Synacthen availability

RE: Synacthen availability

Martin Atkinson — Tue, 30 Oct 2018 13:34:27 GMT

[quote user="Sarah Keir"]

Can someone clarify what the latest situation is? Is it a tetracosaside or synacthen that is unavailable? Only unavailable through wholesalers or DECHRA unable to supply too? Do we know how long this issue might me for this time around?

Thank you in advance.

Sarah

[/quote]I've just called Dechra and they are out of stock or tetracosactide but not expecting a long delay.

RE: Synacthen availability

Sarah Keir — Mon, 29 Oct 2018 18:16:49 GMT

Thank you in advance.

Sarah

RE: Synacthen availability

Thomas Johnson — Mon, 29 Oct 2018 08:39:42 GMT

[quote user="Utlendigur"]I was looking at latest monitoring guidelines a few weeks ago, and Dechra seem to be suggesting that using pre-Vetoryl cortisol levels were more accurate/repeatable than ACTH stims for monitoring as long as the dog wasn't overly stressed by vet visits.[/quote]

We've started to do this over the past month and it seems to work well.

RE: Synacthen availability

Utlendigur — Fri, 26 Oct 2018 19:44:02 GMT

I was looking at latest monitoring guidelines a few weeks ago, and Dechra seem to be suggesting that using pre-Vetoryl cortisol levels were more accurate/repeatable than ACTH stims for monitoring as long as the dog wasn't overly stressed by vet visits.

https://www.dechra.co.uk/news/dechra-launches-improved-monitoring-method-for-cushingoid-dogs-1?PID=5356&M=NewsV2&Action=1

RE: Synacthen availability

Thomas Johnson — Fri, 26 Oct 2018 16:39:12 GMT

[quote user="Martin Atkinson"]

Bump! Finally run out of Synacthen and its not available on NVS. I've forgotten what discussions there were on this on availability of alternatives. Any updates folks?

[/quote]

Is there a new problem then? I thought it had been available again for some time, and we ordered and received a vial from Henry Schein this week.

RE: Synacthen availability

Anthony Dennison — Fri, 26 Oct 2018 14:20:59 GMT

[quote user="robloxley"]Order tetracosactide from Dechra, supplied direct (and billed) by your wholesaler. Contact dechra for the details[/quote]

Wot he said.

RE: Synacthen availability

Rob Loxley — Fri, 26 Oct 2018 13:37:54 GMT

[quote user="Martin Atkinson"] Finally run out of Synacthen and its not available on NVS. I've forgotten what discussions there were on this on availability of alternatives. Any updates folks?[/quote]

Order tetracosactide from Dechra, supplied direct (and billed) by your wholesaler. Contact dechra for the details

RE: Synacthen availability

zoe north — Fri, 26 Oct 2018 13:14:24 GMT

Veenak has stock but is £45.60 a vial - Synacthen Inj 0.25mg. Free delivery over £50.00, Good price for other pharmaceuticals, fast delivery and reliable.

ok if you are freezing opened vials as 0.25ml doses

http://www.vetordering.com/

RE: Synacthen availability

Bob Russell — Fri, 26 Oct 2018 13:13:45 GMT

We had it for a bit but not at the moment.

Dechra have their version but it is on a named patient basis which makes no sense considering it is a pack of vials. I just used one of my dogs' details!!

RE: Synacthen availability

Martin Atkinson — Fri, 26 Oct 2018 12:39:05 GMT

Bump! Finally run out of Synacthen and its not available on NVS. I've forgotten what discussions there were on this on availability of alternatives. Any updates folks?

Re: Synacthen availability

Busybee — Tue, 28 Jan 2014 21:32:22 GMT

I spoke to Dechra today about a Cushings case and they made noises about possibly even looking into manufacturing their own synacthen!

Re: Synacthen availability

Hanna Bennett — Tue, 28 Jan 2014 19:49:56 GMT

turns out we've used quite a few of ours, sorry folks. we got ours from the pharmacy at our local tescos if that helps

Re: Synacthen availability

Pete Andrew — Tue, 28 Jan 2014 17:36:01 GMT

We have managed to get both our previous lots from online pharmacies - we got 3 boxes/15 vials from Medicines2u.com last week. Cost about £52 inc delivery. the pharmacy I used before that - pharmacydirect I think - was out of stock.

We have reduced the frequency of repeat testing of our diagnosed Cushingoid patients in the meantime.

Re: Synacthen availability

Martin Atkinson — Tue, 28 Jan 2014 17:32:05 GMT

May I suggest you hang onto it and only dispense it to those who are desperate and have tried other monitoring protocols unsuccessfully, other wise someone else will end up hoarding it for possible future use.

Re: Synacthen availability

Hanna Bennett — Sat, 25 Jan 2014 17:12:40 GMT

hi guys - will check and see what we've in stock on Monday.

