Fluoxetine 20 mg caps: Supply issue

Supply issue Active

The brand change for fluoxetine from Fluox to Arrow-Fluoxetine has occurred earlier than expected.

Supply issue for Arrow-Fluoxetine

The brand change for fluoxetine hydrochloride 20 mg cap (from Fluox to Arrow-Fluoxetine) has occurred earlier than expected. This has created a supply issue with Arrow-Fluoxetine (Pharmacode 2450860).

The supplier of Arrow-Fluoxetine, Teva, has indicated that there will be limited supply throughout February 2023. Two large shipments are expected during February. However, it will take 1 to 2 weeks for supply to reach pharmacies after arrival in New Zealand.

This issue was caused by stock of Fluox, the previous brand, running out earlier than expected. We had anticipated Fluox would be available until 1 June 2023, when it is to be delisted.  

Affected products

There are three currently funded fluoxetine hydrochloride products.

Arrow-Fluoxetine

  • Chemical: Fluoxetine hydrochloride    
  • Presentation: 20 mg capsule
  • Supplier: Teva
  • Pharmacode: 2450860 

Fluox

  • Chemical: Fluoxetine hydrochloride    
  • Presentation: 20 mg cap
  • Supplier: Viatris 
  • Pharmacode: 2353121 

Fluox

  • Chemical: Fluoxetine hydrochloride    
  • Presentation: 20 mg tab dispersible
  • Supplier: Viatris 
  • Pharmacode: 2618575 

Schedule listing for fluoxetine(external link)

Dispensing limit in place from 27 January 2023

Effective immediately, pharmacists can dispense a maximum of 7 days' supply at a time of fluoxetine 20 mg at a time. This is a shift from the current monthly dispensing. 

The pharmacist must clearly annotate the prescription for fluoxetine 20 mg with the words “out of stock” or “OOS” and initial the annotation in their own handwriting. 

This applies to:  

  • Arrow-Fluoxetine 20 mg capsules (2450860)
  • Fluox 20 mg capsules (2353121)
  • Fluox 20 mg dispersible tablets (2618575)

This limit will be in place until 28 February 2023. We anticipate the supply issue will be resolved by then. We will continue to monitor the situation and may remove the limit if supply is available earlier.  

Pharmac is activating rule 5.5 of the General Rules of the Schedule to limit dispensing quantities for this medicine. Where appropriate, pharmacists can use their discretion and apply rule 4.2.2.

Rule 5.5 of the General Rules

Substitution of Fluox 20mg dispersible tablets

Our clinical advisors have informed us that Fluox 20 mg dispersible tablets are an appropriate substitution for Arrow-Fluoxetine 20 mg capsules or Fluox 20 mg capsules. The dispersible tablets can also be swallowed whole like the capsules. 

During this supply shortage, pharmacists can dispense Fluox 20 mg dispersible tablets, in place of Arrow-Fluoxetine 20 mg capsules or Fluox 20 mg capsules. The tablets are still limited to a maximum of 7 days’ supply at a time. 

Pharmacists should process the prescription as endorsed for everyone, regardless of the Schedule criteria. 

The Online Schedule cannot be updated to reflect this change because of the timeframes. 

Brand switch fee

We did not initially apply a brand switch fee to this brand change because it did not meet our criteria. 

Given the issues caused by this supply issue, we are reviewing this decision.

We do not make these changes lightly

We acknowledge the inconvenience that dispensing limits create for pharmacists and people taking medicine. Limiting dispensing will help distribute the limited supply of fluoxetine as fairly as possible.  

We appreciate pharmacists' vital role in responding to this issue and apologies for any inconvenience caused.

Fluoxetine (Arrow-Fluoxetine) caps will be resupplied from late-February

Teva advises that they have stock again by 1 March 2023. It may take time for the product to make its way through the supply chain to pharmacies. 

We appreciate your support during this supply issue.

Key dates

27 July 2022: Brand change notified as a result of our tender decision

1 January 2023: Arrow-Fluoxetine (Pharmacode 2450860) listed

27 January 2023: Dispensing limited to 7 days’ supply for all 20 mg presentations of fluoxetine

1 February 2023: Toniq will update their software to reflect these changes 

28 February 2023: Dispensing returned to normal

1 June 2023: Fluox (pharmacode 2353121) will be delisted

Who to contact

If pharmacies are having difficulty getting access to fluoxetine, we recommend they check with other wholesalers. We understand there are varying stockholdings around the country.

If you have questions about this supply issue, email enquiry@pharmac.govt.nz