Wednesday, April 30, 2014

There's a Massive Shortage of One Critical Drug in American Hospitals

The news: Saline is essentially a fancy word for salt and water, albeit in a sterile condition. It is used in all manners of crucial, intravenous procedures, from dialysis to hydration. Still, it sounds like a rather no-frills product — how hard can it be to mix salt and water together?
Apparently, pretty hard.
Since January hospitals across the country have been struggling to cope with a saline shortage. In fact, it got so bad that last month the Food and Drug Administration (FDA) started to import shipments of 0.9% saline solution from a manufacturing facility in Norway. A bag of saline solution, which used to go for a $1, can now fetch five or six times that.
It seems ludicrous to imagine bags of salt water being flown across the Atlantic when we have facilities that could easily manufacture it at home, but it's hardly that simple.
Why do we have a saline shortage? Despite the huge market and demand, the production of saline is concentrated among a few companies, which means that if even one of them has a problem — like, say, a recall — there can be huge consequences for the entire country.

Image Credit: Vox
It also doesn't help that there was a spike in flu cases earlier this year. Dehydrated flu patients need intravenous saline injections, and this pressing need has exacerbated an already dwindling supply.
And there's no reason why there should be more saline manufacturers. The solution is hardly a high-profit product, and it's a costly challenge to produce the solution in a completely sterile environment to make it safe for injection directly into a patient's veins.
What will happen next? The FDA is working with manufacturers to kick saline production into a higher gear. The agency is also easing regulations so that foreign plants, such as the Norwegian company and the Spanish branch of a company called Baxter, can send some much-needed reinforcements in the meantime.
Hospitals have also had to tackle the challenge of rationing their remaining supply. Some are using smaller-sized bags or diluting the solution with non-saline ingredients. It's a strange and unexpected predicament, but it's a potentially dangerous reality that pharmacists and doctors across the country must face.

Today's Shortages

Ondansetron Inj
Pantoprazole Tablets
Propofol Inj
Rabies Immune Globulin

Tuesday, April 29, 2014

Today's Shortages


Pantoprazole Tablets

Propofol Inj.

Rabies Immune Globulin


FDA Attempting to Ease Drug Shortages

The FDA is assuring healthcare executives that it "will take every action within its authority" to address shortages of saline and other drugs, but reminding them that it doesn't have the authority to direct manufacturers' business decisions.
Responding to a letter from American Hospital Association Executive Vice President Rick Pollock, FDA Commissioner Margaret Hamburg says what the agency can do, among other measures, is work with current manufacturers to better understand and alleviate the quality-related disruptions in production that can lead to shortages, and expedite inspections of additional manufacturers that are interested in starting new production of products that have been in short supply.
The AHA had asked the FDA to "do even more to end this shortage by pushing current manufacturers to not only continue to produce these products at their maximum capacity but also to make investments to ensure an increasing supply for the future."
The 4 companies currently manufacturing IV saline — Baxter Healthcare, B. Braun, Hospira and Fresenius Medical Care — are working to restore the supply of IV saline and other saline solutions, says Ms. Hamburg.

ISPE Announces Development of New Drug Shortages Prevention Plan for the Pharmaceutical Industry

