Q: If I receive a prescription for 'diamorphine 100mg ampoules' can I supply vials?

A: A situation arises where you receive a prescription for ‘diamorphine 100mg powder for solution for injection ampoules’ but you only have vials in stock. Can you legally supply the vials against this prescription?

Firstly, it is clear that there is no real difference between an ampoule and a vial; they are both small, glass vessels containing a liquid or powder for injection. The practical difference is that ampoules are single-use whereas vials can be used multiple times and this may impact on use within a syringe driver. In most cases the prescriber or patient is unlikely to perceive any difference other than how the vessel is sealed and opened. But is there a difference to us in pharmacy?

The Dictionary of Medicines and Devices (DM+D) lists two separate generic descriptions:

Diamorphine 100mg powder for solution for injection ampoules
Diamorphine 100mg powder for solution for injection vials
This means that effectively they are two different dosage forms – in the same way as tablets and capsules are both oral formulations but different dosage forms. Each of these formulations must be entered in its own separate CD register.

Legal and ethical considerations
Under the Misuse of Drugs Act 1971 it is illegal to supply a controlled drug in a dosage form other than as prescribed by the doctor. So, to dispense a vial on a prescription for an ampoule would be an offence under this Act. The prescriber could be contacted to see if they do have a preference or to arrange a replacement prescription. Alternatively local pharmacies could be contacted to see if they stock the appropriate product.

However, conceivably, a pharmacist’s professional judgement might come into play in the best interests of the patient. Imagine the same scenario but the prescription is presented ‘out of hours’ and it is for palliative care. The surgery is closed as are all local pharmacies. The pharmacist has to weigh the consequences of not supplying against the illegality of supply and justify their actions. Could you justify denying pain relief to a dying patient over a legal technicality?

This applies to any controlled drug be it diamorphine, morphine or any other. It is not relevant for non-controlled drugs as the Misuse of Drugs Act does not govern supply. It should be noted however that switching formulations of a non-controlled drug could result in differences in reimbursement.

Tariff Tip written by Sue Swift, UK Drug Tariff and Information Technician