I understand that in some areas there is short/no supply of fluoxetine and sertraline This appears to be related to supply chains as opposed to the country running out of these medications. Some pharmacies appear to have run out of these medications; others continue to have some supplies. I understand that other SSRIs (citalopram and escitalopram) are still available.
If ongoing antidepressant treatment is required and your patient is unable to obtain supplies of their fluoxetine or sertraline, I would recommend changing to another SSRI (citalopram, escitalopram, paroxetine), or a different class of antidepressant such as venlafaxine or mirtazapine especially if they did not adequately respond to an adequate trial of fluoxetine or sertraline.
When switching medications (especially from fluoxetine), please be aware of the impact on Cytochrome P450 metabolism of other medications (e.g. warfarin) that in turn may require further monitoring and dose adjustments.
Please also closely monitor for any variations in mood, anxiety, agitation and suicidal ideation during the change over period.
I would recommend switching according to the NZF Antidepressant Switching Table: https://nzf.org.nz/nzf/resource/Antidepressant_Switching_Table.pdf.
When switching from one serotonergic agent to another, there is a very low risk of inducing serotonergic syndrome. This link provides a good summation of clinical signs and symptoms: https://www.medsafe.govt.nz/profs/PUArticles/SerotoninSyndromeToxicityReminder.htm
This patient brochure is available at: https://www.medsafe.govt.nz/consumers/educational-material/Serotonin%20Syndrome%20December%202015.pdf
Please do not hesitate to contact me should you have any questions.
Click here for printable document
Dr Andrew Darby
Primary Care Consultant Psychiatrist