ISPE, the International Society for Pharmaceutical Engineering, announced today that it will work with stakeholders world-wide to produce a Drug Shortages Prevention Plan to guide the pharmaceutical and biopharmaceutical industry in establishing reliable, robust and resilient supply chains that provide quality medicines to patients without interruption. The Plan, which will be based on ISPE research with the input of its membership, company leaders and regulators, will serve as a roadmap that when implemented, can significantly reduce drug shortages. The Plan will address optimal organizational strategies, such as aligned governance and communication practices, effective manufacturing and quality systems, and appropriate measures of supply chain robustness and quality. This effort addresses rising concerns around drug shortages within companies, among global health authorities, and for patients who depend on a reliable and available supply of quality medicines. 
The ISPE Drug Shortages Prevention Plan will be the Society's second major output on this topic since launching its Drug Shortages Initiative in 2012. This second phase of the Initiative is aimed at addressing the root causes of drug shortages to prevent delay of supply. The 2013 survey   provided clear evidence that mitigating shortages requires a holistic approach that encompasses both the organizational and technical issues affecting drug manufacturing and quality. "How much of the increasing number and severity of incidents of drug shortages within our industry are fundamentally tied to a lack of understanding, or even concern for, the risk profiles of our current supply chain structure?" commented Andy Skibo, Regional VP, Biologics Supply, AstraZeneca/MedImmune. "I therefore welcome ISPE's initiative to tackle the root causes of shortages for the benefit of all stakeholders—ISPE Members, industry companies, regulators and health authorities, third-party providers and patients."
The ISPE Drug Shortages Prevention Plan will provide a key component of the Society's input to a European multi-association task force, moderated by ISPE, which intends to provide EMA a proposal and plan that address the prevention of drug shortages due to manufacturing quality issues. "I'm delighted to be collaborating with colleagues from the Parenteral Drug Association to deliver our proposal to the EMA later this year, and appreciate the support we are receiving from EFPIA, EGA, AESGP and PPTA as well as regulators representing the EMA, the UK, Irish, Spanish and French national agencies," said Dr. John Berridge, ISPE's Advisor and inter-Association task force moderator.
In 2012, ISPE formed a Drug Shortage Task Force in order to help stakeholders better understand the root causes of global drug shortages and to define mitigation strategies that can help prevent drug shortages. In ISPE's initial approach to this challenge, the group led a comprehensive survey in 2013 that revealed multi-factorial causes of drug shortages, as well as success strategies for avoiding supply interruptions. Those companies that have adopted organizational drug shortage prevention strategies, including contemporary governance, progressive cultures and effective quality systems, were successful in the avoidance of drug shortages and supply interruptions. "Our research findings indicated that, while shortages are often the result of quality systems or related deficiencies, what was equally profound was that those companies with dedicated and sophisticated systems for avoiding drug shortages were clearly more successful in avoiding supply disruptions and shortages," said Nancy Berg, ISPE's President and CEO. "Recognizing the impact of these success strategies motivated ISPE to develop its Drug Shortages Prevention Plan and to develop guidance on organizational strategies for drug shortages prevention, which include the engagement of company leadership and execution of governance, culture, especially a culture of quality risk management throughout the supply chain, and insightful quality metrics."
ISPE's Drug Shortages Prevention Plan will feature an organization and product lifecycle approach to ensuring a more reliable supply of medicines through development of company-wide drug shortages strategic plans, aligned governance, good communication, ongoing capability building (which includes training), proactive regulatory interaction and integrated quality systems. The development of industry-wide quality metrics is being addressed by the Society through a parallel Quality Metrics Initiative, led by another ISPE expert team recommending to FDA and other health authorities a set of common metrics on which the health and reliability of a company's production and quality systems and products can be assessed.

Monday, April 28, 2014

Today's Shortages


Adenosine Inj.

Atorvastatin Tablets

Bupivacaine nj

Cefotetan Disodium Inj.

Cisatracurium Inj.

Erythromycin Lactobionate Inj.

Mannitol Inhalation Capsules

Octreotide Inj.

Sincalide Inj.

