High-blood pressure drug shortage highlights wider problem in Canada

High-blood pressure drug shortage highlights wider problem in Canada
There are more than 1,800 current drug shortages in Canada, according to Health Canada s third party reporting website Drug Shortages Canada.

Published Friday, August 23, 2019 10:47AM EDT

The recent shortage of a medication used to treat high blood pressure and other heart conditions is calling attention to the greater problem of drug shortages in Canada.

In July, pharmaceutical company Bayer Canada reported it was experiencing shortages of its extended-release Adalat XL tablets in the 20 milligram and 60 milligram dosages.

Adalat XL, or nifedipine, belongs to a class of medications called calcium channel blockers that are used to control high blood pressure and prevent chest pain from angina by relaxing the blood vessels.

According to Drug Shortages Canada , a third-party website launched by Health Canada that pharmaceutical manufacturers are required to report their shortages to, Adalat XL is in short supply due to disruption of the manufacture of the drug.

There is no other information on the website about what is responsible for the disruption or when the issue might be resolved.

Dr. Jacalyn Duffin, a physician, hematologist, and the creator of , a website dedicated to tracking drug shortages in Canada, said Adalat XL is representative of a much larger problem and is just one of more than 1,800 current shortages in the country. She said these kinds of disruptions can be incredibly destabilizing for patients, particularly those with long-term conditions.

Its very, very upsetting for people to suddenly lose a drug theyve come to rely on, she told during a telephone interview on Friday. In conditions like high blood pressure, but also in conditions like epilepsy or arthritis, for example, these are problems that sometimes take a long time to stabilize.

Even though nifedipine is available from several other manufacturers in Canada, Duffin warns there is a risk those, too, will become in short supply due to the sudden increase in demand. For example, there are currently 10 shortages of nifedipine in Canada, including the ones from Bayer Canada. The affected manufacturers include Apotex, Mylan, AA Pharma, and Pharmascience.

In cases where nifedipine is unavailable, Duffin said patients will have to resort to other calcium channel blockers that may not be as effective for them.

Some medications cant be tolerated, she said. Some medications that the patient has never been exposed to before have to be titrated to find the right dose thats going to work to control that persons blood pressure. So you can end up spending weeks chasing your tail trying to find something that will work instead.

Duffin called the problem frustrating beyond belief because it consumes so much time for pharmacists, doctors, and patients to find a solution.

It strikes me, [as someone] who has been looking at this problem for nine years, that its so unnecessary, she said.

The Canadian Pharmacists Association echoed those concerns in a letter sent to the prime minister earlier this month.

In the letter , the association warned of significant increases in drug shortages in the last three to five years. In some cases, pharmacists have reported not being able to fill 50 per cent of their weekly order, the organization stated.

This trend has also been confirmed by patients with one in four Canadians saying that they have experienced a shortage, either personally or a family/friend, the association wrote.

A global problem

When it comes to why these shortages are happening in the first place, Duffin said there isnt one simple explanation. In fact, on her website, for the recurring drug shortages in Canada.

These include growing demand for certain drugs, breakdowns in manufacturing or quality control, shortages in raw materials used to make the medications, the pricing of generic drugs, and the competition between big pharmaceutical companies and generics.

Duffin said its not as easy as blaming pharmaceutical companies for the disruptions because in actuality, its in their best interest to supply these medications if the demand is there.

It doesnt make sense because if theres a desire to have a drug, theres money to be made by making it, she said.

Drug shortages arent just affecting Canada, either. Duffin said shes listed more than 100 countries with reported shortages on her website.

This is a global problem. The problem is not residing here in Canada. The problem is something to do with the international pharmaceutical market well beyond our borders, she said.

As for finding solution, Duffin said she doesnt think one individual country will be able to fix it and it will require international collaboration. However, that doesnt mean she doesnt think the Canadian government should take a more active role in measuring the reasons behind the shortages and trying to find a solution.

Canada should be standing up and leading the world in investigation to figure it out, she said.

The Canadian Pharmacy Association is also urging the government to conduct research on the underlying causes of the shortages in Canada and around the world and to take a leadership role in launching a global task force to look at the problem. They also asked for more resources and tools to support front-line health-care workers to mitigate the shortages and recalls.

On its website , Health Canada said its working with stakeholders throughout the supply chain to better prevent, mitigate and communicate shortages. The agency described drug shortages as a complex, global problem that may arise from any number of possible causes. These causes include production issues, sole source contracting, unexpected surges in demand for a drug, and difficulties accessing raw supplies.

As of 2016, Health Canada said it introduced new regulations requiring manufacturers to report actual and anticipated drug shortages as well as discontinuations to the website Drug Shortages Canada .

In 2012, the health agency also created the Multi-Stakeholder Steering Committee on Drug Shortages (MSSC), comprised of industry and health-care representatives, which is aimed at working towards a more rigorous and coordinated approach to the problem.

Duffin said shed like to see the government go one step further and study the reasons behind the shortages that are reported on the online database.

Theyve got this website and it says Oh, there are 1,800 shortages, but they arent measuring them through time. So they arent summarizing how many per month or how many per year. Theyre not finding out if theyre seasonal. Theyre not finding out if theyre getting worse or getting better. Theyre just reporting them.

To find a solution, Duffin said the number one focus for all countries experiencing drug shortages should be to understand the different causes behind each shortage.
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