Intended for healthcare professionals

Letters Crisis in the supply of medicines

Changes in prescribing during drug shortages could increase harm to patients

BMJ 2019; 367 doi: (Published 09 December 2019) Cite this as: BMJ 2019;367:l6868
  1. Anthony R Cox, senior lecturer in clinical pharmacy and drug safety
  1. School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Birmingham B15 2TT, UK
  1. a.r.cox{at}

Ferner and colleagues discuss current drug shortages in the UK and worldwide, noting that “sometimes alternatives will be identifiable, but there will often be therapeutic and financial costs.”1 Naproxen is a good example of this. From September to December 2018, prescribing of naproxen in English clinical commissioning groups fell from 581 927 items to 480 171 items (a 17.5% fall). In September 2018, naproxen prescribing cost £1 495 703—by January 2019 it had risen to £9 206 903, despite reduced prescribing.2

Apart from these financial costs, there was a regrettable shift in prescribing, as the proportion of non-steroidal anti-inflammatory drugs (NSAIDs)—with greater risks of cardiovascular, gastrointestinal, and renal adverse effects—rose. The “number of prescription items for all NSAIDs, excluding ibuprofen and naproxen, as a percentage of the total number of prescription items for all NSAIDs” rose from 20% in September 2018 to 24% in January 2019.3 The management of prescribing during drug shortages needs careful thought, and timely advice, to avoid sudden increases in the risks of harms to patients.


  • Competing interests: None declared.