Sodium Cvhloride 0.45% Inj. Bags

State legislation would tighten controls on compounding pharmacies

Compounding pharmacies in Michigan may soon operate under a system of tighter controls and regulations, and employees could face felony charges and prison sentences if patients are injured or die because the new rules are not followed.
The aim behind Senate bills 704 and 904, sponsored by Sen. Joe Hune, R-Hamburg, is to prevent the kind of injuries and deaths suffered in the state two years ago when the Framingham, Mass.-based New England Compounding Center allegedly sent tainted medicine to clinics around the country.
Michigan was the hardest hit when the tainted steroids were delivered to clinics in the state, resulting in 264 infections and 19 deaths. Nationwide, the death count hit 64 with 751 cases of fungal infections or meningitis, according to the Centers for Disease Control and Prevention.
"Hearing from constituents that have been so adversely impacted by these tainted steroids, it's the least we can do," Hune said.
Compounding pharmacies mix and assemble pharmaceuticals to create a drug or form of medicine needed by a patient.
Hune's bills would add a series of requirements for these businesses, including that accurate records of its procedures are maintained, that the pharmacies are subject to a physical state inspection once every two years and that all compounding pharmacies designate a "pharmacist-in-charge" responsible for making sure the business follows the state regulations.
The criminal penalties for violating the rules that result in personal injury include a maximum of a four-year prison sentence. A violation that resulted in a patient death would carry a maximum 15-year sentence.
The legislation would also give the state the ability to immediately suspend the pharmacy license of the business if notice was received by the CDC or the Food and Drug Administration of imminent risk to public health or safety.
Attorney General Bill Schuette's office has been working with Hune on the bill, and supports the legislation he says will protect patients and hold pharmacists accountable.

"We can never undo the damage experienced by the victims of this meningitis tragedy, but we have a responsibility to find justice and ensure this never happens again," Schuette said in a statement to Crain's. "There is nothing more important than patient safety, and our laws should reflect that commitment."
The bill received its first hearing Thursday before the Senate Health Policy committee, and several organizations testified in support of it. No one voiced opposition.
Kelly Elizondo, state assistant attorney general, said she has handled a half-dozen licensing actions involving compounding pharmacies, and the legislation could save lives.
Compounding pharmacies currently do not have to create or keep records of the calculations or formula used to fill a prescription, she said. A recent case she worked on involved a pharmacist at a compounding pharmacy who made an error when mixing components of the medication.
The pharmacist was supposed to include 0.6 grams of the active ingredient of the drug, and instead included 6 grams of the ingredient, resulting in great harm to the patient, who had to be hospitalized, she said.
The record-keeping requirements in Hune's bills would have made a difference, she said, because it would require the pharmacist to record the strength, quantity and dosage of the compounded pharmaceutical, the formula used and the mixing instructions, all ingredients, the date of preparation and the name of the person who conducted the compounding.
"If that pharmacist had the formula and had been writing down what he was doing, I firmly believe he would have caught his error, and this gentleman would have been spared hospitalization," Elizondo said. "This is a very good bill that could save patient lives."
The record keeping also would assist investigators if there was an outbreak of illness, so that it could be traced back easily to the source. Part of the problem with the tainted steroid case in 2012 was that the company in Massachusetts was allegedly acting as a manufacturer of compounded pharmaceuticals -- making batches of steroids and selling them to clinics across the country -- rather than making a specific drug linked to a prescription for a specific patient.
That practice was also found to be going on in Michigan after the Department of Licensing and Regulatory Affairs inspected every compounding facility in the state after the news came out about the tainted steroids.
Those pharmacies changed their practices, and many compounding facilities updated their facilities to make sure they were compliant with state and federal laws following the inspections, according to LARA, which supports Hune's bill.
Larry Wagenknecht, chief executive officer of the Michigan Pharmacists Association, whose organization includes those working in compounding pharmacies, said he supports the bill as do the vast majority of compounding pharmacies.
However, he said there could be unintended consequences, if some of the compounders feel the penalties are not worth the risk of operating in the state, and may get out of the business.
Sen. James Marleau, R-Lake Orion, chairman of the Health Policy Committee, said the legislation could be approved and sent to the full Senate at next week's hearing.

