Some drugs scarce because of coronavirus
Shortage includes leading antidepressant
When Dr. Jeremy Faust ordered medications for a coronavirus patient he planned to put on a mechanical ventilator several weeks ago, he saw warning messages pop up on his computer.
“We’re very, very accustomed to seeing drug shortages and alarms coming up on our screen,” said Faust, an emergency physician at Brigham and Women’s Hospital in Boston. “But during this crisis, it’s become a lot more frequent.”
Although Faust was able to ventilate the patient as planned, he was alarmed by the warnings of new shortages at a time acute cases of the virus were surging.
A USA TODAY analysis found 28 generics in 405 dosages hit the U.S. Food and Drug Administration’s list of drugs currently in shortage from January through May. All but one, chloroquine phosphate tablet, an antimalarial drug, remain on the list.
USA TODAY’s review shows that even as daily new cases of coronavirus declined nationally in May, more generics hit the FDA’s list: 11 for the month.
Doctors said at least 17 of this year’s 28 new drug shortages are directly or indirectly prompted by events the current COVID-19 pandemic has brought on – including the demand for anesthetics and other medicines used to ease intubation.
Among the recent additions related to the coronavirus was one of the nation’s most commonly used antidepressants, sertraline, which is marketed under the brand name Zoloft.
“We’re seeing a mental health pandemic that’s not going to go away,” said Charles Nemeroff, professor and chair of the Department of Psychiatry at the University of Texas at Austin’s Dell Medical School.
A USA TODAY analysis found 28 generics in 405 dosages hit the Food and Drug Administration’s list of drugs in shortage from January through May. More than half of those shortages are directly or indirectly related to the current
coronavirus pandemic based on interviews with doctors and patients.
The FDA adds drugs to its shortage database all the time. Dozens entered since 2012 haven’t come off, mainly due to manufacturing problems and difficulties maintaining a supply of imported ingredients that are of adequate quality.As states reopen and hospitals resume elective surgeries, doctors and experts voiced concern.
Dan Kistner, group senior vice president for the health services company Vizient, said drugs needed for ventilators are also the ones commonly used in elective surgeries.
“Knowing that COVID is still prevalent and knowing that we’re going to see other uses for these products,” said Kistner, whose group purchasing organization serves about 3,000 hospitals in the United States. “We’ve got to make sure we’re doing everything we can to increase the supply of these drugs.”
Physicians and other health experts cited five broad categories and causes of shortages related to coronavirus.
Anesthetics
Patients with severe COVID-19 symptoms need ventilators. But patients must be intubated first. That requires anesthesia.
Six anesthesia drugs, including four sedatives and two muscle relaxants, hit
the FDA’s drug shortage database since April 2 due to skyrocketing demand.
According to Vizient, the demand for essential drugs used for ventilation in April increased by more than 50% compared to January. Although supply increased along with demand, the volume of drugs ordered was 1.5 times greater than units available in April.
Heart and kidney drugs
Besides essential drugs for sedation, a super sick COVID-19 patient who’s on ventilation may need additional drugs for other medical problems.
The list of new drugs in shortage includes two cardiovascular and renal drugs used for COVID-19 patients with underlying heart diseases or needing dialysis while using ventilators.
Continuous renal replacement therapy solution, for example, is used for patients whose kidneys stopped working and need continuous dialysis. “There’re so many more critically ill patients,” Faust said. “There are a lot more patients on dialysis than usual.”
Antimalarial drugs, antibiotics and heartburn meds
Four drugs typically used for treating other conditions entered the FDA’s shortage list this year after being promoted as possible treatments for COVID-19.
Those generics include hydroxychloroquine, an antimalarial drug commonly prescribed to treat lupus and rheumatoid arthritis, azithromycin, a common antibiotic, and famotidine, a heartburn drug.
On March 20, results were published from a French clinical trial that included 36 confirmed COVID-19 patients, with the authors suggesting hydroxychloroquine reduced the viral load in patients and azithromycin helped reinforce the reduction. President Donald Trump has touted hydroxychloroquine as protection against the virus since then.
Criticism of the French study’s methodology has followed, and experts have warned about side effects. But the FDA reported a lack of hydroxychloroquine on March 31 as demand increased rapidly. Two weeks later, azithromycin was added to the shortage list, followed by famotidine.
Antidepressants
On May 26 and May 29, two types of antidepressants, sertraline hydrochloride tablets and sertraline hydrochloride oral solution, usually sold under the brand name, Zoloft, hit the FDA drug shortage list.
The reason, according to Nemeroff, the University of Texas psychiatry professor: Anxiety has risen during the pandemic.
“In my entire career, I’ve never seen the shortage of Zoloft or sertraline before,” said Nemeroff, who has about 35 years of experience treating depression.
Eye medications
Two drugs manufactured by Bausch Health American for treating dry eyes and lowering high pressure in eyes became in shortage last month. In this case, the issue was not increased demand. It was because the company’s capacity was “impacted due to COVID-19 Pandemic,” according to the FDA data.
Michael Repka, the spokesperson for the American Academy of Ophthalmology, said the exact connection wasn’t clear, but he said short-staffing or lack of active ingredients from overseas suppliers might be to blame.