Metoprolol

PHARMAC would like to acknowledge the work that pharmacists and wholesalers have done to help manage the metoprolol succinate stock issue and ensure that patients have continued to receive their medicine when they have needed it.

As we move toward sole supply of the Betaloc brand from 1 March 2018, wholesalers will continue to manage the remaining brands of metoprolol succinate in the supply chain to help minimise wastage.

The details of the currently available brands are below:

• From 1 October all strengths of the Betaloc CR brand will be available. Wholesalers will be helping ensure a smooth transition of brands and will be working to minimise wastage of the Myloc CR and Metoprolol-AFT CR brands.

Update as at 1 July 2017

Stock availability: as at 1 July 2017

Please note:

• Betaloc 23.75 mg: is listed from 1 July 2017.
• Betaloc CR 47.5 mg and Betaloc CR 95 mg: there will be very limited quantities of this available until 1 October 2017. The remaining stock available should be prioritised for patients who previously received this on the private market. This stock will remain listed on the Pharmaceutical Schedule to allow pharmacies to claim if they need to. Further stock for the general public will be available from 1 October 2017.
• For further updates on stock, please contact your wholesaler.

Update as at 6 June 2017

From 1 March 2018, AstraZeneca will be the sole supplier of metoprolol succinate in New Zealand. Until that time, there will continue to be several different funded brands available.

Your wholesaler will have different brands of metoprolol available and they will be managing stock to ensure all the brands currently in the market are used first to help manage the transition to AstraZeneca stock by 1 March 2018.

PHARMAC would like to thank pharmacists and wholesalers all over New Zealand for assisting their patients through this stock shortage. We’re pleased that with your help and understanding, people could still receive the medicine they needed during this time.

Stock availability: as at 1 June 2017

Please note:

• Metoprolol-AFT CR – 23.75mg: this will shortly be exhausted. Myloc CR 23.75 mg will continue to be available.
• Metoprolol-AFT CR – 190 mg: this will shortly be exhausted. Myloc CR 190 mg will continue to be available.
• Betaloc CR 47.5 mg and Betaloc CR 95 mg: there will be very limited quantities of this available until 1 October 2017. The remaining stock available should be prioritised for patients who previously received this on the private market. This stock will remain listed on the Pharmaceutical Schedule to allow pharmacies to claim if they need to. Further stock for the public will be available from 1 October 2017.

PHARMAC will update pharmacy via fax and on this page as stock availability changes. For further updates on stock, please contact your wholesaler.

Update as at 30 March 2017

PHARMAC is pleased to confirm that stat dispensing will return to metoprolol succinate from 1 May 2017.

This means that from 1 May 2017, pharmacies can dispense up to three months’ supply of metoprolol succinate for their patients. This applies to all presentations of metoprolol succinate.

For patients wanting to fill repeats, pharmacies will be able to fill all remain repeats at once.

PHARMAC has begun consultation on a long-term solution for the supplier of metoprolol succinate. Until the any new supply has started, there will be a number of different brands of metoprolol succinate available. This includes:

Some pharmacies may also still have Betaloc CR 47.5 mg or 95 mg in 30 tablet blister packs, and they remain listed. A limited volume was available to cover supply issues and we understand that some pharmacies still have stock that they purchased. Any Betaloc CR available currently from AstraZeneca and via wholesalers will be for the private market only, until further notice.

You can begin to order stock for the return of stat dispensing from wholesalers now.

As a part of the return to stat dispensing, patients picking up repeats can be dispensed the full amount remaining on their prescription from 1 May 2017.

PHARMAC would like to thank all pharmacists who have helped patients with the metoprolol stock situation. Your guidance and counsel with your patients has made this situation easier for them to work through, despite different brands and sizes being available.

If you have any questions about the return of stat dispensing to metoprolol succinate, please call 0800 660 050 or email enquiry@pharmac.govt.nz.

Update as at 1 December 2016

23.75mg strength

We can now advise that the 23.75 mg strength of Myloc CR brand of metoprolol (distributed by AFT) has landed in the country and is being distributed to wholesalers. This is being distributed as a weekly allocation to wholesalers, however quantities remain more limited than the other strengths.

95mg and 190mg strengths

From 1 January 2017 the Myloc CR 95 mg presentation (again distributed by AFT) will also be listed on the schedule, and supplies of Myloc CR 95 mg and 190 mg strengths are anticipated to be available early in 2017.

Summary of all presentations

The table below outlines the various metoprolol succinate presentations and brands that are listed on the Pharmaceutical Schedule. These products will remain listed until further notice to allow pharmacies to continue to claim for them. For the 47.5 mg and 95 mg strengths of metoprolol, Betaloc CR brand (distributed by AstraZeneca) should still be used where possible until this stock has run out.

There is still not sufficient stock available in New Zealand to consider returning to stat dispensing and Wholesalers continue to have specific stock management approaches in place for these products to ensure appropriate distribution to their pharmacies. If you have any specific questions about stock ordering, please contact your wholesaler directly. PHARMAC continue to work towards resolving this situation.