Sunday, April 27, 2014

Rationing Salt Water — Disaster Planning and Daily Care Delivery

Over the past several years, drug shortages have continued to complicate the routine delivery of health care in the United States. The Food and Drug Administration (FDA) is currently tracking nearly 100 shortages resulting from a host of causes, such as the consolidation of markets and manufacturers, limited availability of raw materials, and quality problems resulting in product recalls and delivery interruptions (see Examples of Drug Shortages Listed on the FDA Website for examples).1
Clinicians have become accustomed to these deficiencies, and they troubleshoot accordingly. Yet there are important implications for the quality and safety of patient care, since clinicians must regularly negotiate unfamiliar drug alternatives, concentrations, or dosing strategies. Shortages also have significant budgetary implications. For example, according to some of our colleagues, in 2012 doxycycline sold for a penny a tablet, yet because of a cascade of manufacturer shutdowns and discontinuations, the current price is at least $1.59 per tablet.
Current critical shortages of vecuronium, intravenous nitroglycerin, and lorazepam have required the hospitals where two of us work to adopt contingency measures, including, in one case, providing explicit, written direction about substitutions for intravenous nitroglycerin. Complicating the ability to substitute, however, are further shortages of potential replacement medications. Nicardipine and a component of nitroprusside drips, thiosulfate, are both in short supply.
The national shortage of normal saline, however, represents a new chapter in supply shortages.2The administration of normal saline (and other crystalloids) is a basic underpinning of patient care. In many ways, it is more the lifeblood of hospital care than blood itself. As supply-chain disruptions have caused a shortage of saline, demand for alternatives has spiked, causing a ripple effect. As hospitals increase their product orders to compensate for the shortage, the backlog of orders awaiting delivery grows. The fact that health care facilities would have to ration the use of such a fundamental resource is perhaps the most significant demonstration yet of the importance of addressing these vulnerabilities.
So what should we do? Drug shortages provide the opportunity, if not the imperative, to apply emergency-management methods to the daily delivery of care. Using these “disaster-response” tools on a day-to-day basis offers a systematic, coordinated approach and also prepares institutions to deploy them more effectively during a large-scale disaster.
Four foundational elements of emergency management — mitigation, preparedness, response, and recovery — provide a framework that health care institutions can use to grapple with the everyday challenge of drug and other product shortages. Mitigation involves preventing the incident from occurring or blunting its impact through design or system changes. The FDA has taken proactive steps, in partnership with manufacturers and others, to prevent or reduce the effects of shortages. Through a range of approaches, such as early notification, expedited inspections, and regulatory flexibility, the FDA helped prevent 282 shortages in 2012 and 170 shortages in 2013. These successful efforts provide strong groundwork on which to build greater transparency and supply-chain monitoring into our daily systems, although a recent report of the Government Accountability Office suggests that there is still room for strengthening responses to drug shortages.3
Preparedness activities involve making plans and obtaining adequate supplies. Health care institutions can take these steps by determining who has what authority (e.g., for purchasing or new vendor agreements), roles, and responsibilities for incident management during supply shortages; stockpiling vital supplies during times of no shortage; identifying backup vendors; and finding partners, such as other health care institutions, that can collaborate and share information and resources during a shortage.
During an active drug shortage or other crisis, the plans and partnerships developed during preparedness activities can be put to use. Primarily, the response can be managed through an incident-management system, a framework widely used by hospitals and emergency services that establishes leadership, clear roles, responsibilities, procedures, and communication channels for addressing the incident. Incident management is scalable and responsive to the size of the event. In the case of a shortage of normal saline, a hospital system could designate a pharmacy or administrative leader who would coordinate and be responsible for activities to address the shortage.
Many hospitals and health care coalitions are already taking this approach to respond to drug shortages. Pharmacy supervisors are often designated as incident managers. They maintain situational awareness by comparing any shortfalls in orders against current stock levels and expected monthly consumption levels, optimally providing early warning of a shortage situation. They can communicate these shortages to providers in terms of “red, yellow, green” triage categories denoting the degree of severity, taking into account factors such as the urgency of the shortfall and its probable effect on clinical practice. They can also build safeguards into the ordering of unfamiliar agents (through alerts incorporated into the electronic health record system) and their preparation (for instance, preparing them in the pharmacy rather than on the patient's hospital floor).
The collaboration involved in the incident-management process and the clarity that ideally results from it mean that clinicians are not forced to make ad hoc decisions that may be inconsistent with ethical frameworks or preferred strategies. Instead, uniform stewardship actions taken throughout the whole institution — or the whole community — such as sharing, conserving, substituting, adapting, reusing, and reallocating, can be used to address shortages.
These key stewardship actions are components of the Institute of Medicine's standards-of-care guidelines for catastrophic emergencies. Developed initially for planning for an H1N1 influenza pandemic, these guidelines provide foundational ethical and procedural guidance for the allocation of scarce resources during disasters. This guidance was recently adapted by the Association of State and Territorial Health Officials for use in drug-shortage events.4,5
Incident management also promotes coordination of decision making with other health care facilities, systems, and partners in the community (including emergency medical services and public health agencies) by designating liaisons as the points of contact and coordination. During the recent saline shortages, for example, the Northern Virginia Hospital Alliance released a coalition-purchased disaster cache of intravenous fluids to member hospitals for their immediate use, stemming the need for restrictive conservation measures. Many hospitals offered guidance to providers on using alternative crystalloids or smaller bags, emphasizing oral hydration, enteral feeding, and reduced preoperative fasting times whenever possible. These policies are often shared with other facilities and through health care networks and response coalitions, resulting in consistent, community-wide practices.
Recovery should begin even during an organization's response to a shortage, through replenishment of consumed “emergency” supplies, with the goal of returning the facility to usual practices, if not better ones. For example, a retrospective review might lead to decisions to increase the backup for critical supplies when they are not in short supply or to revise plans for similar events in the future.
The shortage of normal saline highlights the way in which breaking even a single link in our fickle supply chain can have profound effects on routine health care delivery. Application of stewardship strategies for resource allocation tailored to the degree of deficit, coupled with the use of an incident-management system, will ensure a fair, informed, and structured response across this delivery continuum.
Finally, an added benefit to “practicing” these strategies during day-to-day incidents is that personnel will then be more comfortable with them when a full-scale disaster occurs. In other words, preparedness rests on the back of strong day-to-day systems. Daily use translates to disaster utility.


