Story 32 Haloperidol and Lorazepam injectables

The Centre for Addiction and Mental Health in Toronto as well as other hospitals are encountering extreme shortages of two very important and potent injectable pharmaceutical products.  The product is Haloperidol LA 50 and 100 mg/ml intramuscular injection used as an antipsychotic agent.  Possible availability for the latter is sometime in December; the former has no expected delivery date.  In addition, the anxiety reducing Lorazepam 4 mg/ml, 1 ml vials is unavailable until sometime in December as well.  Pharmacist-led discussions and communication is occurring with clinicians to determine best possible alternatives for patients, including those that have been stabilized on the long acting antipsychotic, Haloperidol.

Wayne Marigold, Director, Pharmaceutical Services

Centre for Addiction and Mental Health (CAMH)

Story 31 Topical ear and eye treatment

An Ontario GP reports

Garamycin (otic and ophthalmic) and topical trentinoin are no longer available.

 

Story 30 Proctosedyl for hemorrhoids

A 63 year old man wrote in late June and again in mid-August 2013:

Proctosedyl suppository (cinchoncaine and hydrocortisone) is not available in my Ontario city, and the manufacturer claims to have been having trouble making it. My pharmacist has been unable to find it or any substitute. He said that they hoped to have supply again in the first or second week of July. In another province where we went on holiday the local pharmacy did not have it, but had a different version as a substitute (proctol).

When I got home, my pharmacy and all the other ones in its chain in my city had neither proctosedyl nor proctol. I tried another chain. They did not have it. In mid-August, an independent pharmacy had only one small box of proctosedyl left and could not get any more, but was able to order in proctol.

The pharmacists called their suppliers — one had proctor the other did not. Therefore I wonder what is going on at the level of the distribution network.

This has been going on for two months (August 18).

Story 29 Tissue Plasminogen Activator (tPA) for stroke

A neurologist from Calgary reports that on 30 April 2013 Hoffman-LaRoche announced a shortage of tPA, an injectable drug used to treat acute stroke by breaking down clots. It is an old reliable drug  first approved for use by US FDA in 1996.

Neurologists were given just one week’s notice and told that they can expect the shortage to last two weeks.

An alternative drug is available but it is not yet approved for use in Canada, although it may eventually prove to be superior to tPA. Neurologists are advised to obtain consent from their patients prior to using the unapproved treatment.

 

Story 28 Clobazam for epilepsy

Since early January 2013 Canadians with epilepsy have been having difficulty filling their prescriptions for clobazam.

Epilepsy Ontario e-News has been tracking the problem and offering advice.

Sarah Begin – has also written about her experience with this shortage on her blog:
My Own Personal Experience With Canadian Drug Shortages - January 14, 2013

Story 27 Beta-blocker (acebutolol) for blood pressure

Your faithful webmaster has just been told that acebutolol–a generic, beta-blocker that she has taken for more than 12 years to control blood pressure–is now in short supply. Yes! it’s same the little pill you see above in the banner of this website.

Ironically, I leave tomorrow for a conference at Emory University in Atlanta — on the drug shortage problem.

The drug is said to be on back order. Nevertheless it does not appear on lists at any of the sites dedicated to tracking the shortages.

Instead of being able to fill the 3-month prescription, the pharmacist provided medication for 10 days, but charged the full amount and owes me the rest. He also promised to “phone around” to try find more somewhere in the city.

Neither he nor I have time for this fiddling– but there’s more (I know it–does everyone else?): suddenly stopping a beta-blocker can lead to angina, irregular heart rate, and heart attacks.

I’ll update this post when I have more information … if I am still here.

22 June 2012

While I was in Atlanta, my pharmacist found the remaining 80 days worth of pills. I notice that the manufacturer has changed. I am grateful. Looks like I will live to keep running this website.

The conference was interesting. Watch for a Consensus report on the Statements page.

25 September 2012

Well, it happened again. I renewed my BP meds again in mid-September 2012, and was told to come for pick up in two days. But when I got there,  once again the pharmacist could give me only 10 days worth — and he owes me another 90 days. Three days later, I got a call that the remainder was in stock.

However, this raises a new question–not life threatening, but irritating.

I am on two prescription medications — each prescribed for three months–repeat times three ( a year’s worth). Normally, I would go to the pharmacy four times over the year.

Instead the two drugs are now out of synchrony owing to the shortage. I go twice for each renewal–that is SIXTEEN visits to the pharmacy every year instead of four. Maybe pharmacy owners actually like this arrangement — more visits=more sales of other stuff. I can’t believe that they do–but I wonder: Is anyone  tracking the effect on sales? AND — who has time for this?

Story 26 Shortage of Divalproex sodium (or valproic acid)

A reader in the Greater Toronto Area wrote the following to his Member of Parliament and to us:
“I would like to bring to your attention some strange going ons in the pharmaceutical industry.  I have been taking a particular drug, Apo-Divalproex, for years and all of a sudden, my drug store says it is on back order and to check back in a few weeks.  I do so and am told that it is still on back order and to check again in a few more weeks.  In the meantime, I am running out of this medication.
A quick search of the internet (in particular http://www.canadadrugshortage.com) shows that it is not just my area or even my medication that is mysteriously in short supply.
It seems that even some particular medications (not mine in particular) are manufactured in only one factory on earth and if ever there is a fire or a similar disaster, it could spell big problems for people that rely on these medications to survive.
I urge you to fight for government regulations to ensure that drug shortages become a thing of the past.”
To this story we can also add the fact that the shortage has not been reported by the manufacturer as per the agreement made between government and industry September 2011.
Report all shortages to your MP!
If you would like to find out who is your MP follow this link.

Story 25 Trusopt [dorzolamide hydrochloride] for glaucoma

A Toronto reader reports:

I suffer from glaucoma and have tried a number of medications for it.
The only medication I have found which is effective is the Trusopt
Preservative Free eye drops [ dorzolamide hydrochloride]. A couple of days ago, I was informed that these drops are on back order and will only be available in July.

If left untreated my glaucoma will cause serious damage and potentially blindness by July. Is there any way I can receive the eye drops sooner?

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.