Advertisement 1

Quebec pharmacy shelves running out of crucial heart medication

"We need a contingency plan so patients don't lack for medication," the president of the Quebec association of cardiologists says.

Article content

Montreal cardiologists are scrambling to find a medication that is rapidly disappearing from local pharmacies.

Nearly 8,000 Quebec cardiac patients risk ending up in a hospital emergency room because of a shortage of an essential heart medication. That’s because there is no equivalent substitute for sotalol, a drug that keeps their hearts beating steadily, Quebec heart specialists warned this week. They say it’s the only treatment for some cardiac arrhythmias, especially atrial fibrillation — a condition that is difficult to stabilize.

Advertisement 2
Story continues below
Article content

An alarm sounded after local pharmacies sent fax messages to cardiologists warning the supply will run out, a “rupture de stock,” and to consider switching patients to another beta blocker medication before the shelves empty entirely.

Article content

However, switching is not an option, cardiologists say, without causing debilitating side effects, and even death.

“This drug cannot be replaced by another equivalent drug,” said Magdi Sami, senior cardiologist at the McGill University Health Centre. “Other (beta-blocker) drugs that treat the same condition are either less potent or potentially more toxic such as Amiodarone.”

“My patients are at risk of ending up in the emergency room, should they run out of their medicine.”

In a letter dated Nov. 15, the Quebec Health Insurance Board (RAMQ) confirmed that the usual manufacturers or suppliers — Apotex, Cobalt, Jamp, Novopharm, Pharmel, Pharmascience, Pro-Doc, Riva and Sivem — had run out of sotalol.

It’s not clear why a shortage occurred in a generic drug that several companies supply.

Health Canada and RAMQ referred a reporter directly to the companies reporting the shortages, saying the problem could be anywhere along the chain of manufacturing, distribution or delivery, for example, a lack of availability of a key active ingredient.

Article content
Advertisement 3
Story continues below
Article content

“With regard to the reason for the shortage, manufacturers are not required to inform us of the reasons for this breakdown,” said Caroline Dupont of RAMQ, but that alternative medications exist. 

But heart specialists are worried, saying there is nothing to replace sotalol.

“It’s a unique medication without a good substitute,” said Montreal Heart Institute cardiologist, Arsène Basmadjian, also president of the Quebec association of cardiologists.

“It’s not the first time a ‘rupture’ has happened,” said Basmadjian, who sent a sharp letter to the Quebec Health Department and the provincial group of specialists, Fédération des médecins spécialistes du Québec, “about the need to create a committee in charge of pre-empting that kind of crisis.”

Canadian patients are facing constant shortages in medications used to treat cancer, epilepsy and psychosis, among others — and the frequency has increased to more than 600 drug shortages in 2014.

“Certain drugs shouldn’t have backorders,” Basmadjian said. “We need a contingency plan so patients don’t lack for medication.”

Advertisement 4
Story continues below
Article content

Basmadjian asked his chief of pharmacy at the Institute to contact suppliers to try and shore up availability, and one of them — Pharmascience — readjusted its distribution to provide enough of the medication until February. And by then production should be back to normal, he said.

“Hopefully the shortage crisis is averted,” he said.  “A real rupture would be a problem. If we’re talking about thousands of patients then that’s major issue.”

Pharmascience did not return a reporter’s request for comments.

It’s always the same recipe, explained Jean-François Bussières, head of the pharmacy department at CHU Ste-Justine. 

“We’re worried, we try to be proactive and we call the supplier and we exert pressure. Because if the shortage becomes permanent, we have to change practice. That means calling in patients, re-evaluating and doing follow up and monitoring, and it’s extremely demanding,” said Bussières, also chair of the board of pharmacists at SigmaSanté, which awards contracts to drug suppliers for the Montreal area.

“We don’t understand” why all the suppliers seem to be suffering a shortage simultaneously, he said. “I would like to have an answer to that.” 

Advertisement 5
Story continues below
Article content

Health Canada confirmed shortages of sotalol affecting provinces and territories outside of Quebec, that “are anticipated to be resolved in January 2018.”

The federal agency said in a statement that it “recognizes that drug shortages can have a significant impact on Canadians and is committed to doing its part to address them when they occur.”

However, there is no indication of a shortage of sotalol on its drugshortagescanada.ca website. The site was launched in March along with mandatory reporting regulations requiring industry to publicly report drug shortages and discontinuances within a specified time frame.

cfidelman@postmedia.com

Article content
Comments
You must be logged in to join the discussion or read more comments.
Join the Conversation

Postmedia is committed to maintaining a lively but civil forum for discussion. Please keep comments relevant and respectful. Comments may take up to an hour to appear on the site. You will receive an email if there is a reply to your comment, an update to a thread you follow or if a user you follow comments. Visit our Community Guidelines for more information.

This Week in Flyers