5) Metronidazole – Infection
>Estimated Prescriptions: 4.2 million
>Severity of Shortage: Moderate
Multiple out-patient antibiotic preparations appear on the drug shortage list. Metronidazole, the first line treatment for C. difficile infections and multiple parasitic infections, may be the most problematic. While several generic and non-generic dosages of the drug remain available, the overall supply will be seriously constrained. Worse, there are no appropriate alternatives, as the available ones should be reserved for resistant infections. Shortages of other antibiotics are less troubling: cefpodoxmine can be replaced by cefepime; Cipro, the brand version of ciprofloxacin was discontinued by Merck/Schering, but several equivalent antibiotics are still available; clarithromycin is on back-order, but can be effectively replaced by several similarly priced antibiotics; tetracycline, is on an indefinite back-order, but can be replaced by several equivalent products.
6) Scopolamine – Nausea
>Estimated Prescriptions: 28,000
>Severity of Shortage: Severe
>Alternatives: Injectable anti-nausea/anti-emetic drugs
Scopolamine is routinely prescribed for motion sickness and nausea. It is given in transdermal patch form to those who need to rest their digestive tracts, cannot tolerate drugs by mouth, or suffer from long-term intractable nausea. This is the best way to allow otherwise stable patients to return home. The patch provides drugs for three days, making it a very efficient and easy way to relieve long-term nausea in cancer patients. While other anti-nausea medications are available, including ondansetron and metoclopramide, they frequently do not provide the same consistent and long-standing relief. Both manufacturers of scopolamine transdermal patches currently have the product on back-order due to increasing demand.
7) Trazodone – Depression
>Estimated Prescriptions: 9.1 million
>Severity of Shortage: Mild
>Alternatives: Other antidepressants
Depression affects approximately 17% of Americans over the course of their lives. While there are many anti-depressant drugs available, a large proportion of depression patients do not respond to the first, second, or even third drug they try. Once patients find a drug or combination that works for them, they should continue to use it. According to the most recent CDC survey, approximately 8% of patients, or 9.1 million people, use Trazodone as part of their treatment regimen. Currently, multiple manufacturers are experiencing shortages due to increasing demand and importation bans. While there are several preparations still available, another disruption may keep many people from getting the treatment they need.
8) Zoster Vaccine – Shingles
>Estimated Prescriptions: 237,000
>Severity of Shortage: Resolving
Shingles, a disease of the elderly caused by the reactivation of the chickenpox virus, occurs in nearly 1 million Americans annually. In 2006, the FDA approved Zoster Vaccine, or Zostavax, which can reduce its incidence by over 50% annually. In 2007, the first year it was fully available, 237,000 Americans were vaccinated. However, Merck, the only manufacturer, has been unable to meet demand since. Zostavax has been on continual back-order since and is not reaching nearly as many people as it could benefit. While shingles is not life-threatening, the pain associated with it can be completely debilitating.
There have been some issues with two other vaccines — inactivated hepatitis A vaccine and a combination vaccine for measles, mumps, rubella, and varicella — but supplies remain adequate and there are excellent alternatives so shortages do not pose a danger to public health.
Baxter B. Allen and Ashley C. Allen