Re: Synacthen availability

peter kettlewell — Sat, 25 Jan 2014 13:02:37 GMT

Hi Hanna,

If you still have spare and are prepared to let some go... I would be really grateful. If you are happy, please call me at the surgery on 01608 642547

Thanks Peter

Re: Synacthen availability

Rachael Winder — Thu, 23 Jan 2014 11:34:45 GMT

Hi Hanna,

Does that offer still stand? We'd love to source a few vials if possible- we're down to a couple vials spread over 4 sites now!

Thanks,

Rachael

Re: Synacthen availability

Hanna Bennett — Mon, 20 Jan 2014 19:25:37 GMT

we have quite a few if anyone needs some?

Re: Synacthen availability

Martin Atkinson — Fri, 17 Jan 2014 13:34:40 GMT

[quote user="Garfy gecko"]If you have dogs on trilostane, contact Dechra and they will send you a protocol for monitoring patients without Synacthen. Hope this helps.

[/quote]It kind of helped, I called and they emailed the protocol straight away but no revelations, only what we've already discussed on this forum.

Re: Synacthen availability

patrick murphy — Fri, 17 Jan 2014 13:31:41 GMT

my medic at Idexx said that the word was that the eye wateringly expensive product bought the license for Synacthen

Re: Synacthen availability

Rory Bell — Fri, 17 Jan 2014 12:11:17 GMT

Honestly Martin I don't know. Given that there is no bacteriostat in the vial then perhaps storing in a fridge as opposed to freezing may carry with an increased rick of contamination - which would probably increase over time. I think that's whats driving the recommendation to freeze it. As far as I know though no comparative studies have been done. I'd definitely store the ACTH in a sealed container rather than an opened vial though.

cheers

rory

Re: Synacthen availability

Martin Atkinson — Fri, 17 Jan 2014 10:56:36 GMT

[quote user="Rory Bell"]What is usually done if that once opened, the remaining contents of the vial are drawn up into plastic syringes (usually in aliquots so that one need thereafter only thaw out the requisite amount for use in the next patient), the syringes are capped and frozen at -20.[/quote] I have been just storing in the fridge in capped syringes with all the air expelled. Is there any reason to believe it will then have a shorter shelf life than if frozen or indeed than the unopened vial? It is rarely more than a couple of weeks before it gets used anyway.

Re: Synacthen availability

Garfy gecko — Thu, 16 Jan 2014 23:11:30 GMT

If you have dogs on trilostane, contact Dechra and they will send you a protocol for monitoring patients without Synacthen. Hope this helps.

Re: Synacthen availability

Rory Bell — Thu, 16 Jan 2014 22:03:31 GMT

The information regarding freezing ACTH is largely derived from North America, where, because the product is eye-wateringly expensive, as Alan pointed out, there has long been a tradition of using it sparingly......hence the studies confirming the efficacy of a 5ug/kg dose of the intravenous preparation in eliciting post ACTh cortisol concentrations which were identical to the standard dose (i.e. maximal adrenal stimulation)

What is usually done if that once opened, the remaining contents of the vial are drawn up into plastic syringes (usually in aliquots so that one need thereafter only thaw out the requisite amount for use in the next patient), the syringes are capped and frozen at -20. Just thaw out the syringes by holding in your hand. Apparently good for at least 6 mths if frozen. Please note that this information is anecdotal and the products used are slightly different to synachten, so we cannot be absolutely certain of efficacy....but again anecdotally, it seems to work.

Regarding diagnosis of hypoadrenocorticism, there are some studies that agree that a basal cortisol of >55nmol/l fairly reliably excludes addison's. Because hypoAC is quite a rare disease, the positive predictive value of a result <55nmol in CONFIRMING addison's is quite low.....hence the advice to confirm with an ACTH stim test. Although addison's is the most common cause of a low Na:K ratio in dogs, there are planty of other disease states (renal failure, GI disease for example) that can also give rise to low Na:K ratios, so this result is by no means specific for addisons. One study (Javadi et al JVIM 2006) showed that both the cortisol:ACTH ration and the renin:aldosterone ration showed an excellent ability to distinguish between non-addisonian and addisonian dogs when compared to an ACTH stim test as the gold standard. Measurement of renin is not widely available and waiting times are a problem. If however, you have no ACTH and a dog that you suspect of having addisons with a basal cortisol<55nmol it might be worthwhile treating for addisons but using the cortisol:ACTH ratio to confirm your diagnosis, given that a diagnosis of addisons carries with it an expectation for lifelong therapy.

Hope this helps

cheers

Re: Synacthen availability

Alan Tevendale — Thu, 16 Jan 2014 20:47:25 GMT

[quote user="Martin Atkinson"]

I am not sure as to the benefits or downsides of freezing.

[/quote]

From speaking to Idexx their advice was that there was no problem with freezing although they recommended only freezing / thawing once.