Drug shortages: The new norm for veterinary medicine?
NATIONAL REPORT — Drug shortages are becoming more common, and the trend could be getting worse, veterinary officials report.
While there are only four medically necessary veterinary drugs in short supply, there are more than 200 human drugs that have been added to the endangered list. The trend poses a threat to patients and veterinarians, with shortages noted in multiple drug classes—from pain relievers to chemotherapeutics to antibiotics—and it may get worse.
Veterinarians are currently facing shortages of four medically necessary veterinary drugs—Levamisole HCI, Vetsulin, Epinephrine and Immiticide, according to the U.S. Food and Drug Administration. But for veterinary clinics that have to beg or borrow to get the supplies needed for patients, the situation is more dire.Shortages of human-approved drugs are becoming more common, according to the Institute for Safe Medication Practices. And those shortages have a trickle-down effect on veterinarians who depend on their off-label uses.
"Veterinarians, in general, are compassionate people, and we like helping animals. Drug shortages make our day hard," says Ann Hohenhaus, DVM, Dipl. ACVIM (SAIM, Oncology) of The Animal Medical Center. "I don't think it's going to go away, either.
"We have fewer and fewer companies making drugs," she adds. "The system, the model, the process by which drugs are produced kind of set themselves up for this drug shortage thing."
Dinah Jordan, PharmD, DICVP, chief of pharmacy services and clinical professor at the Mississippi State University College of Veterinary Medicine, says the last two years have been particularly difficult in terms of drug shortages. According to FDA figures, there were more veterinary drug shortages in 2010 than in any other year, she says.
"2011 appears to be not much better," Jordan says.
"To be honest with you, it's very frustrating because we know we need these drugs. So, we go to the source; we can't find them. We go to alternates; we can't find them—and we have to start scrambling," says Arnold Sabino, director of materials management at The Animal Medical Center in New York City.
A vicious cycle, Sabino says the situation is made worse when shortages are anticipated and clinics start to stock up on certain drugs, depleting the stock for others.
The American Society of Health-System Pharmacists (ASHP) tracks more drug shortages than FDA, which only monitors those deemed medically necessary. It reports that more than 200 human drugs are now in short supply, with 19 no longer available and 102 recent shortages resolved.
Many of those drugs can and are used by veterinarians, says Jennifer Coates, DVM, of Home to Heaven, an in-home hospice and euthanasia practice in Fort Collins, Colo. Coates reports a number of shortages outside the four medically necessary veterinary products (MNVP) tracked by FDA. They include chemotherapy drugs like cisplatin and doxorubicin; antibiotics such as amikacin, azithromycin, ciprofloxacin, metronidazole and gentamicin; and pain relievers like buprenorphine and butorphanol. Also in shortage is acyclovir, an antiviral drug used to treat feline herpes infections; propofol, an injectable anesthetic; acetazolamide, used to treat glaucoma; aminophylline, used to relieve airway constriction; injectable atropine sulfate and glycopyrrolate, used to keep an animal's heart rate up during anesthesia; azathioprine, used in autoimmune therapies; bupivacaine with epinephrine, a local anesthetic often used in declawing procedures or for incisions; injectable diazepam, used in treating seizures; and injectable furosemide, used to reduce fluid build-up in the body.
Frank Alvarez, central supply supervisor at Animal Medical Center says the hospital is also currently facing shortages of lidocaine, norepinephrine and fentanyl injections.