Currently listed brands and strengths of metoprolol succinate

Metoprolol-AFT (distributed by AFT)

Myloc CR (distributed by AFT)

 Betaloc CR (distributed by AstraZeneca)

PHARMAC is continuing to work with AFT Pharmaceuticals and other suppliers of metoprolol succinate to secure longer-term supply. We’ll continue to send updates as more information becomes available.

Thank you all again for your ongoing support and assistance on managing the metoprolol succinate stock issue.

Update as at 9 November 2016

PHARMAC is aware of some communication in the sector regarding stock of metoprolol succinate and metronidazole that may be creating some confusion and we would like to clarify the current situation for these products.

Metoprolol succinate

The table below outlines the various metoprolol succinate presentations and brands that are currently listed on the Pharmaceutical Schedule. These products will remain listed until further notice to allow pharmacies to continue to claim for them. For the 47.5 mg and 95 mg strengths of metoprolol, Betaloc CR brand should be used where possible until this stock has run out.

Wholesalers have specific stock management approaches in place for these products to ensure appropriate distribution to their pharmacies. This will continue – if you have any specific questions about stock ordering, please contact your wholesaler directly.

Currently listed brands of metoprolol succinate

Myloc CR brands

The Myloc CR 23.75 mg tablets were listed on the Pharmaceutical Schedule from 1 November 2016. These are anticipated to arrive in New Zealand soon.

The Myloc CR 190mg tablets are currently unavailable. We will communicate to you once we know when additional stock is expected.

PHARMAC is continuing to work with AFT Pharmaceuticals and other suppliers of metoprolol succinate to secure longer-term supply. We’ll continue to send updates as more information becomes available.

We’d like to again thank all pharmacies and wholesalers for your ongoing support and assistance on managing the metoprolol succinate stock issue.

Metronidazole tablets

The supplier of metronidazole tablets (Trichozole), Mylan, has advised PHARMAC that there has been a delay in resupply of the 200mg and 400mg tablets. They are expecting stock to arrive in New Zealand from mid-November, and stock will be available shortly after.

We understand that this issue has been going on longer than expected and patients need to seek alternative therapy from their prescribers.

As a result of the delay in the tablets, there has been additional demand for the oral liquid and suppository presentations of metronidazole. We would like to reassure pharmacy that there is adequate supply of these presentations and these will still be available for patients.

Update as at 9 August 2016

As indicated previously, PHARMAC has secured stock of the Betaloc CR brand of metoprolol succinate, which will be available over the next three months. This stock has arrived in New Zealand and will be distributed from wholesalers soon. Wholesalers will be managing the distribution of the Betaloc CR stock so you should contact your wholesaler to work out what stock you require.

PHARMAC is continuing to work with AFT Pharmaceuticals and other suppliers of metoprolol succinate to secure longer-term stock. We’ll continue to communicate with pharmacy as more information become available.

Images of Betaloc CR brand of metoprolol succinate

Betaloc CR 47.5 mg

Betaloc CR 95 mg

 

Pharmacodes of available metoprolol succinate stock

Brand Switch Fee

As noted in mid-July, a brand switch fee has been applied on all brands of metoprolol succinate for one month from 1 August to 31 August 2016, as we recognise the challenge the ongoing supply issue has presented. This timeframe is different from the published Schedule update, and we apologise for the confusion this may have caused.

We could not apply the brand switch fee at the chemical level because pharmacy IT systems do not allow this. Therefore a brand switch fee has been applied to each of the four funded brands listed in the Pharmaceutical Schedule for one month. As metoprolol succinate is being dispensed monthly, all dispensings should receive a brand switch fee within that month period.

If you have any concerns, you can email PHARMAC at enquiry@pharmac.govt.nz or call 0800 660 050.

Thank you for your ongoing support and assistance on this matter.

Update as at 20 July 2016

AFT has informed PHARMAC that unfortunately the Actavis stock we advised of in our update dated 8 July 2016 has been exposed to high temperatures during transportation from the USA.  Following the normal quality assurance process for release into New Zealand it was determined that the product was not able to be released.

Update as at 19 July 2016

PHARMAC recognises how challenging the ongoing supply issue with metoprolol succinate is for both pharmacies and patients. To help compensate for both the extra work and extra time with patients this situation has demanded, PHARMAC has decided to apply a brand switch fee on all brands of metoprolol succinate for one month from 1 August to 1 September 2016.

We have been unable to apply the brand switch fee at the chemical level because pharmacy IT systems do not allow for this technically. Therefore a brand switch fee has been applied to each of the four funded brands listed in the Pharmaceutical Schedule. This means that you can claim a brand switch fee for each dispensing regardless of brand, over this time.

