Coumadin 5mg availability in Australia

[pellicle]

A good friend of mine recently sold his pharmacy, he regularly lamented that people would come in at closing time and say they were out of supply.

One year is impressive - I always keep some extra but after this will be even more careful

This is the first time I've been without more than a month's supply in advance.

It won't happen again.

I recommend that you do the same.

This Russian war is going to put everything to the test.

 

[pellicle]

To all Australians who may be effected by this supply issue I offer the following suggestions

1. determine your exact supply for your dose in days
2. determine your present level of scripts and if you aren't currently written up for sizes which may be in supply, as a priority get that done at your GP
3. contact your usual pharmacy and ask about supply and availablity
4. its better to have some 1mg tablets and have 7 (for instance) of them a day than not have any
5. as a last resort consider skimming the lower end of your range rather than running out completely. Being INR 1.8 is much safer than being totally un-anti-coagulated
6. I would advise against acting like people did in the pandemic but with warfarin instead of toilet paper, panic buying could see someone go without

Self testers will be aware of how to do this already. (one more reason to be a self tester).

In a small way: 5hit has hit the fan it seems at least in NSW

Best wishes

 

[ATHENS1964]

When absolutely necessary
Do not eat any food with vitamin K so you can save the pills you have.
Do an INR test every day
Take aspirin
In absolute necessity, take the new noac pills. better than nothing.
However, always talk to your cardiologist and if possible go to the emergency room of a hospital, hospitals always have a stock and priority in the supply of medicines.
Here in Greece, the legislation says that pharmaceutical wholesale companies and warehouses must have a specific stock of pharmaceuticals whenever and if requested by the state in case of need, i.e. they cannot sell the entire stock to private pharmacies as they should have declared in which warehouse and in which part of the country do they have them for periodic inspection.

 

[pellicle]

When absolutely necessary
Do not eat any food with vitamin K so you can save the pills you have.
Do an INR test every day
Take aspirin
In absolute necessity, take the new noac pills. better than nothing.
However, always talk to your cardiologist and if possible go to the emergency room of a hospital, hospitals always have a stock and priority in the supply of medicines.
Here in Greece, the legislation says that pharmaceutical wholesale companies and warehouses must have a specific stock of pharmaceuticals whenever and if requested by the state in case of need, i.e. they cannot sell the entire stock to private pharmacies as they should have declared in which warehouse and in which part of the country do they have them for periodic inspection.

a couple of quick points:

1. what is your rational for daily testing? Apart from consuming strips you can be sufficiently informed by testing every 3 days and keeping a graph (which one should be doing all the time anyway. Not everyone has sufficient supply of strips.
2. In Australia the hospitals have a supply of drugs but you can count on a minimum of an hour wait while they prioritise you and then administer you a dose. They will not give you a take home bag of 50 pills just because you present and say "I can't get them at the shop". They will do this because they have their supply for their in-patients.

Its important to keep within therapeutic range, but at the same time when dealing with emergencies one needs to make plans to minimise harm.

Obviously obtaining continuity of supply is the #1 priority, the #2 is then what to do if you can't.

The patient (me) need to be aware of the possibility that there will be supply issues and work around that. I'm not talking a basement filled with drugs, foodstuffs, rifles and ammo here, just a couple of the medicines which you regularly take and your health is dependent upon. This concept (called planning) has been around for millennia ... even starting with the education of children

Best Wishes

 

[pellicle]

Just got back from the Chemists (40km each way) after they confirmed they had stock (and had just received a shipment. I got 1's and 5's

to supplement the 3's I just opened. So that's about 2 months supply right there.

I don't know the situation with the other brand or other locations, but major chemist chains are showing it available in Queensland.

Perhaps its a Sydney issue or perhaps its only just specific pills.

Anyone else got any other experiences?

 

[aussiemember]

So I’m in Melbourne and talked to my chemist and apparently they’ve changed manufacturers - bottle now a bright blue container - no availability of the new 5s at the moment which is why there is a shortage.

 

[pellicle]

So I’m in Melbourne and talked to my chemist and apparently they’ve changed manufacturers - bottle now a bright blue container - no availability of the new 5s at the moment which is why there is a shortage.

is mylan the new manufacturer?

if so then it may now be exactly the same formula, I'd bring this to the attention of your GP ... maybe they could give you a script for either ... you could then try and see if there is a difference.

