There have been reports recently about a shortage of the Epi-pen®– a device used to treat serious life threatening allergies.  Pharmacies and patients are unable to order the devices leading to worry and panic among patients and healthcare professionals.    A drug shortage occurs when there is a shortage of supply to meet the public demand.  This can occur for a number of reasons such as:

• Supply issues: Most active compounds come from a select group of Health Canada approved companies.  Any issues with making these active compounds can greatly affect the chain.
• Manufacturing Issues: Pharmaceutical companies follow rigorous standards to make our medications.  Each step of the process needs to ensure the medications are perfectly safe and effective.  Problems in this process can delay the final product reaching the public.  For example, companies use the same equipment to produce multiple products meaning that an increase in production of one product can lead to a decrease in another.  Contamination can lead to a final product which cannot be used and must be destroyed.  Sometimes a product reaches the pharmacies or patients and is later recalled due to issues found after the product had been released.  These manufacturing issues can snowball.  For example if three companies produce a medication and one has an issue, the other two may not have the capacity to meet the demand leading to further shortages.
• Economic Decisions: Pharmaceutical companies have shareholders and while they make medications to help our lives, their primary reason for doing so is to make a profit.  A company may decide to discontinue or slow down production of less profitable drugs for those that have a better return on their investment.

When a shortage occurs or when a medication is completely taken off the market, there are a number of options available.  One option is to switch to another brand that is interchangeable.  Changing strengths is another option; this may mean taking half tablets or multiple tablets.   Your pharmacist may contact the prescriber and change to a similar drug with hopefully the same effect.  Some pharmacies are able to custom make medications.  We are often asked to make capsules for medications that are no longer available.  In the case of Epi-pen®, currently no auto injector exists.  We can provide patients with epinephrine ampules and instruct how to administer them. Hopefully this sheds some light on drug shortages; they can be a pain to doctors, pharmacists, and most importantly patients.  Your pharmacist is here to help.  Take care of yourselves and each other.