In Short Supply - Drug Recalls & Shortages

Jul 26, 2018

By Barret Procyshyn, Family Pharmacist

Last week a popular blood pressure medication called valsartan was recalled across Canada; and in fact, across the world. The medication available in a generic and name brand form was wiped off the shelves in every pharmacy across the country. Manitoba Health has reported that up to 10 000 Manitobans will be affected by this shortage. To complicate the matter in Manitoba a pharmacist is unable to make a therapeutic substitution to another blood pressure medication without a doctor signing off on a new prescription. Having access to medication is something we take for granted, so when shortages occur they wreak havoc on the health care system.

Why do recalls and shortages happen?

Most recalls occur because there is either something wrong with the medication or the packaging it comes in. Recently, we saw a total recall of all Buckley's liquid preparations. Nothing was wrong with the actual medications; it was discovered there was an issue with the seals under the lids. We have seen birth control pill recalled because of chipped pills or packing mistakes where the week of placebo pills were mixed up with the pills containing the active ingredient.

In the case with valsartan, most of the raw ingredient was coming from a Chinese company and being supplied to the Canadian manufactures to make the actual pills. It was discovered this raw ingredient contained trace amounts of a known "probable carcinogen" called NDMA. It is being reported the NDMA was an impurity in the medical ingredient from the manufacturing process. Prolonged use of this contaminated powder could increase your risk of cancer based on labs tests on the chemical. The actual risk of using the contaminated valsartan is not known.

With improved technology and shipping logistics one would think there should be less shortages and recalls, but this is not the case. As generic drug prices are squeezed lower by governments, some medications which are not profitable are dropped by generic manufacturers. If less manufacturers produce the raw material or the pill, there is not enough supply to meet demand. As generic prices decrease many companies are sourcing the product from the same suppliers. This was the case with valsartan. In April alone, the selling price of valsartan dropped by almost 30%.

Some products are being dropped by manufacturers all together. The drug industry is big business, and its simple; if a drug is not making a company money they stop making it. That leaves the patient in a tough position and their health care professionals scrambling to find other options.
Because many generic medications or their raw ingredients are made overseas, questions have been raised on the safety of these medications. After a couple of instances where Health Canada did not properly inspect some facilities the rules tightened up. According to some generic companies this made producing some medications very difficult or even impossible.

What should you do?

In the case of valsartan and most other recalls, you should continue to keep using your medication until it is changed to another option. If you stop your blood pressure medication suddenly, the risks of having a cardiac event are exponentially higher than your risk of getting cancer.

In the event of a shortage or a recall you should speak to your pharmacist as soon as possible. It will give us time to find you alternatives and talk to your doctor. Do not wait until you run out of medications. Luckily in the case of valsartan other options to treat blood pressure are available. However, we do not know if the supply of these alternatives will be able to keep up with the demand created now that valsartan is not available for the foreseeable future.

Remember your pharmacist is your most accessible health provider and we can help you navigate through drug shortages and recalls. You can contact us at anytime to discuss your medications.


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