sunday Times this morning - pharmacists seeking new powers to change medications without referring back to GP - plea to reduce Brexit shortfall. Oh dear. Those of us on T3 and NDT need to take action on this.

thetimes.co.uk/article/phar...

[diogenes Remembering]

It should not be possible for pharmacists to suggest this. It is legitimate for them to offer alternative supplies of the same drug because this is merely basically a formulation problem. But surely not basically different drugs with different actions re speed of response, pharmacological clearance rate, intrinsic differences in activity, etc etc. Patients should be armed with this objection that T3 is not an equivalent to T4 in any way.

[Aurealis in reply to diogenes]

Thanks diogenes for your reassurance.

Article does say ‘different drug’ and so many are poorly informed about this, as I found out, e.g. the one who gleefully told me that the prescription I was collecting would be my ‘last one’.

[MaisieGray in reply to Aurealis]

Why would a pharmacist be gleeful about your meds changing?

[Aurealis in reply to MaisieGray]

Good question - cost to NHS maybe? He was a locum, seemed to enjoy his power, feeling he had information that I didn’t? My meds didn’t change. When I told him that I didn’t think they would, he replied ‘you’ll see’ with a smirk on his face.

[TSH110 in reply to Aurealis]

What a nasty little individual

[RedApple Administrator]

Of course, in the event of a shortage of T4 as well as T3, they can just substitute anti-depressants instead!

[Aurealis in reply to RedApple]

Nothing new there then!

[helvella Administrator]

If granted, would these so-called emergency powers ever be revoked? After all, if brexit goes ahead, we will be perpetually in a state of brexit so no obvious point at which they could/should/would expire. (Unless, of course, an arbitrary but specific date were written in.)

Seems another instance of hard cases making bad law - potentially.

[Aurealis in reply to helvella]

Yes I agree. As it seems it is to reduce pressure on GPs, I can’t see there ever being a time when GPs need more work.

[Aurealis in reply to helvella]

Also, as the nhs seem to be doing nothing to reduce the price paid for T3, other than withdrawing it from patients that need it and making it very difficult for the rest, I fear that ‘Brexit’ could become a way to ‘solve’ the situation - an excuse for the sudden non-availability of T3. Just one supply problem amongst many others. ‘Never mind, we have plenty of Levo’

[helvella Administrator in reply to Aurealis]

As we do not know where the ingredients for manufacturing UK levothyroxine tablets come from, we have no idea whatsoever if brexit will have an impact on that. (Or any other medicines across the entire spectrum.)

[Aurealis in reply to helvella]

Isn’t Levo the second most frequently prescribed drug? So therefore quite high up the list of importance? And cheap with long shelf life...

[helvella Administrator in reply to Aurealis]

It is somewhere like that (second in the USA not certain about the UK). But we have seen numerous shortages over the years. Have to admit, don't seem to have been many recently - more look like individual pharmacies not willing/able to get specific makes.

My concern is that if there is a problem, it could happen very quickly and there might not be sufficient stock. Being so often prescribed means that there needs to be a lot available - and whatever there is will deplete quickly.

[DippyDame]

While we are all worried about the availability of T3, I can see nothing in this article to suggest T4 will be offered as a substitute forT3.

You quote the following, "BEWARE: “We can’t find any T3 so you’ve got Levothyroxine, it does the same thing", suggesting this as a possible future scenario. Doctors have been known to confuse the hormones but they are not pharmacists!

I'm part of a family with three generations of pharmacists (I'm not one) and I very much doubt anyone in the profession would suggest such a thing. It's like comparing apples with pears... and would be professional suicide.

Raising awareness is admirable but heaping unnecessary coals on an already blazing furnace (ie mounting patient anxiety about T3) may not be the best way.

Times are hugely difficult but we all need to try and keep cool heads

[Aurealis in reply to DippyDame]

No offence intended DippyDame. I’ve edited the title, hope that’s more appropriate now.

My experience of pharmacists has not been the best as you will see above. I find that many GPs openly state having little knowledge of T3. I have no reason to suspect a greater level of understanding of T3 amongst pharmacists.

[DippyDame in reply to Aurealis]

No offence taken.

Unfortunately, yes, every profession does have it's "weak spots" - pharmacists are the drug experts, rather than GPs, so should be conversant with T3 and its use.

I've had a run in with a pharmacist but that had more to do with their high handed approach to customer service than their dispensing abilities!

The whole T3 debacle beggars belief

Fingers crossed for us all

[LindaC in reply to DippyDame]

Hmm, just a few [maybe 4] years back I spoke personally with [an ex's daughter] who is a pharmacologist and was senior lecturer in pharmacology who had no clue was T3 is, other than in injectable form. She's not a dumb plodder either.

[DippyDame in reply to LindaC]

We certainly have a battle on our hands!

[LindaC in reply to DippyDame]

Worst thing is, 'they're' doing everything to shut down all sources... and 'they' know who they are!

[greygoose in reply to DippyDame]

I've come across several pharmacists that didn't know the difference between T4 and T3 and told me it was 'exactly the same thing'.

[Valarian]

I remember hearing something about his on the radio a while back, although it wasn't Brexit-releted, more about a shortage of a particular (not thyroid-related) drug.

From that discussion (and 'The Times" article), I didn't get the impression that pharmacists would have the power to replace levo with T3, which is clearly something different altogether. I know that if the doctor prescribes the generic form of a drug, we can be given any brand that fits....on the other hand, if a specific brand is prescribed, presumably they can't just switch ?

[Aurealis in reply to Valarian]

I think we have reached a time where everything is blamed on ‘Brexit’, just as it was previously blamed on ‘austerity’. If this goes ahead, all we can be sure of, is that it’s a political decision.

The article states ‘different drug’, it depends how accurate the article is.

In any case, we can’t all ‘just switch brands’ as we can’t all tolerate all brands. I believe that GPs are unable to specify brands.

As diogenes says above, we should all be ready to make a clear argument, just in case it’s necessary.

I hadn’t heard of this before but I watch with dismay as it becomes progressively more difficult to get a gp appointment, a prescription and an acceptable brand dispensed every 12 weeks. The thought of going through all those hoops to have a pharmacist make changes at the end of the line would be the final straw.

[trelemorele]

I've never had problems with pharmacists. They much better informed on medications and their purpose than GPs.

In other countries (where you pay for medications) pharmacist will often advise and suggest swapping to cheaper alternative if your prescription gives patent drug with branded name. Good example are antibiotics. They're allowed to suggest, you may refuse.

I found it helpful and it often saved me money.

[Aurealis in reply to trelemorele]

I agree they can be well informed on medications and on saving money. But a good proportion seem less well informed on difficulties with swapping brands or on the use of T3 - even for instance on the difficulties of cutting T3 tablets, or the recent advice to dissolve tablets in water. Others seem to have trained at a time when their role was less customer faced and for instance may not be fluent English speaking.