Hospital pharmacists Chief Pharmacists to forward on to Medicines Information Pharmacists Community pharmacists
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1 Primary and Community Care Directorate Pharmacy Division T: F: E: 18 August 2009 abcdefghijklmnopqrstu = IMMEDIATE MESSAGE TO: 1. Directors of Pharmacy 2. Chief Pharmacists, NHS Boards 3. Hospital Pharmacy Managers 4. Medical Directors NHS Boards 5. Chief Executives NHS Boards Dear Healthcare Professional, DRUG ALERTS NO 23 CLASS 2 Please find attached revised drug safety information from the Medicines and Healthcare Products Regulatory Agency (MHRA) for onward transmission (see list below). 1. Please could Directors of Pharmacy forward this alert to:- Hospital pharmacists Chief Pharmacists to forward on to Medicines Information Pharmacists Community pharmacists 2. Please could Medical Directors forward the message on to :- General Practitoners Dispensing Doctors Chief Executives NHS Boards Thank you for your co-operation. Yours sincerely IRENE FAZAKERLEY Pharmacy Division * NB: Drug alerts have the following classifications: 1. Action now (including out-of-hours); 2. Action within 48 hours; 3. Action within 5 days; 4 Caution in use St Andrew s House, Regent Road, Edinburgh EH1 3DG abcde abc a
2 Defective Medicines Report Centre Market Towers 1 Nine Elms Lane London SW8 5NQ Telephone: +44 (0) Fax: +44 (0) D R U G A L E R T CLASS 2 MEDICINES RECALL Action Within 48 Hours PHARMACY AND WHOLESALER LEVEL RECALL Date: 18 August 2009 EL (09)A/23 Our Ref: MDR 84-07/09 Dear Healthcare Professional, Karib Kemi Pharm Ltd Please note - Ciprofloxacin tablets are in both Karib Kemi Pharm and Sandoz Liveries. All other products are solely in Karib Kemi Pharm Livery Multiple Product Drug Alert Product Name PL No. Amoxicillin Caps 250mg 18224/0004 Amoxicillin Caps 500mg 18224/0005 Atenolol Tabs 50mg 18224/0018 Atenolol Tablets 100mg 18244/0019 Ciprofloxacin Tablets 250mg 18224/0008 Ciprofloxacin Tablets 500mg 18244/0009 Fluoxetine Caps 20mg 18224/0059 Paracetamol Tabs 500mg 18224/0003 Phenoxymethylpenicillin Potassium Tabs 250mg 18224/0049 Ranitidine Tabs 75mg 18224/0028 Ranitidine Tabs 150mg 18224/0006 Ranitidine Tabs 300mg 18224/0007 Details of over one hundred batches are attached to this document as Appendix 1. Please note the Sandoz livery products are listed in line numbers 68, 70 and 72 of Appendix 1. Contd/.. MHRA Distribution: Regional Contacts for NHS Trusts and Provider Units Chief Pharmacists: England, Scotland, Wales, Northern Ireland Prison Health Policy Unit (DH) Chief Pharmacists: Jersey, Guernsey, Alderney, Sark, Isle of Man, Gibraltar Special Hospitals Healthcare Commission for distribution to Independent Health Care Establishments Primary Care Trusts (England) Page 1 of 8
3 Karib Kemi Pharm Ltd, the marketing authorisation holder, are recalling all unexpired stock of the above products due to unsatisfactory shipment conditions during sea transit from their overseas contract manufacturers. All unexpired stock of the listed products and batches should be quarantined and returned for credit. However, care needs to be taken to ensure only those specific batches listed in this drug alert are returned. There are a number of other batches and products which have been transported by air and are not subject to recall action. For any Medical Information enquiries related to this case please call Karib Kemi Pharm Ltd on or For enquiries related to stock returns and credit please call Karib Kemi Pharm Ltd on the numbers in the previous paragraph. Further details of the products and liveries involved are attached as Appendix 1. This list has been provided by Karib Kemi Pharm Ltd as all remaining in-date stock which has been shipped by sea. Further information is attached as Questions and Answers in Appendix 2. Recipients of this Drug Alert should bring it to the attention of relevant contacts by copy of this letter. Primary Care Trusts are requested to forward this to relevant clinics, General Practitioners and Community Pharmacists. Yours faithfully Ian Holloway MHRA DMRC Manager Page 2 of 8
4 Appendix 1 (111 line listing) No. Product Name PL No. Batch Livery Pack Number Size 1 Amoxicillin Caps 250mg 18224/0004 KASC 7002 Karib Kemi 21 2 Amoxicillin Caps 250mg 18224/0004 KASC 7003 Karib Kemi 21 3 Amoxicillin Caps 250mg 18224/0004 KASC 7004 Karib Kemi 21 4 Amoxicillin Caps 250mg 18224/0004 KASC 7005 Karib Kemi 21 5 Amoxicillin Caps 250mg 18224/0004 KASC 7007 Karib Kemi 21 6 Amoxicillin Caps 250mg 18224/0004 KASC 7008 Karib Kemi 21 7 Amoxicillin Caps 250mg 18224/0004 KASC 7009 Karib Kemi 21 8 Amoxicillin Caps 250mg 18224/0004 KASC 7010 Karib Kemi 21 9 Amoxicillin Caps 250mg 18224/0004 KASC 7011 Karib Kemi Amoxicillin Caps 250mg 18224/0004 KASC 7012 Karib Kemi Amoxicillin Caps 250mg 18224/0004 KASC 7013 Karib Kemi Amoxicillin Caps 250mg 18224/0004 KASC 7014 Karib Kemi Amoxicillin Caps 250mg 18224/0004 KASC 7015 Karib Kemi Amoxicillin Caps 250mg 18224/0004 KASC 7016 Karib Kemi Amoxicillin Caps 250mg 18224/0004 KASC 7017 Karib Kemi Amoxicillin Caps 250mg 18224/0004 KASC 7018 Karib Kemi Amoxicillin Caps 250mg 18224/0004 KASC 7019 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7003 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7004 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7005 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7008 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7009 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7010 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7011 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7012 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7013 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7014 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7015 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7016 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7017 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7018 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7019 Karib Kemi 21 Page 3 of 8
