Understanding your medication

Welcome to our section on medicines and medication. The focus of this section is on medicines for mental health problems, but the information and links will hopefully be more widely useful.  

Click on one of the buttons below to learn more. At the bottom of the page you can find information on current issues in mental health medicines availability.

Staying safe with medicines

We use medicines to help people get well and stay well. The same medicines can be a danger if too much or too many are taken. Click on the drop down box for more information about some of the dangers and how to keep yourself or others safe. This information can also be downloaded as a leaflet.

Healthcare professionals who are talking to patients about these risks and how to stay safe can use our guidance to help with their conversations.

Risky alone, toxic together

Reducing the risk of overdoses with opioids, benzodiazepines, pregabalin and tricyclic antidepressants

Overdoses can involve prescribed medicines; medicines bought at a shop, pharmacy or on-line. They can involve illegal “street drugs” or alcohol. Overdoses are often accidental. The medicines or drugs might be the person’s own property or someone else’s to which they have access.

Many of the medicines we use can be dangerous in overdose. There are particular concerns about the ones mentioned here.

Opioids are natural drugs derived from the opium poppy, or artificial drugs that do the same things.

Opioids act in the brain and nervous system to block pain signals. Commonly used opioids include oxycodone, morphine, codeine, fentanyl, heroin, methadone and buprenorphine.

Benzodiazepines are drugs that cut-down overactivity of the brain and nervous system. They are often given to help with pain, help you to sleep or to feel less anxious. Commonly used benzodiazepines include diazepam (Valium), lorazepam and temazepam. Alprazolam (Xanax) is a benzodiazepine that is not used by the NHS but is increasingly of concern to drug misuse services.

Opioids and benzodiazepines reduce normal, automatic functions like breathing. If an overdose is taken, the person may stop breathing and die.

Pregabalin is a medicine for treating epilepsy, pain or anxiety. Pregablin increases the effect of opioids in reducing breathing. At higher doses it directly reduces breathing. Pregabalin seriously increases the harm caused by an opioid overdose.

Tricyclic antidepressants (TCAs) are used to treat depression, anxiety and long-term pain. Commonly used TCAs include amitriptyline, clomipramine and imipramine.  In overdose TCAs can stop the heart.

The chance of overdose and the amount of harm is increased by taking:

  • high doses of these medicines
  • a combination of these medicines, because their effects add-up
  • alcohol with these medicines, because alcohol increases their effects
  • street drugs with these medicines, because their effects might add-up

Opioids, benzodiazepines, TCAs and pregabalin are still useful medicines when used properly and safely. There are a number of things that can be done to keep people safe.

TIPS FOR STAYING SAFE
  • Store medicines safely, where children and pets can’t get at them.
  • Don’t assume one prescriber knows all the details of how another team is treating you. Tell healthcare professionals about all of the medicines or drugs that you are using and how much you take. This helps them to make the best and safest decisions. A psychiatrist prescribing benzodiazepines may not know exactly how much opioid medication you are prescribed by your GP or pain clinic, unless you let them know.
  • If you take a number of the medicines in this leaflet, ask your doctor or pharmacist if it is safe to carry on.
  • If you are prescribed a medicine, ask how long you should take it for. Opioids and benzodiazepines are usually used only for short periods.
  • Don’t mix prescription medicines with ones you have bought, unless you have checked they are safe together.
  • If you have been in hospital, check which medicines and doses have been stopped, started or changed. Make sure your next prescription from your GP matches what you expect. If it doesn’t, ask why.
  • If you have any questions about the medicines you are prescribed, talk to one of your healthcare professionals. This might be a doctor, pharmacist or nurse. Ask about things like side effects or if you feel the medicine is becoming less effective.
  • Don’t change your medication dose without discussing it with a healthcare professional. Larger doses increase the risk of overdose. Smaller doses or stopping medicines suddenly might make you unwell.
  • Don’t keep more medication in your house than you really need. This increases the chance of taking too much.
  • Don’t keep unwanted medicines. Take them to your usual pharmacy to be safely destroyed without damaging the environment.
  • If you buy prescription medicines over the internet, read our handy fact-sheet about the dangers.

