What's with all the medication shortages?

[psychoandy]

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I'm not a wet behind the ears rookie intern by any means, but I don't have the years of experience that sdn1977 and zpacksux have, and this question has been bugging me.

Over the last year I've noticed the following:

-When I was working in the outpatient sector of my hospital earlier this year, we were always running out of albuterol MDIs and having to switch to brand name proventil hfa and whatnot (which is bad when 50% of the patients are on free care).

-These last couple of months, pretty much all the IV hydralazine was recalled, leaving a 900 bed hospital with a total of <25 vials for a couple weeks. It's not exactly fun explaining to the charge nurse of the cath lab that i have to destock all of their hydralazine and having her tell me that all the cardiologists are gonna go nuts. Not only that, but there have been almost-code situations because nurses actually have to order it and have it tubed, as opposed to just grabbing it out of an omnicell.

-Oh yeah, and in my neck of the woods, the next 2 weeks we can't get any cefepime (not that we had that much to begin with)...so everyone now is ordering tons and tons of ceftaz and ID keeps sending emails to the main pharmacy email list begging for cefepime.

-My ex-gf was telling me how she could never get coreg in stock, but I never ran into this.

Are med shortages over a week long always happening? Are they usually just regional? Should this not be any shock to me at all?

 

[MountainPharmD]

It happens all the time. It’s usually due to a recall but manufacturing problems happen as well. We are constantly being shorted on Transderm scope patches. Why? I don't know. Albuterol MDI's are being switched from CFC to the new HFA. Generic Levothyroxine 137 mcg is on long term back order from all manufacturers. We can get all the other strengths but the 137, which makes no sense. Coreg had a manufacturing issue for a long time. Paxil CR has had manufacturing issues. Avandamet same issue as Paxil CR.... Which was a great one. We would switch everyone over then we would get Avandamet for a week, switch everyone back, then it would be shorted again. The list goes on and on. I guess all I can say is...**** happens.

 

[bananaface]

137 mcg levothyroxine is not made by as many manufacturers as the other strengths are. Sandoz is the only one I know of who currently makes that strength in a generic. Mylan and Lannett make enough of the other strengths to keep the market in stock most times between them. This week we got shorted on the 112s, 137s, and 200s. We are getting around the every other week stock out BS by ordering 1000 ct Lannett bottles when available.

We have had plenty of notice about the Albuterol changeover.

 

[sdn1977]

Yes....they always happen & for many reasons.

The albuterol was expected, because as explained before....the cfc's were removed after an international agreement in 1987. Albuterol was the last one affected because it was uniformly use, the least expensive product with nothing other than brand names available for world wide use. Manufacturers of albuterol were given more years to retool their plants to reformulate their product &/or design a different inhaler. Many companies just got out of the market - it was too expensive.

For others.....the levothyroxine products have had issues since lactose was removed about 4 years ago. The product is unstable....& potency is an issue over time.

For hydralazine...particulate matter was found in the final product.

Its fairly easy to find the information - go to www.fda.gov/Medwatch & you can see all recalls - voluntary & otherwise.

When drugs are marketed....some of each lot are always kept back for post-marketing testing. It depends on the drug what they test for - particulates, potency, etc....

Be ready to explain reasons & more importantly...be able to offer alternatives.

 

[ZpackSux]

Here you go youngin..

http://www.ashp.org/shortage/index.cfm?cfid=17510252&CFToken=59365804

 

[Caverject]

137 mcg levothyroxine is not made by as many manufacturers as the other strengths are. Sandoz is the only one I know of who currently makes that strength in a generic. Mylan and Lannett make enough of the other strengths to keep the market in stock most times between them. This week we got shorted on the 112s, 137s, and 200s. We are getting around the every other week stock out BS by ordering 1000 ct Lannett bottles when available.

We have had plenty of notice about the Albuterol changeover.

Its too bad the insurance companies have done nothing but sit on their hands with the Albuterol conversion. Everything is a damn brand co-payment because the old skool inhaler is still "available"