Drug Shortage of Essential Medicines

Are you kidding me? We don’t have salbutamol nebules during the peak season where many people are experiencing shortness of breath due to pneumonia, respiratory infections or COPD/asthma exacerbation? Salbutamol is a quick acting bronchodilator medication which is often prescribed to relieve shortness of breath by opening up the airways to the lungs. It is an essential medicine.

The formulation that is currently on back order is the inhalation nebules, intended to be administered with a nebulizer. The more common formulation is the metered dose inhaler, otherwise known as the “puffer”.   There is plenty of evidence indicating that the efficacy of salbutamol given by the nebulizer is the same as that given as a metered dose inhaler with a spacer, at least in acute asthma attack.  However, salbutamol nebules are always going to be needed for the very sick and the critically ill, or in individuals where they simply do not or cannot use the spacer with metered dose inhaler.

So how can we allow shortage to occur for such an essential medicine?


With only a handful of generic companies making salbutamol nebules, things can quickly go wrong if there is a manufacturing issue – perhaps a particular batch did not pass quality control testing. But I also wonder how much of today’s shortage of salbutamol is related to the ratio pharma’s decision to discontinue the product few years ago. Did the pharmaceutical industry do some planning to account for the loss of production capability?


On the http://www.drugshortages.ca website, the status for the Pharmascience brand of salbutamol nebule is listed as “resolved” but if you click for the details, it states “possible recovery in March 2017”. How can you call the shortage status “resolved” when you cannot reliably indicate that supply will be resumed now but “possibly recovery in March 2017”?


Or we can blame it on the flu! I hear it has been a very rough flu season so we can expect to see many sick individuals; some may need to be hospitalized and many will require salbutamol to help relieve their respiratory symptoms.  But at the end of the day, it is related to poor clinical planning (or savvy business planning). No one is taking ownership of the drug shortage problem. It is the consumers (clinicians and patients) who suffer the most.

Few months ago, Dr. Brian Goldman discusses on his blog the benefits of having a list of essential medicines in Canada to minimize the impact of drug shortages.  I wholeheartedly support this initiative but creating a list alone is not sufficient. At a federal level, policies must be implemented to ensure supply and production decisions of these essential medicines cannot be made unilaterally by the pharmaceutical industry. The government must take measures to ensure there will always be an adequate supply of essential medicines available to Canadians.

Am I asking for too much?  Or this must be wishful thinking on my part.

Thank you for reading my post!



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My name is Cynthia Leung and I am a practicing pharmacist in Kingston Ontario, Canada. This blog is for me to share my ideas, opinions and perspectives on how medications are used in our health care system. Note that these posts are my own opinions and do not represent the opinions of my current or former employers and / or organizations that I may belong to. Any possible case scenarios described in my posts would be modified to maintain patient confidentiality. This blog is not a platform for professional advise for patients or health care providers and the content is not meant to support any clinical decisions or replace professional opinions. Also the images are either taken or created by the author, or adapted with permission. I hope you will enjoy reading my posts!

One thought on “Drug Shortage of Essential Medicines”

  1. You are NOT asking for too much. I am so tired of drug companies dropping production of lower-cost essential medicines in terms of chasing higher profits. In my case, Theo Dur (theollphyllin) has been a challenge and I’m now seeing sources in Germany and India in order to be able to both afford the drug, as well as obtain it on a regular basis.

    This whole thing of making a profit is fine, but when the drug has proven reliability and no one is making it, maybe it’s time to visit a drug formulary to see if someone else can make what is needed.

    Liked by 1 person

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