Atropine sulfate injection
Bupivacaine hydrochloride (Marcaine, Sensorcaine) injection
Calcium chloride injection
Calcium gluconate injection
Dobutamine hydrochloride injection
Epinephrine injection
Epinephrine (1 mg/ml, preservative-free)
Heparin sodium injection
Lidocaine hydrochloride (Xylocaine) injection
Magnesium sulfate injection
Nitroglycerin in 5% dextrose injection
Sodium chloride (0.9%) injection bags

Prescription drug shortages compromising patient care

Pharmacists warn a worsening drug shortage is making it increasingly difficult to supply medications for patients and that's compromising their medical care.
Canada's online drug availability reporting system lists 350 products in short supply. That means at least once a day pharmacist Victor Chu sees patients looking for medication they can't find elsewhere.
"We also have pharmacies calling us asking us to — we're a compounding pharmacy — to make up medications. We can actually mimic the commercial product that's not currently available."
Patient Nicholas Read was surprised by when his pharmacist told him she did not have the inhaler he has been using for years.                
"I was told that there was none available and that it wouldn't be available until July," said Read. "She said shortages were typical in pharmacies, but this year they are seeing more shortages than ever before."
Jeff Morrison of the Canadian Pharmacists Association says one reason for shortages is a lack of ingredients. 
"The raw materials used to make the drugs are being sourced from countries like China and India and there's quality assurance problems."

Friday, April 25, 2014

Today's Shortages

Adenosine Inj.
Amikacin Inj.
Azithromycin Inj.
Calcitriol Inj.
Cefpodoxime Inj.
Cytarabine Inj.
Dfexamethasone Sodium Phosphate
Dexmethylphenidate Hydrochloride
Dimercaprol Inj.
Doxorubicin Inj.
Doxycycline Capsules and Tablets
Ephedrine Inj.
Haloperidol Decanoate Inj.
Heparin Sodium Inj.
Indigo Carmine Inj.
Leuco Inj.
Methotrexate Tablets

Thursday, April 24, 2014

April 24, 1943: U of A prof grows belladonna to help meet drug shortage

EDMONTON - A University of Alberta pharmacology professor was credited for “doing the impossible” with the first large-scale production of the medicinal plant belladonna in Canada.

