National Patient Safety Alert: Shortage of salbutamol 2.5mg/2.5ml and 5mg/2.5ml nebuliser liquid unit dose vials (26 February 2024)

Summary

Salbutamol is a selective beta2-agonist providing short-acting (4-6 hour) bronchodilation with a fast onset (within 5 minutes) in reversible airways obstruction. The nebuliser liquids are licensed for use in the management of chronic bronchospasm unresponsive to conventional therapy, and in the treatment of acute severe asthma.

A Medicines Supply Notification (MSN) issued on 14 February 2024, detailed a shortage of salbutamol 2.5mg/2.5ml and 5mg/2.5ml nebuliser liquid. The resolution date is to be confirmed. The supply issues have been caused by a combination of manufacturing issues resulting in increased demand on other suppliers. Terbutaline, salbutamol with ipratropium, and ipratropium nebuliser liquids remain available, however, they cannot support an increase in demand. Ventolin® (salbutamol) 5mg/ml nebuliser liquid (20ml) is out of stock until mid-April 2024 and cannot support an increased demand after this date.

Content

Actions to be completed as soon as possible and not later than 8 March 2024.

All providers MUST:

1. Liaise with local pharmacy teams and place urgent orders for unlicensed imports of salbutamol nebuliser liquid - do not wait for supplies to be exhausted before placing orders for imports.

2. Wean all patients off nebulisers as soon as their condition has stabilised.

3. Consider use of high-dose salbutamol pressurised metered-dose inhaler (pMDI) via a large volume spacer in patients with mild to moderate asthma attacks or COPD (see clinical information) ensuring the patient is issued with a new inhaler to avoid risk of using a near empty device and can administer it effectively if not being administered by a healthcare professional.

NOTE A Secondary care providers should:

4. Where a pMDI is not appropriate, prescribe salbutamol nebuliser liquids when required (PRN) rather than regularly (QDS), as early as possible during admission, if appropriate.

5. Prioritise supplies of salbutamol nebuliser liquids for the following indications: a. acute, severe exacerbations of COPD and asthma b. bronchospasm secondary to refractory anaphylaxis c. in patients who cannot use a pMDI d. other conditions where the use of high-dose salbutamol pMDI via a spacer is inappropriate e.g. moderate to severe hyperkalaemia

Primary care prescribers should:

6. Review need for home nebuliser use, and if deemed necessary, determine if the patient has sufficient supplies of nebuliser liquid at home before issuing repeat prescriptions.