A dentist in eastern Ontario reports that triazolam has not been available for conscious sedation during dental procedures for about six months.
On 26 September, posted this announcement:
The Public Health Agency of Canada (the Agency) has been made aware of a national cefixime shortage which is expected to last until September 2015. There is only one Canadian supplier of cefixime at present; however, the shortage is a result of a problem with a third party manufacturer.
Gonococcal infections have shown progressive resistance to penicillin, tetracycline, and quinolones; third generation oral and injectable cephalosporins are the last remaining first-line treatments. As one of the recommended treatments for gonococcal infections, the shortage of cefixime hinders our efforts to control this infection.
A pharmacist in a cancer treatment centre reports that his hospital’s stock of cancer chemotherapy drug, paclitaxel, produced by the Canadian firm Biolyse, has run out. Soon an order will be placed with the American firm, Hospira.
The Hospira price for a treatment is $4000 — whereas the Biolyse price is $50.
The increased, unexpected, annual cost to his institution will be over $2M.
Health Canada inspectors revoked the licence of Biolyse because of publicly unspecified safety violations, and it had to stop production.
The pharmacist asks the following questions, which we cannot answer:
1. If safety had really been violated, why were pharmacies allowed to use up the remaining stock presumably made under the same “unacceptable” conditions?
2. Why is the American firm’s price for this drug 80 [EIGHTY!] times that of the Canadian company?
3. What are the real costs of manufacturing this drug?
pharmacies. Sometimes it is possible to get a replacement drug that way
depending on what the drug is.
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)
An Ontario GP reports
Garamycin (otic and ophthalmic) and topical trentinoin are no longer available.
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).
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.