5 Appendix 1 (111 line listing) No. Product Name PL No. Batch Livery Pack Number Size 33 Amoxicillin Caps 500mg 18224/0005 KADC 7020 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7021 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7022 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7023 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7024 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7025 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7026 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7027 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7028 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7029 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7030 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7031 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7032 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7033 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7034 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7035 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7036 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7037 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7038 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7039 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7040 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7041 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7042 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7043 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7044 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7045 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7046 Karib Kemi Amoxicillin Caps 500mg 18224/0005 KADC 7047 Karib Kemi Atenolol Tabs 50mg 18224/0018 KA5 701 Karib Kemi Atenolol Tabs 50mg 18224/0018 KA5 702 Karib Kemi Atenolol Tabs 50mg 18224/0018 KA5 703 Karib Kemi 28 Page 4 of 8
6 Appendix 1 (111 line listing) No. Product Name PL No. Batch Livery Pack Number Size 64 Atenolol Tabs 100mg 18224/0019 KA1 702 Karib Kemi Atenolol Tabs 100mg 18224/0019 KA1 701 Karib Kemi Atenolol Tabs 100mg 18224/0019 KA1 703 Karib Kemi Ciprofloxacin Tabs 250mg 18224/0008 KF2 601ML Karib Kemi Ciprofloxacin Tabs 250mg 18224/0008 SF2 602ML Sandoz Ciprofloxacin Tabs 500mg 18224/0009 KF5 601ML Karib Kemi Ciprofloxacin Tabs 500mg 18224/0009 SF5 602ML Sandoz Ciprofloxacin Tabs 500mg 18224/0009 KF5 701 Karib Kemi Ciprofloxacin Tabs 500mg 18224/0009 SF5 702 Sandoz Fluoxetine Caps 20mg 18224/0059 DH Karib Kemi Fluoxetine Caps 20mg 18224/0059 DH Karib Kemi Fluoxetine Caps 20mg 18224/0059 DH Karib Kemi Paracetamol Tabs 500mg 18224/0003 DL Karib Kemi Paracetamol Tabs 500mg 18224/0003 DL Karib Kemi Paracetamol Tabs 500mg 18224/0003 DL Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 7004 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 7005 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 7006 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 7007 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 7008 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 7009 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 7010 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 8002 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 8003 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 8004 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 8005 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 8006 Karib Kemi Penicillin VK Tabs 250mg 18224/0049 SPT 8007 Karib Kemi Ranitidine Tabs 75mg 18224/0028 KR7 701 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 704 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 705 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 706 Karib Kemi 60 Page 5 of 8
7 Appendix 1 (111 line listing) No. Product Name PL No. Batch Livery Pack Number Size 96 Ranitidine Tabs 150mg 18224/0006 KR1 707 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 708 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 709 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 710 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 711 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 712 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 713 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 714 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 715 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 716 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 717 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 801 Karib Kemi Ranitidine Tabs 150mg 18224/0006 KR1 802 Karib Kemi Ranitidine Tabs 300mg 18224/0007 KR3 705 Karib Kemi Ranitidine Tabs 300mg 18224/0007 KR3 706 Karib Kemi Ranitidine Tabs 300mg 18224/0007 KR3 707 Karib Kemi 30 Appendix 1 Ends Appendix 2 Questions and Answers follows on next page Page 6 of 8
8 Appendix 2 Questions and Answers Why is a product recall being carried out? These products have been subjected to unsatisfactory conditions during shipment from their overseas manufacturing sites to the UK. Is the temperature monitored during shipment? Yes, but the Qualified Person took no action to review the data, ensure shipment conditions were acceptable or to find a better shipment system. This explains why all remaining in-date stock of these products is being recalled. Why are you not recalling the product to patient level? Products imported from non-eu countries have to be tested on import to the EU. These medicines have been tested on import and passed the required tests. However, testing is a sampling activity which examines a limited proportion of the batch and only reflects the condition at the time of testing. We are adopting a precautionary approach at this stage. If any of the additional testing, mentioned below, indicates a higher risk then we will reconsider this position. Is any more work going on to obtain more information about the risks and potential problems? Yes, laboratory testing is being carried out and should provide more information. This obviously takes time and some problems might only be detected as the product ages. The recall action taken now should minimise risk to the patient. Are all products from this marketing authorisation holder shipped by sea? No. The above listing excludes some recent products which have been shipped by air. Page 7 of 8
9 Appendix 2 Questions and Answers Are you anticipating any product shortages following these recalls? No. These products are widely used generics with several active suppliers. What should a company do if they think their products may have been subjected to unsatisfactory conditions during shipment? They should call the MHRA Defect Centre on or inform their local medicines inspector. Appendix 2 Ends Page 8 of 8
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