Archive for April 22, 2012

Story 24 Anesthetics

An anesthesiologist in Atlantic Canada writes…

It is about time to inform the public how these shortages are going to affect about everybody. The shortages in IV medication, those especially used in anesthesia and critical care, have affected patients already. For example, our institution has currently no available IV PPI [intravenous proton pump inhibitors].

The CAS (Canadian Anesthesiologists Society) has sent letters to politicians and representatives to raise awareness – however, it seems not to be enough.

I think the reason is that there is no sole supplier – we believe that competition pays out better in the end. But I think there has to be better deals with the pharmaceutical companies – if the society agrees to pay for their drugs, they have to make sure they can supply enough.

Story 23 Apo-Divalproex for seizures

A Toronto mother writes:

I’m wondering how to report a problem I am having in trying to source a medication that makes the differences between “intractable seizures” and “well” for [my child].

As you may be aware, for certain classes of medication — including anti-seizure medicines — there is a very real danger in substituting between different generic manufacturers, as the various non-active ingredients used can differ and alter the way an individual might metabolize the active ingredient. Once a certain medication ceases to achieve efficacy, it may never do so again, which our family learned in December, 2010, when we were provided with 25 mg tablets of Apo-Lamotrigine to supplement 150 mg tablets of Novo-Lamotrigine when the medication dosage was increased to 175 mg of Lamotrigine twice daily. The result, simply put, was devastating.

While neurologists were exploring alternate treatments options, we experienced difficulties in sourcing a certain size of tablet (750 mg) of a second medication, Apo-Levitiracatem; however other sizes of pills by the same manufacturer were available to make up the total dosage (1500 mg twice daily). It may be demoralizing to take larger numbers of pills than required, but it isn’t dangerous.  … this problem occurred in May and June of 2011.

We were very relieved to find a drug that actually worked to stop all [my child’s] seizures: Apo-Divalproex, 250 mg, one tablet taken in the morning and two in the evening (for a total dosage of 750 mg/day). Unfortunately in February 2012 our pharmacy was unable to order this medication — in any size — through its regular suppliers as it was on back order. As of 12 April 2012, it remains on back order. The pharmacy managed to order a bottle of 500 pills from another pharmacy, and dispensed 180 on February 15. Knowing that I was planning to report the shortage issue, I asked yesterday if they know [when] they can secure a supply of the correct manufacturer (given that we know my [child] is sensitive to the non-active formulations of her anti-seizure medication, substitution of a generic manufactured by another company is unacceptable). I am fortunate that the pharmacist did not find my request to attempt to secure a supply that can be dispensed through Labour Day to be unreasonable: I only hope that this is possible.

I am deeply concerned about the issues surrounding continuity in the supply chain of essential medications. I am alarmed that in the space of less than 18 months I have had problems sourcing three different generic medications. …Please let me know how best to report the issue we are having in sourcing Apo-Divalproex.

Story 22 Palliative care drugs

A senior medical student writes….

I’m currently doing an elective with a palliative house call service through [a Toronto hospital].  When patients are nearing their final days and hours, the palliative care doctors used to prescribe a number of injectable drugs for families to have on hand, in case common symptoms like pain, dyspnea, nausea, restlessness, and confusion occurred.  They can’t do that anymore, and have to prescribe on a case-by-case, symptom-by-symptom basis.

I suppose this decreases waste, but it also leaves families with one fewer resource/back-up plan to draw on while their family members are dying at home.   I think knowing the drugs were on hand gave family members comfort.

Story 21 Zarontin for seizures

A reader in Fergus Ontario writes:

“My daughter requires a couple of anti-convulsant medications to control her partial complex seizures.  This is particularly important as she is in a high-stress teaching position.

One of these drugs is Zarontin which she needs to take in capsule form because the liquid form upsets her stomach.

She has been unable to obtain the capsules for months, which has resulted in her eliminating Zarontin entirely.  This has resulted in an increased seizure frequency.

No one seems to understand why there is a shortage of Zarontin capsules or what can be done about it.

Do you have any information on this that we can use to help her remedy this problem?”


Dear Readers

If you have any answers for our friend in Fergus, please send them to us via

Story 20 Birth control pills

A website reader wrote:

In the last year I’ve had my birth control pills switched 4 times due to shortages.  From brand name to generic, back to brand name (but only one package at a time) back to generic one at a time to generic three packages at a time.  This pattern has repeated itself many times in the last 6 years with my prescribed meds becoming unavailable and switching from one brand name to another.  Granted, it’s not perhaps as big an issue as drugs that are absolutely required but it is inconvenient.