I have ranted about drug shortages in the past. It is extremely frustrating that medications go on drug shortage with little warning, or when drug shortages occur, simple modification of the therapy isn’t an option.

I recently saw a patient with schizophrenia who has been stable on benztropine 2mg po TID for management of her extrapyramidal side effects.  Unfortunately, benztropine 2mg is on back order. While 1mg tablet is available, it isn’t listed and covered by the provincial drug formulary.   When the supply of benztropine has been exhausted, a recommendation was made to switch to trihexyphenidyl. Unfortunately, the dose may have been too low and the patient experienced very unpleasant tremors as well as other extraopyramidal symptoms, ended up in emergency department who then switched her medication back to benztropine. We still have to search for a sufficient supply of benzotropine for this patient.

Wouldn’t be more straight-forward to switch to 1mg tablet strength of benztropine but to advise patient to take twice as many tablets?  No. This is because 1mg tablet is not covered by provincial drug plan and the patient cannot afford to pay out of pocket. We had to resort to trying trihexyphenidyl which resulted with very unpleasant and unsafe outcome for the patient.

Recently, nabilone has also experienced drug shortage but the Ontario Drug Benefits Program made an exception to allow pharmacists to apply for Exceptional Access Program for other strengths  as substitution.  They have even developed a form to address this specific concern.   What makes Nabilone special? Why can’t we utilize the same mechanism for other medications experiencing drug shortage?

It seems to be a simple fix from a patient’s point of view to substitute with another strength but we have to make things so complicated. In the end, it’s the patient who suffers.

We need a quick and safe solution to address our drug shortage crisis. It’s serious but it seems no one is paying attention because these medications are not as profitable and no longer manufactured by Brand name drug companies who have the resources for advocacy and lobbying work.

Maybe we can turn this issue into a research idea to apply for a research grant?  Any thoughts?

Thank you for reading my post.