If you don’t feel safe with your medicines, please talk to someone. Your doctor, nurse or pharmacist can help you.

Current issues in mental health medicines availability

Click on the drop-down boxes below for more information about each type of medication. Please also read the disclaimer at the bottom of the page.

Which medication is affected?

Heminevrin capsules. These contain 192mg of clomethiazole per capsule.

(Heminevrin is the brand name, clomethiazole is the active ingredient.)

What is the problem?

  • There is only one maker of clomethiazole 192mg capsules and this is the only strength made.
  • The maker has a short-term supply problem and cannot provide this medication.
  • Although clomethiazole is also available as Heminevrin syrup, there is not enough for it to be used in place of capsules.

When will the problem stop?

The maker thinks that the capsules will be available again by the end of September 2019.

What else can be done?

  • There are other medicines that can help with sleep. Switching from clomethiazole to an alternative medication can be discussed by the patient and their doctor.
  • Pharmacies can attempt to obtain capsules imported from overseas, however it might take some time for these to arrive and will require the prescriber, patient and pharmacist to agree that this is the best thing to do. These capsules are not made for the UK and might be made to different standards or not have information in English.

How can I learn more?

More information about clomethiazole can be found on the clomethiazole page on the Choice and Medication website
 
More information about treating sleep problems can be found on the insomnia page on the Choice and Medication website.

Last updated: 09/10/2019 by Stephen Jones

Source: Specialist Pharmacy Service
 

Which medication is affected?

Olena dispersible tablets. These contain 20mg of fluoxetine per tablet and are designed to be mixed with water before taking.

(Olena is the brand name, fluoxetine is the active ingredient.)

What is the problem?

  • There is only one maker of Olena dispersible tablets.
  • The maker has a short-term supply problem and cannot provide the medication.
  • There is no other dispersible tablet than contains fluoxetine.

When will the problem stop?

The maker thinks that the tablets will be available from October 2019.

What else can be done?

  • Patients who can swallow capsules can be switched to fluoxetine 20mg capsules.
  • Patients who cannot swallow capsules can be switched to fluoxetine oral solution (20mg in each 5mL).

How can I learn more?

More information about fluoxetine can be found on the Choice and Medication website.

Last updated: 28/08/2019 by Stephen Jones

Source: Department of Health and Social Care
 

Which medication is affected?

Fluoxetine capsules, but only the 10mg, 30mg and 40mg strengths

Most other fluoxetine medicines are available

What is the problem?

  • There is only one maker of fluoxetine 30mg and 40mg capsules
  • There are only two makers of fluoxetine 10mg capsules
  • The makers have a short-term supply problem and cannot provide these capsules.

When will the problem stop?
The makers say that the 10mg capsules will be available again by the end of October 2019 from one of them, and by early December 2019 for the other.
The maker says that the 30mg capsules will be available by early November 2019.
The maker says that the 40mg capsules will be available by early November 2019

What else can be done?

  • If you have enough of your fluoxetine to last until November, there is no need to do anything

If it is necessary to provide fluoxetine before November, alternatives to the 10mg, 30mg and 40mg capsules can be used instead:

  • Fluoxetine 20mg capsules are available
  • Fluoxetine oral solution 20mg in each 5mL spoonful is available (liquid medicine)
  • Fluoxetine 10mg tablets are available

If changing from capsules to solution there is no need to change the dose taken.

Pharmacies can attempt to obtain 10mg capsules imported from overseas, however it might take some time for these to arrive and will require the prescriber, patient and pharmacist to agree that this is the best thing to do. These capsules are not made for the UK and might be made to different standards or not have information in English. In most cases this will not be the best thing to do as other types of fluoxetine products are available in the UK

How can I learn more?
More information about fluoxetine can be found on the fluoxetine page on the Choice and Medication website
 
Last updated: 24/09/2019 by Stephen Jones


Source: Department of Health and Social Care

Which medication is affected?

