Unfortunately there is no obvious solution for this at the moment as changing all patients to other preparations e.g. dinitrate formulation or MR preps. is not practical as a mass switch will more than likely make those preparations also unavailable.
There is also evidence that alternative drugs (such as Nicorandil) is also going into short supply.
There has been reportedly some unlicensed stock available; if using these they will need to be prescribed on a patient named basis with the prescription clearly stating to use unlicensed Isosorbide Mono etc.
Locally, medicine management teams have advised GP's to not change patients over to any particular product but to issue the Isosorbide Mononitrate on a separate prescription so that the patient can take it to different pharmacies and obtain stocks without affecting their other items.
On receipt of a Isosorbide Mononitrate prescription pharmacies are encouraged to let the prescriber know if they have an alternative non-M/R in stock so that item can be changed for the patient, in that instance, and if they have no stock to encourage the patient to check other pharmacies. If the patient cannot get their prescription dispensed then they should contact their GP. The GP will then liaise with the patient’s pharmacy of choice as to what M/R product is available for a one-off prescription.
Whilst this is not an ideal scenario it was deemed the best course of action in order to give a patient the best chance of obtaining the medicine.
Pharmacies are also encouraged to proactively work with surgeries to ensure continuity of supply for patients getting their medicines via a dosette box etc. i.e. those where it is not practical to try an alternative pharmacy.
The department of health have issued a letter about the issue and that can be downloaded here. Local guidance can also be downloaded here.