BTW the difference is complex to explain.

 

[aussiemember]

is mylan the new manufacturer?

if so then it may now be exactly the same formula, I'd bring this to the attention of your GP ... maybe they could give you a script for either ... you could then try and see if there is a difference.

BTW the difference is complex to explain.

Mylan was the old manufacturer - new one is Viatris - I’m okay for a few months now but will definitely speak to my cardiologist about making the switch if supplies don’t free up by then.

 

[geoffreyt]

The pharmacies I tried in Sydney are not able to supply 5mg Coumadin. There is a supply problem that appears to have been caused by a change in suppliers. The TGA is reporting that the supply issues will not be resolved until July Medicine Shortages Information Initiative)
Have other Coumadin users in experienced this availability issue?
Also, has anyone changed from Coumadin to Marevan? If so, what do i need to be aware of?
The advice is that you should stay with one brand.
BTW, I take 11mg per day and doing this with 2mg tablets for the next 4 months won't be fun and there is a high likelihood that these tablets will quickly end up in short supply if everyone is using them (instead of the 5mg).

Cheers, Bill

I'm in the same boat bill. It seems that the US has stopped producing Coumadin ? The supply by a company called Viatris seems the sole supplier???
I am on 12mg daily and get given a bottle of 1mg.........it is a bloody joke.
Who is to produce this essential drug for mechanical valve patients?

 

[ATHENS1964]

Substitution instrument to address shortage of COUMADIN warfarin 5mg tablets​

https://www.tga.gov.au/safety/short...ddress-shortage-coumadin-warfarin-5mg-tablets

 

[LondonAndy]

For what it is worth: here in the UK I have been taking Warfarin for 8 years now, and have never been given Coumadin: it has always been different brands, and they appear to be treated as interchangeable. Currently my 1 and 5mg tablets are made by Crescent, and my 3mg by Almus. However, I was interested to read in the "Substitution" instrument posted by @ATHENS1964 that the Australian authorities don't like changing to different brands.

"Advise the patient that whilst there are different brands of warfarin, these have not been shown to be bioequivalent and should not be interchanged without the prescriber’s advice."

 

[pellicle]

Substitution instrument to address shortage of COUMADIN warfarin 5mg tablets​

https://www.tga.gov.au/safety/short...ddress-shortage-coumadin-warfarin-5mg-tablets

very interesting (and thanks @LondonAndy I missed this)

I wonder how they reconcile with the point the other arm of Australian Medical Governance made which I raised over here:

https://www.valvereplacement.org/threads/coumadin-5mg-availability-in-australia.888967/post-922682
specifically

The patient was on a dose of 4 mg of warfarin, initially provided by 1 x 1 mg, 1 x 3 mg Marevan, and had an INR = 2.7. Upon completion of that supply, the patient was given Coumadin (2 x 2 mg) and subsequently presented with an INR = 4.4. After questioning, we established that the patient was well and that brand substitution had occurred. The Coumadin was stopped and replaced with Marevan and the INR returned to an acceptable level.​

 

[pellicle]

I am on 12mg daily and get given a bottle of 1mg.........it is a bloody joke.
Who is to produce this essential drug for mechanical valve patients?

its an interesting question. Personally I'm preplexed by the rigidity of the situation but understand that brand substitution could be a problem of INR.

Again I come back to why the hell aren't we all actually not only encouraged but actually trained in INR management? I'm glad I've worked it out, but I'd still be hit by the prescription regulation wall.

I'm not effected by this (because I'm using Marevan) however I've talked about it with my GP and she's entirely happy for me to have a different prescription if it was needed because

• she knows I self test
• she's seen my results
• she knows I'd quickly dial in with any changes and not be out of range

 

[LondonAndy]

The patient was on a dose of 4 mg of warfarin, initially provided by 1 x 1 mg, 1 x 3 mg Marevan, and had an INR = 2.7. Upon completion of that supply, the patient was given Coumadin (2 x 2 mg) and subsequently presented with an INR = 4.4. After questioning, we established that the patient was well and that brand substitution had occurred. The Coumadin was stopped and replaced with Marevan and the INR returned to an acceptable level.

To my mind, it would have been equally acceptable to reduce the Coumadin dose to achieve the target INR. (I know that's not useful in the current supply issue of this thread!)