  • Moclobemide tablets.
  • Both strengths of tablet are affected, these contain either 150 milligrams or 300 milligrams of moclobemide per tablet
  • Moclobemide is also known by the brand name “Mannerix”
  • Moclobemide is usually used to help with depression and some types of anxiety

What is the problem?

  • There are a number of makers of moclobemide
  • All makers have a short-term supply problem with moclobemide tablets
  • We don’t know more than this at the moment
  • When will the problem stop?
  • One of the makers thinks they will be able to provide the 150 milligram tablets by mid-October
  • The same maker thinks their 300 milligram tablets will be available from February 2020
  • The other makers cannot currently say when they will be able to provide moclobemide tablets

What else can be done?

  • There is no other medicine that works in quite the same way as moclobemide.
  • If moclobemide is helping you then the best thing is to continue it, even if this means taking a different strength of tablet.
  • If your regular pharmacy cannot get moclobemide tablets it is worth approaching other pharmacies to see if they have any. Your regular pharmacist might be able to help with this.
  • If you are not able to get moclobemide then you should discuss this with your doctor as soon as possible and you might need to see a specialist to recommend a different medicine

How can I learn more?
More information about this medicine can be found on the moclobemide page on the Choice and Medication website. 
More information about treating depression or social anxiety can be found on the Choice and Medication website.

Last updated: 03/10/2019 by Stephen Jones
Source: Local clinical opinion as there is currently no national guidance

Which medication is affected?

Nardil tablets. These contain 15mg of phenelzine per tablet.

(Nardil is the brand name, phenelzine is the active ingredient.)

What is the problem?

  • There is only one maker of phenelzine 15mg tablets and this is the only strength made.
  • The maker has a short-term supply problem from August 2019 and cannot provide the medication.
  • There is no other medicine that contains phenelzine.

When will the problem stop?

The maker thinks that the tablets will probably be available after October 2019.

What else can be done?

  • Pharmacies should attempt to obtain tablets imported from overseas; at the time of writing the national advice is that these supplies are available.  This will require the prescriber, patient and pharmacist to agree that this is the best thing to do. These tablets are not made for the UK and might be made to different standards or not have information in English.
  • Switching from phenelzine to different medicine could be very difficult and is not recommended unless considered essential. It might be necessary to refer patients into specialist mental health services if they will run-out of phenelzine and imported supplies cannot be obtained.

How can I learn more?

More information about phenelzine can be found on the Choice and Medication website

Last updated: 28/08/2019 by Stephen Jones

Source: Specialist Pharmacy Service
 

Which medication is affected?

Trifluoperazine tablets in both strengths (1mg tablets and 5mg tablets).

There are no longer any brand-names for trifluoperazine. It used to have the brand name “Stelazine”.

What is the problem?

  • There have been a lot of problems with the supply of trifluoperazine 1mg tablets and trifluoperazine 5mg tablets for a long time.
  • The tablets are sometimes available and sometimes not.

When will the problem stop?

  • We do not expect reliable supplies of the tablets soon.
  • This might improve after October 2020, but we are not sure about this.

What else can be done?

  • At the moment, trifuloperazine is available as a liquid medicine so patients can take that instead of the tablets. There is no need to change the dose.
  • We currently suggest that trifluoperazine is only prescribed for people who are already taking it, so that we have a better chance of being able to continue to supply them.

How can I learn more?

More information about trifluoperazine can be found on the Choice and Medication website.

Last updated: 28/08/2019 by Stephen Jones

Source: Department of Health and Social Care

Disclaimer

Always speak to your healthcare professional(s) to ensure that the information provided here applies to your personal circumstances.

This information is provided on the understanding that it is the best available to us at the time of writing.

The information does not endorse particular medicines and is a resource to supplement the expertise, knowledge and judgement of healthcare professionals working in partnership with patients and carers.

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