Substitution between formats during a shortage posts 91–120

I keep a log for substitution between formats specifically because my memory of it turned out to be systematically wrong in one direction. Six weeks of notes cost nothing and settled it.

Fine by me. I had wanted a stronger conclusion and there is not one available.

Coming back to post #103, because the follow-up matters more than the original answer.

Dose hold versus tapering: if a temporary shortage forces a gap, holding your dose and resuming when supply returns is different from gradually tapering. The two are different decisions.

A qualification I should have led with rather than closed on.

Post #107 is right about the mechanism and I think understates the practical bit.

Shortage status determines what compounding is permitted in some jurisdictions, which links two questions that otherwise seem unrelated.

The rule of thumb is fine; the edge cases are where it earns its keep.

Post #107 describes the usual case. This is about the unusual one.

Supply interruptions: official shortage notices are published by regulatory agencies. That is the correct primary source rather than pharmacy rumors or forum discussion.

Not the whole picture, but the part of it I can speak to.

Adding the measurement that post #107 says would settle it.

I disagree with the framing of substitution between formats above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.

The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.

Patient advocacy during shortages: some advocacy groups advocate for patients during shortages. Knowing who they are and following their communication is useful.

Post #108 describes the usual case. This is about the unusual one.

Having read the whole substitution between formats thread before replying: the question in the first post has not actually been answered yet, and three of us have answered a nearby one instead.

That matches what I have seen, for whatever a single anecdote is worth.

Allocation and rationing: during severe shortages, suppliers might ration allocation to prescribers. Understanding rationing policies from your prescriber matters for planning.

I would rather say I do not know than round it up to an answer.

Shortage predictions: regulators and suppliers issue shortage alerts before they become acute. Checking the regulatory website for shortages gives you advance notice.

Stockpiling in response to a shortage worsens it, which is true and is a poor argument to make to somebody who has run out.

Confirming post #114 from a second method, which matters more than confirming it from a second person.

An honest declaration on substitution between formats: I have a prior here and it is strong enough that you should weight what I say downward. Stating it rather than hiding it.

I had written a reply contradicting post #116 and deleted it. Here is what survived.

Regional differences during a shortage are large, and a supply position in one country says nothing about another.

That distinction has done more work for me than anything else in this category.

Narrowing post #118, because the general version has more than one answer.

Switching presentation or strength during a shortage is a prescribing decision rather than a substitution anybody should improvise.

The number is defensible. The precision I gave it is not.

Where a shortage forces a gap, the pharmacokinetics mean a missed week is a perturbation rather than a reset, which is worth knowing.