Nationwide Medication Shortage — Diazepam Injectable
Diazepam (Valium) is a class IV medicine. It is a benzodiazepine sedative that has many applications including the treatment of Migraine symptoms, usually used in combination with other helpful medicines.
Like most other medications in our arsenal, diazepam is used off-label for Migraineurs who find it helpful. This means that its affects are sometimes helpful to us, but it was not originally intended to be used in Migraine. Its effects are varied and include the ability to make you drowsy as well as relieve muscle spasms and anxiety. Diazepam is highly addictive though, and although it has its uses in a Migraine setting, it is not something your doctor is probably going to prescribe for you to use every day.
Diazepam comes in many forms and can be compounded into others. Some available forms include: injection, tablets, suppositories, and gel.
The pharmaceutical company Hospira is currently the only company in the United States that manufactures diazepam for injection. Unfortunately they have reported manufacturing delays that have created a shortage of the medicine across the nation. According to the FDA website, supplies will begin shipping on particular dosages as soon as later this month or April 2012. It will probably take some time to re-build depleted or non-existent hospital and physician supplies however, so expect the shortage to continue past these points in time.
I learned of the shortage when other larger hospitals began contacting our small county trying to procure its supplies.
What does this mean for Migraineurs?
Because of its short supply and its need for conditions usually found to be more serious than Migraine, diazepam is a drug that may not be offered to you in an emergency department setting until the shortage has been resolved.
If diazepam is a drug that you depend on to help you during intractable or especially serious Migraine attacks, please understand that the shortage may mean that you will not be able to use this drug as you have in the past. Physicians may refuse to give it to you and not explain that either their facility is currently out of the drug, or that they are preserving their small supply for someone who may not have the option of other medicines.
Fortunately, most Migraineurs will find that there are other medications that are as effective for their Migraine treatment as diazepam. One commonly used drug is Versed (midazolam). Midazolam has a much shorter half life however (this means it doesn’t last as long in the body) and may not work for some patients especially if their attack is particularly long-standing and intractable. Midazolam is listed in short supply for the next few months. Lorazepam - another medicine in the same class as diazepam, is also currently in short supply. Knowing this, you will be able to talk to your ED physician or headache specialist about other options that may work longer and more effectively for you.
If your current care plan includes diazepam injectable, it might be a great time to have a conversation with your physician or headache specialist about changing it to another medication that is not in such short supply.
Diazepam rectal gel is still available however, and may be a viable option for patients willing to use this application. Studies have shown that rectal absorption is fast, and certainly less painful than an injection or establishing an IV.
Can you tell when a migraine attack is coming?