If you aren’t aware, you can’t prepare.
Never before have I seen a drug shortage list with so many injectable medications which Migraineurs may need if they find themselves with serious, intractable or status Migraine.
I am not entirely sure why so many medicines are currently on the FDA’s shortage list simultaneously and my own pharmacist couldn’t even guess the reason, but there seems to be multiple problems causing the issue.
The shortages are important for patients to be aware of however, especially if they find themselves in a doctor’s office, clinic or emergency department while these shortages are still a problem. Some shortages seem like they may be quickly resolved, others are unknown.
Thankfully, none of these medications are likely to be used by Migraineurs that find themselves on the easier end of the spectrum that is Migraine Disease. These are medicines most often used in hospital or emergency situations, or in specialized headache clinics around the country. Still, a large percentage of our readers fall into the difficult end of the Migraine spectrum, so it’s important they have access to this information.
Currently on the shortage list:
- Dexamethasone Injection (Decadron etc) updated 2/7/2012
- Diazepam Injection (Valium)updated 2/7/2012
- Diphenhydramine Chloride Injection (Benadryl) updated 2/7/2012
- Keterolac Injection (Toradol) updated 2/2/2012
- Lorazepam Injection (Ativan) updated 2/7/2012
- Magnesium Sulfate Injection updated 2/2/2012
- Metoclopromide Injection (Reglan) updated 1/27/2012
- Midazolam Injection (Versed) updated 2/2/2012
- Ondansetron Injection (Zofran) updated 2/2/2012
- Ondansetron Injection pre-mixed bags (Zofran) updated 1/6/2012
- Prochlorperazine (Compazine) updated 1/30/2012
- Valproate Sodium Injection (Depacon) updated 1/4/2012 (not currently listed on the FDA’s site)
Opioid or opioid like drugs include:
- Butorphanol Injectable (Stadol) last updated 1/31/2012 (not currently listed on the FDA’s site)
- Fentanyl Citrate Injection (Duragesic, etc) last updated 1/27/2012
- Morphine Sulfate Injection (Duramorph etc) last updated 2/2/2012
- Nalbuphene Injection (Nubain) last updated 1/13/2012
Drugs pertinent to other headache disorders include:
- Acetazolamide Injection (Diamox) last updated 11/12/2011 (not currently listed on the FDA’s site)
Great patience is going to be necessary for many Migraineurs and their physicians.
I know it is terribly difficult when you’re in pain — I’m right with you there – but please, try not to blame your physician or their staff if the treatment you need or want is unavailable at the time.
Because these medicines are not designed specifically for Migraine, this shortage may mean that a hospital or clinic has had to stop using it for Migraineurs because it is needed for other patients for whom that medication is their only choice. Until the shortage is resolved, it may be difficult or even impossible to receive these specific treatments no matter how much your doctor would like to give it to you. Thankfully, there are options/substitutions that can be made for most patients however.
If a hospital or clinic has found itself in short supply of any of these medicines, it may take some time for them to receive a sufficient shipment despite the fact the manufacturer may again be making or shipping the drug.
If you are not seeing a physician who routinely uses these medications, they may be unaware of the shortages. Either way, the best way to protect yourself if you find one of your go-to medicines on this list, is to contact your physician or pharmacist and begin a conversation about your options.
If you have an ER “prescription” or care plan and it includes one of these medicines, it might be a great time to have a conversation with your physician or headache specialist about temporarily changing it to another medication that is not in such short supply. The dates you’ll find within the references at the bottom of this article will give you much more specific information than I possibly could in a single post.
Don’t forget to ask your doctor to contact the hospital or clinic about any revisions if they have your care plan on file, and carry a copy of your revised plan with you.
If you are a patient that occasionally or often receives emergent care yet is unaware of the medications usually used to treat your attacks, now is a super time to get copies of your records and educate yourself. Getting these records often takes time, so getting started soon may be very helpful in the long run.
A note on the FDA’s shortage list: Some medications on the FDA’s shortage list are only difficult to find in specific dosages or from specific companies, however other medicines are simply scarce in that specific form across the board. If your doctor or hospital’s supplier can’t access a medicine because they use only a particular brand, it may be difficult for you to receive needed treatment.
In some cases it may be possible for a compounding pharmacy to make up a batch of the medicine you need – - if they have enough warning before you need it.
About Medication Shortages
Medication shortages are an ongoing problem. Availability literally changes daily. This is one reason many facilities — large and small – try to keep a rotating supply of drugs they use frequently. Ordering almost always occurs well before a supply is gone. Medications for which a shortage exists for a single dosage usually aren’t too much of a problem, but when a pharmaceutical manufacturing company closes production either temporarily or permanently (or recalls a product) problems can quickly arise, even when the drug may be actually manufactured by multiple companies. You see, if one company suddenly stops production, the other companies must raise production to keep up with the increased demand, and this isn’t always possible in sufficient time to keep the supply going without interruption.
In some instances there is literally only a single manufacturer of a drug. In this case the realities of the situation are clear.
How can I maximize my outcome in this situation?
As proactive patients, we should actively keep tabs on the medicines in which we depend. The references below are two excellent go-to sites for up to date shortage information. Usually I only list shortages that are on the FDA’s list, however there is often a lag time and this time after checking with my local pharmacy, I found the second list to be more complete.
If a question arises, contact your local pharmacist for more up to the minute information on the availability of specific medicines and dosages.
Thankfully, the majority of Migraineurs won’t ever need these medications, and for those who do, this isn’t a reason for panic. But, it is a time to become educated. As a patient who has had to depend on several of these on the list, I am concerned about other patients and want at least to be sure you are aware of the situation.
References: 1. “Drugs” — “Drug Shortages”, U.S. Food and Drug Administration. Page last updated 2/7/2012 http://1.usa.gov/ywg5sk 2. “Drug Shortages: Current Drugs”, American Society of Health-System Pharmacists, Copyright 2012 http://bit.ly/zmZ0t7