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.