Dextrose and 6 other medications that hospitals are scrambling to keep on their shelves
These seven drugs are running short in US hospitals. What is the cause of the drug shortage when considering the power of the pharmaceutical industry. How can we get them back to the hospital shelves.
Drug shortages are nothing new, In fact, in 2011, there were 251 drug shortages reported by the FDA. 183 of those involved sterile injectable drugs. In 2012, there was less with only 117 new drug shortages, 84 of which involved sterile injectable drugs. Fortunately through early notifications from manufacturers the FDA has been able to prevent 282 shortages last year and numerous times this year as well. The 2012 Food and Drug Administration Safety and Innovation Act, helped to reduce some of these shortages. Even then some very important and common medications have been running low or missing entirely in hospital shelves.
Hard to believe in this day and age that there could be shortages of medications used to fight infections, sedate you during procedures, regulate heart rates, and maintain glucose levels. Even diagnostic testing is being affected. These shortages make pharmacists and physicians rethink diagnostic testing and drug administration. Plans of care have had to be rewritten and cooperation between hospitals has been a necessity. Hospital CEOs have had to reach out to other hospitals and borrow needed pharmaceuticals.
Causes of drug shortage in hospitals
There are many reasons for shortages. In fact, EmaxHealth warned about the upcoming drug shortages in 2008 in a story by Dr. Stanley Feld. The major reason is quality manufacturing issues. However there have been other reasons such as production delays at the manufacturer. Also there have been reports of delays from companies receiving raw materials and components from suppliers. To make matters worse some producers are just not making some medications anymore in favor of developing newer and more profitable medications. When one company discontinues, it is difficult for the remaining companies to increase production quickly enough to prevent a shortage. An increase in demand of some medications has also led to further shortages.
The list on the FDA shortage list grows and shrinks on a daily basis. I have reviewed it and find some common and very important agents in short supply right now. Here are only seven of the 108 medications that are currently on the shortage list.
Atropine – Produced by 4 manufacturers. This medication has many effects on the body. One of the most important ones is that it can temporarily increase the heart rate and can decrease A-V heart block until intervention can take place, In other words it is the stop gap until a temporary pacemaker can be utilized. It is one of the more important main stay cardiac medications.
Barium Sulfate for Suspension – Produced b only 1 manufacturer. This is a thick liquid that is swallowed before a diagnostic barium swallow or CT scan. These diagnostic studies are used to determine the cause of difficulty swallowing or abdominal issues. It can be the difference between diagnosing a cancerous growth or not.
Dextrose Injection 50% – Produced by 2 manufacturers. When administered intravenously this solution increases blood glucose levels in hypoglycemia and provides a source of carbohydrate calories. Without these calories there can be seizures and the brain can die. Very basic and important need!
Lidocaine Hydrochloride (Xylocaine) Injection – Produced by 4 manufacturers. It can be injected as a local anesthetic for minor surgery or dental extractions. It is used in clinics and hospitals on a daily basis. If there is no local anesthetic, procedures cannot be completed without excruciating pain.
Magnesium Sulfate Injection – Produced by 3 manufacturers. Magnesium is a mineral that is important for many systems in the body especially nerves and muscles. Without proper magnesium levels the body cannot function properly. It is vital for heart function. It is also used to prevent preterm labor. Again, this is a basic mineral however very important for proper body function.
Zofran – Produced by Eleven manufacturers, yet is in short supply. This medication used to be used exclusively for severe nausea and vomiting in individuals having chemotherapy induced vomiting. It has however over time gained mainstream favor and is used frequently within the hospital for post operative and other causes of vomiting.
Calcium Chloride Injection – Produced by 4 manufacturers. Like Magnesium, Calcium is a very important mineral. It is used in the treatment of tetany and during cardiac resuscitation. It is crucial for cardiac contractions. During the most current shortage the FDA initiated an unusual allowance for importation from a facility in Bangalore India.
Medications that are back on the shelf
There are several medications that were scarce earlier this year but are now back in stock and no longer seen as in short supply. They include:
• Acyclovir (Anti viral)
• Diazepam Injection (Tranquilizer)
• Gabapentin (Anti seizure and Nerve pain reliever)
• Propofol (Diprivan) Injection (Sedation for surgery and ventilator patients)
• Vitamin K (Vitamin used to reverse bleeding issues with patients on blood thinner)s
• Sodium Bicarbonate (pH buffer critical in ventilator patients and individuals with blood infections)
New Plan Aiming to Reduce Drug Shortages
Adding to President Barack Obama’s 2012 initiative, this week the U.S. Food and Drug Administration released a new plan that further attempts to reduce shortages. By working closely with companies and encouraging programs to avoid shortages and build inventory they hope to reduce disruptions to the supply. The newest ruling extends their work into the makers of biological drugs as well. The FDA cannot require companies to guard against shortages however it looks into ways to reward those with high manufacturing standards.