Story 51 – Methotrimeprazine in Palliative Care

A resident physician working in palliative care in Alberta writes…
[We] have been unable to get Nozinan SQ [injectable methotrimeprazine] in the community in the past week (to be fair, I just switched to home care this week and the impression I got is that this shortage has been going on for quite a while this year). According to home care here and the local pharmacists, it is on backorder. This has been a recurring problem.
This is a relatively critical drug for patients at end of life for comfort (it is often used for agitation when some component of sedation is beneficial – for example haldol can address agitation but does not have the sedation property) and when patients cannot take PO medications we turn to the SQ form. Have you heard anything about this medication experiencing a shortage?
Webmaster’s reply:
Thank you for remembering my endless quest. I had not heard about this particular shortage.There are usually 700 to 1000 shortages going on at any given time. We hear only when someone speaks up.
The shortage is reported here at Health Canada’s site
Apparently it began 4 Jan and should end 28 Feb 2019. “Delay in manufacturing” is the vague “cause” given.  You will note that the first report came on the very day that the shortage began — despite a “rule” that shortages should be reported in advance.
But why might it be recurring?
From checking the Health Products Database we learn that it is also the only injectable format left after Sanofi appears to have cancelled all its other formats:
However the Drug Product Database also shows that some oral versions are still available from AA Pharma:
At the same time — it reveals that several other companies have just stopped making it, one by one since 2003— Aventis, Pro Doc, Pharmascience, Riva, Novopharm.
Why? Usually it is for business reasons — not enough profit from low prices and few sales.
This, then, is the perfect set up for a shortage — a single maker with a problem and no back up.