We are applying the brand switch fee because of exceptional circumstances and the number of patients who take metoprolol succinate. Normally stock issues do not attract a brand switch fee because we can usually secure alternatives, or there is a clinically acceptable alternative. However, in this case we acknowledge the extra work and inconvenience that has been created with this ongoing stock situation.

Stock Update

The current stock level of metoprolol in New Zealand remains tight however we remain confident there is sufficient supply available to meet demand and will continue to inform you of any new information as needed

More generally, the tablets in bottles currently being supplied (Pharmacode 2505193) have a shorter expiry than the stock in blister packs. While these should flow through the supply chain before expiry is reached, the loose tablets should be used first.

We will update you through our website, www.pharmac.govt.nz/metoprolol and via the pharmacy fax as needed.

If you have any concerns, you can email PHARMAC at enquiry@pharmac.govt.nz or call 0800 660 050.

Thank you for your ongoing support and help managing this difficult situation.

Update as at 8 July 2016

Last week we let you know that a supply of 23.75 mg and 95 mg of Actavis metoprolol succinate would arrive from the United States. It will begin to be distributed by AFT week starting 11 July 2016. This stock is to bridge a potential supply shortage and will be short term supply.

• The 100 tablet bottle of 23.75 mg metoprolol succinate tablets is labelled as 25 mg. This 25 mg refers to the equivalent metoprolol tartrate dose. Each tablet contains 23.75 mg of metoprolol succinate.
• The 100 tablet bottle of 95 mg metoprolol succinate tablets is labelled as 100 mg. This 100mg refers to the equivalent metoprolol tartrate dose. Each tablet contains 95 mg of metoprolol succinate.
• These tablets have been approved by Medsafe as having 23.75 mg or 95 mg of metoprolol succinate. Therefore this is not a dosage change for patients.

The Actavis brand looks different to other brands currently used by patients, therefore this stock is most suitable for pharmacies using robotic packaging, in particular for supply to rest-homes or other supervised care facilities. Directing this stock to these locations will help minimise any patient disruption or concern about medication changes at this time.

23.75mg

95 mg

Wholesalers continue to have specific stock management approaches in place for the Actavis stock and other brands available.

If community pharmacies receive the Actavis brand from their wholesaler, in order to avoid confusion at a patient level, it should not be dispensed in the original American packaging. Prescriptions should be dispensed in 30 day lots, and labelled with the appropriate metoprolol succinate dose, i.e. 23.75 mg or 95 mg.

Patient support materials

Information to help support conversations with patients can be downloaded from this site (top right hand corner). Hardcopies can be ordered from www.pharmaconline.co.nz (external link) .

Pharmacodes of available metoprolol succinate stock

Update as at 27 June 2016

PHARMAC has been working with the supplier of metoprolol, AFT Pharmaceuticals, and the manufacturer directly to ensure ongoing stock. There has been a packaging problem at the manufacturer, which has meant we now have to activate a range of other stock options to ensure continued supply. These are outlined below:

In the short-term we have also managed to secure limited supply of the 23.75 mg and 95 mg from Actavis stock, and this is expected in mid-July. Once available, we will send you more details about subsidy and availability.

PHARMAC will prepare information for patients which will be available from www.pharmaconline.co.nz (external link) by the end of the week.

Longer term stock

PHARMAC has also secured larger quantities of alternate stock of metoprolol succinate from AstraZeneca. This is due to arrive in the country mid-August and will be immediately subsidised. We will let you know the dates when we have more information.

Stock ordering

To manage the flow of stock of metoprolol succinate long-acting tabs, wholesalers have specific stock management approaches in place. This will continue to be in place until otherwise advised.

Further communication

We’ll provide more details on the stock situation in the coming days. We will update you via the pharmacy fax and through updates on our website here.

If you have any concerns, you can email PHARMAC at enquiry@pharmac.govt.nz or call 0800 660 050.

Thank you for your ongoing support and assistance on this matter.

Update as at 24 June 2016

PHARMAC has been working with AFT and other suppliers to organise additional stocks of this product and to get the supplies back to acceptable levels. We will be providing details of this to pharmacies by the end of Monday 27 June, via pharmacy fax and an update on our website.

If you or your patients have any concerns or questions before then, contact us at enquiry@pharmac.govt.nz or call 0800 660 050 press 1 for metoprolol enquiries.

Again, thank you for your ongoing support and assistance on this matter.

Update as at 21 June 2016

PHARMAC apologises for the additional work this has required of pharmacists in particular, and we are grateful for the way pharmacy and wholesalers around the country have worked together to make sure patients continue to receive their medicine.

PHARMAC is continuing to take this stock issue seriously and we are working very closely with the supplier, AFT Pharmaceuticals. Alternate stock is also in the process of being secured, and further supply options are also being worked through.

We’ll provide more details on alternate stock in the coming days, via the pharmacy fax and through website updates.

If you have any concerns, you can email PHARMAC at enquiry@pharmac.govt.nz or call 0800 660 050.

Thank you for your ongoing support and assistance on this matter.