Glyco shortage

[gymone1]

What is everyone doing for reversal with the glycopyrrolate shortage? Our pharmacy is short of atropine as well! Just wondering. What a pain!

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[BobBarker]

Run remifentanyl as your muscle relaxant.

 

[jwk]

Sux drips!

 

[Impromptu]

Our pharmacy has large, multi-dose vials of glycopyrrolate. We just have to plan ahead and get them to draw some up for us. After that is exhausted we'll go to atropine. Then we'll have to get more creative, like others have suggested. But don't worry, Obamacare will soon stop all of our drug shortages, plus they'll all be free.

 

[sevoflurane]

Enlon +

 

[Sublimazing]

Clearly this shortage was perpetrated by the manufacturers of sugammadex

 

[aneftp]

I have never seen a drug shortage of Plavix and Lipitor.

Yet we seem to have shortages of cheap anesthetic drugs where generics are available.

Makes u wonder....


Lets just say Lipitor and plavix have been the top 2 money making drugs the past 5-10 years. Drug manufacturers have incentive to maintain supply levels when huge profits are involved.

 

[IlDestriero]

Enlon +

I thought this was out of production a decade ago. Is it back? I loved it.

Clearly this shortage was perpetrated by the manufacturers of sugammadex

Wouldn't be the first time businesses colluded behind closed doors.

 

[IlDestriero]

I have never seen a drug shortage of Plavix and Lipitor.

Yet we seem to have shortages of cheap anesthetic drugs where generics are available.

Makes u wonder....


Lets just say Lipitor and plavix have been the top 2 money making drugs the past 5-10 years. Drug manufacturers have incentive to maintain supply levels when huge profits are involved.

Nothing to wonder about.
If you have a billion dollar dream drug with competitors, you'll move heaven and earth to keep it stocked.

 

[cincincyreds]

I have never seen a drug shortage of Plavix and Lipitor.

Yet we seem to have shortages of cheap anesthetic drugs where generics are available.

Makes u wonder....


Lets just say Lipitor and plavix have been the top 2 money making drugs the past 5-10 years. Drug manufacturers have incentive to maintain supply levels when huge profits are involved.

Also never saw a shortage of Viagra.

Everything will be fine under Obama care, I mean the UNaffordable care act, because someone else will be paying for your medical care.

The standard of living in this country is going down so fast it is sad.

 

[Bostonredsox]

Plavix and lipitor went generic quite a bit ago. And even if there had been a shortage of Lipitor, we would have just interchanged it to simva or prava and escalated the dose as needed. Plavix coukd have been substituted for brillinta or effient. Your arguments are valid, but these aren't the best examples. Glyco/atropine do not really have alternatives to use in their place, thus a shortage in one of them is a lot bigger deal.

 

[Bostonredsox]

I have never seen a drug shortage of Plavix and Lipitor.

Yet we seem to have shortages of cheap anesthetic drugs where generics are available.

Makes u wonder....


Lets just say Lipitor and plavix have been the top 2 money making drugs the past 5-10 years. Drug manufacturers have incentive to maintain supply levels when huge profits are involved.

Lipitor was number one because of its marketing. Based on the major trials looking at LDL levels, apoB numbers, etc etc, the conclusion was the lower the LDL with a statin the better. 40 of simva, 20 of atorva, 10 of rosuva. Doesn't matter. If all 3 pts have LDLs of 68 their risk reduction is equivalent. There is some data on additional antiinflammatory effects and hs-crp and such for Lipitor but that is a small subset of patients. The bottom line is across the board for the statins, when adjusted for potency, they do the same job. In fact rosuva is more potent than Lipitor. Lipitor just had a better sales pitch and better marketers. They got more physicians to prescribe it. The profit margins for zocor and Crestor are massive too. But they were not as well marketed and us not as highly used. That's not a government control effect, and yes I know the govt has a hand in Pfizer, just more efficient salesman, and/or more docs willing to take a free lunch and such to prescribe an equally effective drug.

We never used Lipitor at my hospital or my clinic till it went generic. Interchanged everyone to simva or prava based on their LDL.

Plavix is a little different in that it had national guidelines recommending its use for mi patients and it had no effective alternative until brillianta and prasugrel came along. If there's no alternative, I would hope a lot of effort is put forth to make sure it doesn't run out of supply. The same should be true of atropine and glyco. I would venture to say it's a little easier to predict supply for a once a day maintenance drug like plavix then it is for atropine though. Not saying the governments hands are clean, just some other thoughts.

 

[Mentalist]

What is everyone doing for reversal with the glycopyrrolate shortage? Our pharmacy is short of atropine as well! Just wondering. What a pain!

hyoscine butylbromide ( Buscopan )

 

[Impromptu]

I used atropine today instead of glycopyrrolate. I am not as impressed with it as with glycopyrrolate. Maybe that comes from comfort. What ratio of neostigmine to glycopyrrolate have you found effective?

 

[nimbus]

Glyco shortage just hit our shop this month. If the FDA had any sense at all they would approve sugammadex and take sux off the market.

 

[kazuma]

We had a glyco shortage as well, but our pharmacy has found a supplier, so the vials are trickling in for now.

IMO the shortage isn't a scandal, it's simply contract manufacturers and the pharm companies trying to run a profitable business. How profitable they need to be is another debate.

It's very costly to produce parenteral injections while meeting strict FDA requirements. While some drugs are more costly to produce than others in terms of manufacturing (lyophilized vs solution vs raw material costs) many of the costs are fixed leading to varying profit margins between drugs. It doesn't make sense from a business perspective to waste manufacturing time and labor to produce a drug with a slim profit margin. Now if you're one of the few manufacturers that produces a drug with a small profit margin, you could potentially make up for the small profit by selling higher volumes as you'd likely have a larger market share. In some cases of drug shortages, there might be only a few manufacturers of a particular drug. If a batch gets contaminated or put on hold for QA assessment at an individual plant, it can lead to shortages as the other manufactures can't make up for the sudden increase in demand.



There are multiple other factors that play into drug shortages, but supply and demand is a big one. If there is a demand for a highly profitable drug, it behooves the manufacturer to devote more resources to ensuring the supply meets the demand than to waste resources on less profitable drugs. Whether or not that is ethical is up for debate.

 

[urge]

I have never seen a drug shortage of Plavix and Lipitor.

Yet we seem to have shortages of cheap anesthetic drugs where generics are available.

Makes u wonder....


Lets just say Lipitor and plavix have been the top 2 money making drugs the past 5-10 years. Drug manufacturers have incentive to maintain supply levels when huge profits are involved.

That's right. Cheap drugs are not profitable and every now and then they stop making them. They should just charge more for them and be done with it. Some of these drugs are a few cents a vial. Like bicarb. The Arm & Hammer stuff you have in your fridge is a lot more expensive.

 

[btbam]

I used atropine today instead of glycopyrrolate. I am not as impressed with it as with glycopyrrolate. Maybe that comes from comfort. What ratio of neostigmine to glycopyrrolate have you found effective?

Atropine with Neo seems like a bad idea to me as the onset/peak effect times are totally different...Atropine with Edrophonium aka Enlon+ is a pretty neat drug.

 

[pjl]

As a starting point: 1 mg atropine, 35 edrophonium
0.5-1 mg edrophonium per kilo
7-10 mcg/kg atropine

No issues so far except for when people do stupid things trying to avoid a drug they haven't used.