Friday, December 16, 2011

Palliative Drug Shortages

There was a time when I heard about chemo shortages, and I thought that must really force some tough choices for patients and physicians.  But thankfully (I thought) drug shortages for generic non cutting edge medications that have been around for a long time like the ones commonly used for symptom control would probably be relatively immune.

But in the past 2 weeks I began hearing rumblings from our pharmacists about a possible shortage of IV lorazepam.  As I researched this more it appears to be a much bigger problem.  It wasn't just local or even regional but national.  Thanks to the American Society of Health System Pharmacist (ASHP) website I could find out lots of info that is up to date on the supply chain of key meds for hospice patients.  They have a drug shortage page which a pharmacist (Mick Schroeder) turned into an app for iPhone and Android.

Quick quiz: How many medications do you think are on the current drug shortage list? (Answer at the end of the post)

But the thing about the lorazepam shortage is that the other benzodiazepines you might consider for conversion are also involved in this shortage.  The reasons for the shortage are (via ASHP):

  • Bedford discontinued lorazepam in May, 2011 to concentrate on the manufacturing of other products.
  • West-Ward acquired Baxter’s lorazepam injection products in May, 2011. The company cannot provide a reason for the shortage.
  • Hospira states lorazepam vials are on shortage due to increased demand. The 1 mL iSecure syringes were discontinued in September 2011.
Converting patients to other benzos seems appropriate but midazolam and diazepam are also listed as having drug shortages on ASHP.  And even if you do have them in your pharmacy supply chain, without injectable lorazepam there is bound to be a run on these other two injectables thereby increasing the strain.  

While home hospice patients may do fine with PO/SL lorazepam, inpatient units and hospitals may depend more heavily on injectable benzos.  I am curious to see what other hospice and palliative clinicians are doing to handle this shortage that apparently is expected to last until February or March.  Please share your thoughts in the comment section.  

(Related: Outcome Resources blog has a post on the lorazepam injection shortage as well.)

Quick Quiz Answer: Approximately 210 drugs are listed as currently being in short supply.  I thought it was going to be 30.  Yikes!

Pallimed | Blogger Template adapted from Mash2 by Bloggermint