Finding a regular supply of an antifungal medicine such as itraconazole can sometimes be difficult. A local pharmacy may not have the right strength, brand or formulation available immediately, or may need to order it from a wholesaler. This can be worrying when the medicine is part of your long-term treatment for aspergillosis.
One option that may be available for some patients is an NHS medicines homecare service. This article explains what that means, who may be eligible, and what to do if your supply is running low.
What is a medicines homecare service?
Medicines homecare is a way of supplying certain hospital-prescribed medicines directly to your home, workplace or another suitable UK address. Your hospital clinical team writes the prescription and the hospital pharmacy sends it to an approved external homecare provider. The provider dispenses the medicine and arranges delivery.
Some homecare services also provide nursing support, equipment or training for medicines that need to be injected or administered at home. For oral antifungals, the service is usually about safe dispensing and reliable delivery.
Homecare companies are commercial providers working under NHS contracts; they are not replacements for your consultant, specialist nurse, GP or hospital pharmacist. Your hospital team remains responsible for the clinical decisions about your treatment.
Could this be available for itraconazole?
Possibly. It depends on the medicine, your individual treatment plan, and the arrangements at the hospital that prescribes it. Homecare is more commonly used for specialist, high-cost or hospital-only medicines, but some long-term oral treatments may also be suitable.
If you are repeatedly struggling to obtain itraconazole through the usual route, it is reasonable to ask your specialist team or hospital pharmacy:
- Whether your itraconazole can be supplied through the Trust’s medicines homecare service.
- Whether a different dispensing route is available while supply is difficult.
- How much buffer stock you should aim to have at home.
- Who to contact if a delivery or prescription is delayed.
The provider is chosen by the NHS Trust and may vary between hospitals and medicines. Sciensus is one example of a company that provides NHS medicines homecare, but it is not the only provider and patients cannot normally self-refer directly to a particular company.
What homecare can help with — and what it cannot
Homecare can save repeated journeys to hospital and may give you a more predictable delivery arrangement. The service should contact you to arrange deliveries, and you or an agreed representative will normally need to be available to receive and sign for them.
However, homecare cannot create stock where there is a wider manufacturing or national supply problem. Medicine shortages can arise for several reasons, including manufacturing difficulties, shortages of raw materials, increased demand, distribution problems or regulatory issues.
Where there is a shortage, your hospital pharmacy and specialist team may need to find available stock, arrange an alternative formulation, or advise on a different treatment. Do not make these changes yourself.
Itraconazole: do not assume that all forms are interchangeable
Itraconazole is available in different formulations, including capsules and oral liquid. They are absorbed differently and should not be swapped without advice from the clinician or pharmacist managing your treatment.
In particular, itraconazole oral solution has higher bioavailability than capsules. The timing of doses in relation to food can also differ between formulations. Any change may require a dose adjustment and, for many people being treated for aspergillosis, repeat therapeutic drug monitoring.
Do not ration doses, borrow medicine, change from capsules to liquid, or restart a previously supplied medicine without discussing it with your specialist team. Itraconazole also has important interactions with other medicines.
What to do if you are running low
Do not wait until your final few doses. As soon as you think your supply may run out, contact the team that prescribes your antifungal medicine. Depending on your local arrangements, this may be your specialist nurse, hospital pharmacy, respiratory clinic or GP practice.
When you call or email, it helps to say:
- the name, strength and formulation of the medicine;
- how many doses you have left;
- where you normally obtain it;
- whether a pharmacy has told you it cannot obtain stock; and
- any upcoming travel or other reason you will not be able to receive a delivery.
If you already use homecare and a planned delivery has not arrived, contact the homecare provider promptly and let your prescribing hospital team know if you are approaching the end of your supply. The hospital’s homecare pharmacy team can often help resolve problems with a prescription or delivery.
Planning ahead
Ask your team what buffer stock is appropriate for you and reorder or respond to delivery contacts promptly. Keep the homecare provider and hospital team updated if your telephone number, address, holiday plans or preferred delivery arrangements change.
For planned travel abroad, ask well in advance about extra supplies, storage requirements and a travel letter. Do not assume that a provider can deliver medicines outside the UK.
The key message
If obtaining itraconazole has become a repeated problem, you do not need to solve it alone by phoning around pharmacies. Ask your specialist team or hospital pharmacy whether an NHS medicines homecare pathway is suitable for your treatment. It may not remove every supply problem, but it can provide a safer and more convenient route for some people on long-term specialist antifungal treatment.
Further information
- NHS England: medicines procurement, supply and homecare services
- Guy’s and St Thomas’: patient guide to homecare medicines
- Specialist Pharmacy Service: switching between tablet/capsule and liquid formulations
This information is for general guidance and does not replace advice from the clinician or pharmacist who prescribes your antifungal treatment.
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