Alberta’s soil and climate, combined with the ingenuity and hard work of Dr. A.W. Matthews, resulted in a drug of excellent quality, and with a better appearance than the prewar drug previously imported from Central Europe, said officials of the company in Eastern Canada where the crop was sent.

Matthews took matters into his own hands a year earlier when drug companies were forced to start rationing belladonna.

The plant was used to increase secretions of the body, as well as by eye specialists to dilate the pupil.
Though widely regarded as unsafe, belladonna is used today as a sedative, to stop bronchial spasms in asthma and whooping cough, and as a cold and hay fever remedy. It is also used for Parkinson’s disease, colic, motion sickness and as a painkiller.

Matthews had been cultivating drug plants on a small scale when he heard of the shortage and planted some seeds in a greenhouse. He then leased a vacant lot and planted 5,000 young plants early in June.

Four months of back-breaking work followed as Matthews and his assistant, Mervyn J. Huston, mothered the slow-growing plants through a wet summer, which further delayed their growth.

At the end of the process, Matthews found the harvest yielded 750 pounds per acre, a yield comparable to that obtained under ideal conditions in a large research project being carried out in the eastern United States. But the professor cautioned Alberta farmers about starting to grow belladonna.

“The basis of growing the crop depends entirely upon hand labour and very special care,” Matthews said. “The plant is definitely not adaptable to mass production methods, and with the shortage of labour growing worse every day (because of the war), the planters’ difficulties are bound to increase. “

Matthews and his assistant hoped some of the drug made from the plants they had grown would fill the empty spaces on shelves of western pharmacies.

“Then we will feel that our work has been of some consequence,” he said.

Hospira, another recall, not surprising anymore

Hospira Recalls Drugs Due to Visible Particulates

The FDA announces that Hospira Inc. will initiate a voluntary nationwide recall to the user level for one lot of 0.25% Marcaine (Bupivacaine HCl Injection, USP), 10 mL, Single-dose Vial – Preservative Free (NDC 0409-1559-10), Lot 34-440-DD. The recall is due to a confirmed customer report of discolored solution with visible particles embedded in the glass as well as discolored solution. 

To date, Hospira has not received reports of any adverse events associated with this issue for this lot. Hospira has attributed the embedded particulate to a supplier’s glass defect. As a result of this issue, Hospira is working with its supplier on implementing corrective and preventive actions.

If the particulate goes undetected and solution is administered - depending on the particle size and number - it could block administration of the drug to the patient, causing a delay in therapy. However, this is an unlikely outcome due to the size of the subvisible particulates identified. It is more likely that particulates are able to pass through the catheter and may result in local inflammation, mechanical disruption of tissue, or immune response to the particulate.

While extremely rare, particulate exposed to strong magnetic fields (e.g. MRI), could potentially dislodge and cause tissue damage. However, the particulate size identified is considered too small. Therefore, an adverse outcome is extremely unlikely. Marcaine is packaged 10 units per carton/100 units per case in glass fliptop vials. The impacted lot of Marcaine was distributed December 2013 through January 2014 to wholesalers/distributors, hospitals and clinics nationwide.

This recall is being conducted with the knowledge of the U.S. Food and Drug Administration.
Hospira is headquartered in Lake Forest, Ill.

Massachusetts Cannot Ban Hydrocodone-Only Medications, Federal Judge Rules

A US District Judge has ruled that Massachusetts may not ban the prescribing and dispensing of hydrocodone-only medication products that have been approved by FDA. Following months of controversy surrounding FDA’s decision to approve Zohydro™ ER, the first hydrocodone-only medication to be approved by FDA, Governor Deval Patrick declared the state’s opioid addiction epidemic to be a public health emergency. As part of the state’s response, Patrick ordered an immediate prohibition on prescribing and dispensing of all hydrocodone-only products. Zohydro ER manufacturer Zogenix, Inc, filed a three-count complaint alleging that the state’s ban on the medication was unconstitutional. Rya W. Zobel, US District Judge ruled (PDF) that the state’s emergency ban on the drug is preempted by federal law. Further, Zobel notes, “If the Commonwealth were able to countermand the FDA’s determinations and substitute its own requirements, it would undermine the FDA’s ability to make drugs available to promote and protect the public health.”

