A pharmacy in the Greater London area

3. Ms A complains the Pharmacy did not tell her when it was giving her different brands of thyroxine between February and November 2022.

4. Ms A says she had a reaction to ingredients in some of the brands and experienced hives (a skin rash with red itchy bumps caused by allergic reactions of the body), itchiness, joint pain, hair loss, insomnia (problems sleeping), abdominal pain, sweating and other symptoms. She says because her doctors did not know she was taking different brands, they could not work out what was causing her symptoms. She says this led to ten months of side effects, pain and misery while trying to look after her baby.

5. Ms A would like a financial payment for the impact this had on her. She would also like the Pharmacy to make improvements to its service so this does not happen to other people.

6. Ms A has been taking levothyroxine medication for many years to treat her underactive thyroid gland. The thyroid gland makes hormones which help to control energy levels and growth. Levothyroxine replaces the missing thyroid hormone thyroxine. Ms A had not experienced side effects from this before. She then changed pharmacy and started picking up prescriptions from the Pharmacy.

7. In February 2022 Ms A developed hives. She saw her GP who gave her antihistamines to calm the itchiness. She saw a private dermatologist (skin specialist) who gave her steroids to help relieve the hives that did not get better with antihistamines. They also gave her medication for insomnia.

8. Ms A’s GP referred her to see a dermatologist. They did blood tests and a biopsy (taking tissue for examination) from her thigh. She was diagnosed with urticarial vasculitis, a type of inflammation of the blood vessels in the skin that causes hive-like lesions. Despite medication Ms A was still struggling with symptoms like itchy skin and swelling all over her body, hair loss, abdominal pain, insomnia, hot skin, an eyelid and sinus infection and shortness of breath.

9. On 5 November Ms A says she looked online and discovered different levothyroxine medication brands can cause allergic reactions due to a difference in some of the non-active ingredients. Ms A says she then realised the Pharmacy were giving her different brands and this caused her symptoms. She says she is now back on her old brand of levothyroxine and is better.

12. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something has gone wrong.

13. There is no guidance that requires, or recommends, pharmacists to tell patients when giving them different brands of medication. There is also no guidance on this when prescribing levothyroxine. Brand information is usually available to the patient as the packaging will have the brand name on it. The patient would have this information when discussing medication with their GP.

14. It is not usual practice, or a requirement, for a pharmacy to get levothyroxine from the same supplier all the time. Generic prescribing of levothyroxine medication is recommended so changes in brand are normal, as advised in the statement from the BTA. Sometimes there is limited availability so it is reasonable for pharmacists to stock what is available. This allows for a quicker medicine supply as advised in the NHS guidance.

15. The patient.info website says if generic medicine is prescribed, a pharmacist can dispense any suitable available product to the patient. The BTA statement does say some patients may need to be prescribed a specific brand due to intolerance. It is the responsibility of the patient’s GP (the prescriber) to prescribe a specific brand if needed.

16. We cannot see that Ms A’s GP had prescribed a specific brand of levothyroxine medication. So it was appropriate for the pharmacy to give Ms A different brands and it was not required to tell her.

17. The GOV.UK guidance on levothyroxine says if a patient reports symptoms after their brand is changed, healthcare professionals are advised to consider testing of thyroid function and follow the ‘advice for healthcare professionals’ section. This says if a patient keeps getting symptoms after switching products, to consider prescribing a specific levothyroxine product known to be suitable for the patient. It says if symptoms continue to consider prescribing levothyroxine in an oral form. As we mention above, the GP is the prescriber so this is something Ms A’s GP would have needed to do. The pharmacist is not the prescriber.

18. We have not seen signs that the pharmacy got things wrong and we cannot say it should have told Ms A when it was giving her different brands of levothyroxine.

19. We appreciate how difficult things have been for Ms A when experiencing side effects to her medication. We hope she does not feel our decision reduces the impact of what she has been through and that she can understand why we cannot hold the pharmacy responsible for her experience.

1. We have carefully considered Ms A’s complaint about a pharmacy in the Camden area (the Pharmacy). We are sorry to hear how difficult things have been for Ms A when struggling with side effects of her medication while trying to look after her baby.

2. We have completed our investigation and have seen no sign that anything went seriously wrong. We cannot say the pharmacist should have told Ms A it was giving her a different brand of levothyroxine medication (used to treat an underactive thyroid).