The four medicines added to the list are alprostadil, beclometasone dipropionate (QVAR), norethisterone and ranitidine.
GPonline reported earlier this month that the government had banned exports of HRT products and activated emergency prescription-switching powers for pharmacists, called a serious shortage protocol (SSP), in a bid to tackle drug shortages. The SSP applies to patients with a prescription of fluozetine 10mg, 30mg and 40mg capsules and allows pharmacists to supply an 'alternative strength or pharmaceutical form' of the drug without first consulting the original prescriber.
Other medicines also covered by the export ban include oseltamivir, ospemifene, adrenaline auto-injectors and hepatitis B vaccines.
GPonline's sister site MIMS reported this week that Zantac (ranitidine) prescription medicines are being recalled as a precautionary measure following detection of possible contamination with the impurity N-nitrosodimethylamine (NDMA), which has genotoxic and carcinogenic potential. The products affected are the 150mg/10ml syrup, 150mg tablets, 300mg tablets, and 50mg/2ml injection.
Other ranitidine-containing products that may be affected are being quarantined while the MHRA and European Medicines Agency carry out further investigations.
The MHRA has said that patients do not need to stop taking ranitidine immediately 'as the health risk of discontinuing the medicines is higher than the potential risk presented by the contaminant'.
The DHSC has suggested that GPs should switch patients taking ranitidine to omeprazole where clinically appropriate, as there are currently sufficient supplies of the PPI to manage an increase in demand. There is more information on alternative treatments here.
The government has also announced that three companies have been awarded contracts for express freight services to deliver medicines and medical products within 24 to 48 hours in the event of a no-deal Brexit.
The DHSC said that the service meant that 'vital medicines and medical products can be transported from the location they are produced to the point they are needed within 24 to 48 hours, to meet any urgent needs that might arise'.
This would include next-day delivery on temperature-controlled medicines and hazardous products, including radioisotopes for cancer treatment, and 48-hour delivery for 'larger loads'. Hand-delivered courier services could also be provided if necessary.
According to the MIMS drug shortages tracker more than 100 medicines prescribed in primary care are currently out of stock in the UK. GP leaders have warned that shortages are having a serious impact on both GPs and patients.