FDA Developing Track and Trace Standards as Part of DSCSA Implementation

To protect consumers from drugs that may be counterfeit, stolen, or tainted, Food and Drug Administration (FDA) is advancing efforts to implement an advanced track and trace program. The Drug Supply Chain Security Act (DSCSA), enacted as Title II of the Drug Quality and Security Act in November 2013, authorizes FDA to create and implement a prescription drug tracking system that will make it possible to identify and track certain prescription drugs throughout the distribution process. “The ultimate goal is to identify each individual prescription drug package in a way that will enable rapid and accurate verification of the legitimacy of the product, which will be an important tool in the fight against counterfeit drugs,” states Ilisa Bernstein, PharmD, JD, deputy director of the Office of Compliance in FDA’s Center for Drug Evaluation and Research in an FDA Voice blog entry. Bernstein also indicates that FDA will be issuing a draft guidance document with initial standards by November 27, 2014. The agency will host a public workshop on the standards May 8–9, 2014.

The DSCSA will be the topic of a continuing pharmacy education session at the NABP 110th Annual Meeting on May 17, 2014, in Phoenix, AZ.

DEA Take-Back Day Is Saturday, April 26

Consumers will have the opportunity to dispose of unneeded or unwanted medications at a Drug Enforcement Administration (DEA) National Prescription Drug Take-Back Day collection site on Saturday, April 26, 2014. On this day, from 10 am to 2 pm, consumers may safely dispose of unwanted medications at one of thousands of collection sites coordinated by DEA and provided by law enforcement agencies and community organizations in all 50 states and United States jurisdictions. This is the eighth DEA Drug Take-Back Day. Additional information and a link to the DEA online collection site locator are available on the AWARXE® website.

DEA Take-Back Days are a unique opportunity for consumers to safely and legally dispose of unneeded medications, including prescription controlled substances, such as certain pain medications, since these drugs can only be returned to law enforcement personnel. The take-back service is free and anonymous, with no questions asked. Sites will accept tablets, capsules, and all other solid dosage forms of unwanted medication. Personal information may be blacked out on prescription bottles, or medications may be emptied from the bottles into the bins provided at the events. DEA collected more than 3.4 million pounds of unwanted medication for safe and secure disposal during the previous seven take-back days combined.

South Africa - Chemo drug shortage at Charlotte Maxeke - Jack Bloom

A shortage of a key chemotherapy drug has halted treatment for certain cancer patients at the Charlotte Maxeke Johannesburg Hospital.
Patients who need to be treated with Gemzar chemotherapy have been told that it is not available as the supplier has not been paid.
Gemzar is a chemotherapy drug used to treat non-small cell lung cancer, pancreatic cancer, metastatic breast cancer, and ovarian cancer.
In one case, a breast cancer patient's chemotherapy was halted in the middle of a multi-week treatment, which is extremely dangerous.
This chemo drug shortage is totally unacceptable as it is endangering the lives of vulnerable patients.
We need swift action to procure this drug and answers as to why medicine shortages continue to happen at Gauteng state hospitals.

Lookout List

Labetalol Carp 4ml

Today's Shortages


Ampicillin Sulbactam


Memantine Hydrochloride

Morphine Inj.

Nitrgoglyercin inj.

Piperacillin Tazobactam Inj.

Prochorperazine Edisylate Inj.

Sufentanil Inj.

Sulfacetamide and Prednisolone Opthalmis Ointment

Wednesday, April 23, 2014

Today's Shortages


Caffeine and Sodium Benzoate Inj.

Ciprofloxacin Inj.

Cisatracurium Inj.

Dacarbazine Inj.


Fluromethalone Opthalmic Ointment

Flourouracil Inj.

Hydromorphone Hydrochloride Inj