 

[pellicle]

To my mind, it would have been equally acceptable to reduce the Coumadin dose to achieve the target INR

Totally agree. I have no idea why they are so fixated on a dose rather than INR.

Further I'm going to say that this goes to show:

1. when changing brands be aware of such things and monitor
2. the power of self testing is the enablement of exactly being able to monitor and do something about it.

In Sustainable Development the focus is on enabling people to look after themselves, not in making them dependent on a provider or agency; this is called Capacity Building.

Capacity-building is defined as the process of developing and strengthening the skills, instincts, abilities, processes and resources that organizations and communities need to survive, adapt, and thrive in a fast-changing world.​

this however doesn't help clinics make money...

 

[Keefo]

Thanks for all your posts.

I've just run out of Coumadin/warfarin (for the first time in 15 years). Have a a script for 5mgs but cannot find any.

Are there any Aussies here having the same issues (still)? Note the last post in this thread was March.

Have any Aussies sourced Warfarin successfully internationally? I tried the link @MdaPA Posted, but they don't post to Aus.

I was informed Yesterday (for the first time ever), that I could switch to Marevan (by the Chemist, so will have to check with my Doc). Anyone made the switch successfully, any tips?

 

[pellicle]

Good Morning Keefo

I've just run out of Coumadin/warfarin (for the first time in 15 years). Have a a script for 5mgs but cannot find any.

bummer

Are there any Aussies here having the same issues (still)?

IIRC there are still issues until June ... but you can get other sizes (which I suggest you do) and make them up.

Have any Aussies sourced Warfarin successfully internationally? I tried the link @MdaPA Posted, but they don't post to Aus.

I don't know if you know this but every country has tight regulations (really tight, with very harsh penalties) for the importation of drugs. Yes, all drugs which are regulated ... not just weed like cannabis. If you don't have a prescription for it and its been dispensed with a label on the bottle that coincides with your prescription and you're caught with it then huge fines and depending on quantity Jail time.

Sure, aspirin or paracetamol are drugs. But you can get caught (say) coming back from the USA and having something (codine) which is available over the counter that's not allowed here (in Oz).

I was informed Yesterday (for the first time ever), that I could switch to Marevan (by the Chemist, so will have to check with my Doc). Anyone made the switch successfully, any tips?

If you do the switch, are you a self tester? If you aren't then it will likely result in a clinic incompetency induced yo-yo of your INR till they work it out.

If you are then it'll be trivial through to no problem. Its a crap shoot because "it depends" on what you get. Myself I suspect that the Coumadin and Marevan we get here are closer formulations than other places (if you've read my above cautionary post).

Best Wishes

 

[Protimenow]

I take generic warfarin - sometimes it's made by more than one manufacturer.

I can get 5 mg pills here in the U.S.

If I couldn't, I'd use 4 mg plus 1 mg (assuming you can get 4 mg). If a larger pill - 5 mg or 7.5 mg becomes unavailable, I'll use whatever mix of smaller pills needed to make up the correct dose.

FWIW - I had a pharmacy that tried to substitute another 'generic' (with a name other than warfarin) for the real generic, and I couldn't regulate my INR. Sometimes the generics with a name other than warfarin may not work the same way as warfarin did (at least in my body the reaction was different).

If the manufacturer of your warfarin changes, it's not a bad idea to test after taking it for a few days to confirm that your body handles it the same way as it does warfarin.

Also - it's my understanding that they don't MAKE coumadin because warfarin destroyed the market for it.

 

[tom in MO]

Thanks for all your posts.

I've just run out of Coumadin/warfarin (for the first time in 15 years). Have a a script for 5mgs but cannot find any.

Are there any Aussies here having the same issues (still)? Note the last post in this thread was March.

Have any Aussies sourced Warfarin successfully internationally? I tried the link @MdaPA Posted, but they don't post to Aus.

I was informed Yesterday (for the first time ever), that I could switch to Marevan (by the Chemist, so will have to check with my Doc). Anyone made the switch successfully, any tips?

A quick search shows the active ingredient in Marevan is warfarin. I'd check my INR 5-days after switching to make sure everything is OK.

 

[LondonAndy]

A quick search shows the active ingredient in Marevan is warfarin. I'd check my INR 5-days after switching to make sure everything is OK.

Just as Perrier, Evian and Dasani are all water with slight differences in mineral content, Coumadin, Marevan and others are all warfarin, with slight differences in the bulking agent.