Ok...just my opinion, but that "Dr-title" horse has been beat dead (but...it will return - always does!). But, to get back to a real clinical situation, which will require an answer when providers and patients ask.....Do you know why there is a shortage of albuterol inhalers currently nationwide? (If you haven't experienced it - great...but it is out there!) Can you articulate why and do you have a good replacement suggestion? I'll let you know later what we do & what we tell providers.......
Time to get back to clinical.....
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Yeah! Good job! Now.....why albuterol just now??? Yeah this is a pimp question, but just for fun (& to get your minds off the Dr thing!). Can you remember (or do you know) the etiology with the whole HFA thing in the first place?? Have fun with it.....
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Do you mean the FDA decision to ban CFC MDIs by 2008? And, since there have only been a couple of HFA patents granted, supply goes down, price goes up. So I guess when generic albuterol is outlawed, only outlaws with have generic albuterol! <)🙂
pharmeronadell said:
Actually, this has a really interesting history...if you are at all interested in the history of drugs and drugs are only one part of this big picture. I know most of you are students and don't have a lot ot time, but....look up Montreal Protocol. The etiology of this Atrovent to Atrovent HFA, Serevent to Serevent Discus, etc inhaler changes all are because of this international agreement to reduce HFA's into the atmosphere. The US was one of the signers on this international agreement, thus...the FDA has to approve new drug patents since it is not only the drug, but the delivery system which is patented. This agreement occured in 1987 (I think - when most of you were children) and was amended in 1991 & 1992. But....why was albuterol left out until now???? What made albuterol so different????? I'll tell you later unless you can find out and tell me. Good job though! And...hopefully, when someone complains to you that the drug companies are just trying to protect patents by changing delivery systems, or keeping the price high....you can come back with a more knowledgable answer that it was done to satisfy an need which was identified by an international community of scientists and the drug companies had to find new delivery systems which would comply
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Wasn't it that albuterol-CFC was deemed medically essential without any suitable alternative? And weren't HFA based MDIs initially difficult to produce because of solvency issues?
pharmeronadell said:
Great answer!!! Yes, albuterol became the gold standard for inhaled bronchodialtors taking over from racaemic epinephrine (waaaay before your time!). The reason it had no suitable alternative was because it had long ago become generic - so....it was very cheap, very effective & used worldwide. It was difficult for the drug manufacturers to spend the money to develop & patent a new delivery system (remember, each country has its own patent process) and there was no way for them to recoup their expenditures (except in countries like the US in which payors - either patients or insurance pays). Countries, especially third world countries, who do not have our system of reimbursement, patenting, could not afford the switch and in 1990 - there was no reasonable alternative. So...manufacturers of albuterol were given an exemption until 2008. So..here we are now.....manufacturers are finally deciding what to do...IVAX has decided to get out of the albuterol business entirely. Andrx & Warrick still produce albuterol, but Andrx has had temporary shortfalls due to trouble with availablity of canister components. Andrx & Warrick are not AB rated with each other...so substitution "should" not happen if the Rx is written for one of the brand names (Ventolin/Proventil), but it really does...and...we still haven't seen what the "new" inhaler will look like. What a tangeled web! Finally, yes - and very good job again, pharmeronadell, solubiliity was one of the issues. Another was just the way the physics of getting the drug (liquid or powder) down to the brochi was going to happen if there was no propellant "help". So...funny (and long...) story of a current drug availability situation. But...knowing it will help you explain to anxious patients, but also gives you some insight into how long and complex some of these issues can be! (oh.....also...as students....when you get time-be sure you know how all these inhalers work!)
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pharmduic said:
This topic is currently being discussed in another thread, which you started. Please keep it over there. Thank you.
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sdn1977, great idea for threads! 🙂 👍
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I'm confused. Are you saying you have a shortage of standard albuterol inhalers or albuterol-HFA inhalers in your area? I am guessing standard because Ivax makes the standard. But, in that case it doesn't make sense that the shortage would be due to massive switching. 😕
bananaface said:
Sorry for the confusion...yes...we do have an immediate/local shortage (ie we order 20 albuterol inhalers & the wholesaler limits us to 2). The reason for the immediate shortage is two-fold: IVAX has decided to close their manufacturing facility for albuterol inhalers & Andrx has run into a temporary shortage of canister components. Both Andrx & Warrick have addressed this shortage and feel this is temporary and will be resolved as soon as they can. I always like to know how & why these things develop (I often quickly judge drug companies switching something just to increase patent life, but that was not the case here) for myself & to help my patients plan ahead, but it may not really be of too much interest to others. Sorry!
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My question was inteneded to ask which albuterol product are you short on. Standard? HFA? Both? I'm sorry, I guess it was written so that it could be read two ways. 🙂sdn1977 said:
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Ok. Thanks. 🙂sdn1977 said:
Maxair would be an alternative, but more expensive.
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This is slightly off-topic of sdn1977's original post, but I saw this article today
on MSN: http://www.msnbc.msn.com/id/11008530/
How many of your patients use these OTC inhalers? If they pull them off the shelves do you think it'll make a big impact? Or do you think that the doctors in the article are correct in stating that they shouldn't be used (and that alubterol should be used instead)?
on MSN: http://www.msnbc.msn.com/id/11008530/
How many of your patients use these OTC inhalers? If they pull them off the shelves do you think it'll make a big impact? Or do you think that the doctors in the article are correct in stating that they shouldn't be used (and that alubterol should be used instead)?
My opinion is they should have been removed long ago! Actually, about 10yrs ago they were removed, but for a very short time only. Inhaled epi makes PPA look like placebos when it comes to cardiovascular side effects. Most pts actually don't like it makes their heartbeat "feel" stronger & faster - unpleasant. Unfortunately, parents can use it on children without realizing its potential risks & the children often don't have the language skills to communicate their discomfort.
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No shortage of albuterol in our pharmacy (MICH), we do carry a generic version of the Proventil HFA not sure who the MFG is. Primatene mist inhalers are not that popular and as an asthma suffere I have tried it and it didn't do much for me. It may work for some and in a pinch just may help someone. It may be good to have around in an emergency situation (ie albuterol is empty etc.)
Since we are on the subject has anyone heard of any therapeutic difference between the HFA and non-HFA versions?
Since we are on the subject has anyone heard of any therapeutic difference between the HFA and non-HFA versions?
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Ivax makes the generic Albuterol HFA, I believe.
