Archive for November 27, 2011

Story 8 Skin treatment and antibiotic

Greg, the family doctor who gave us Story Number Five, reports that two more drugs are missing:

Uremol HC (a generic combination of hydrocortisone and urea for itchy and inflamed skin); and

Pediatric Septra (a  generic combination antibiotic for children).

Story 7 Chemotherapy

An Canadian oncologist reports that in the past few months there have been temporary shortages of certain drugs used in cancer chemotherapy, including Cytarabine (used in leukaemia) and DTIC (used in a variety of diseases including melanoma and Hodgkin’s lymphoma). Often there is only one manufacturer of these older, effective cancer agents.

When these shortages occurred decisions had to be taken to prioritize patients, usually favouring treatment of those more likely to obtain a cure over others.

In her opinion, publishing a list in advance of drugs likely to be in short supply in the future could be useful, but it is not an adequate solution to this problem. Canadian cancer patients should be able to receive the best drug for their conditions when it is needed.

Story 6 Chemotherapy and anti-nausea drugs

Mike works in the pharmacy of a large general hospital. He has noticed transient shortages of certain drugs like Stemetil for control of nausea for patients on cancer treatment. He has not yet noticed a shortage of any chemotherapy drugs; however, he is worried.

For example, the drug, Vincristine, which is effective in childhood leukaemia, has been temporarily in short supply in the USA. Recently, his usual orders for 5 milligram vials of Vincristine have been filled with 2 milligram vials. He wonders why. Is it because the company had an overstock of the 2 mg vials and wanted to use them up before they expired? Or is it because there is not enough supply to make 5 mg vials and respond to all the orders?

Ironcially, vincristine is one of the vinca alkaloids, which were discovered in London Ontario Canada, by Robert Noble and Charles Beer, although now they are made only in the USA.


Story 5 Generics in family medicine

Greg is a family doctor who has noticed that the drug shortage is causing a number of problems in his practice. He spends a lot of time talking to pharmacists on the telephone trying to accommodate shortages, which seem to be unpredictable and crop up in many different areas.

For example, nitrofurantoin — an antibiotic used in resistant urinary infections–is now unavailable in his city.

For another example, the reliable, old, combination medication for blood pressure, Aldactazide, has also gone missing and he has had to rewrite prescriptions for patients that recreate the combination.

Story 4 Cyclobenzaprine

Wendy has painful musculoskeletal problems that have been well controlled with cyclobenzaprine. Her regular pharmacist told her that she would have to wait a few days for her prescription to be filled, so she went to another pharmacist. But that pharmacy also had a shortage. Although her prescription should cover several months, she can obtain only two weeks supply at a time and keeps having to go back to the pharmacy because there is never enough to fill the prescription.

Story 3 Dilantin

Donna has had epilepsy and she has been on Dilantin since she was 12 years old (1952). In the past, if she had not had a seizure for two or more years, her doctors would stop the medicine; however, within 36 hours, she would always have a seizure. Her neurologist agrees that her Dilantin should not be changed. Reports of a shortage of generic epilepsy drugs began appearing in October 2011. Donna writes, “I am so afraid that one of these days when I go for a refill, the drug will not be available.”