By Rosanna Sutherby, PharmD
The COVID-19 pandemic has affected the world in numerous ways, including disrupting the supply of some medications. You may have wondered why the pharmacy near you is short on supply of some of your medicines. Drug shortages are the product of many factors, including manufacturing issues and shortages in critical ingredients necessary to produce the drugs.
Your medications are composed of active pharmaceutical ingredients (APIs), which is the part of the drug that does the work, and excipients, which many people refer to as “fillers.” About 80% of APIs used to make drugs sold in the United States are manufactured abroad.
The majority of suppliers for active ingredients are located in China and in India, and worldwide shutdowns of manufacturing plants have interrupted the supply of ingredients essential in the production of many drugs.
Several factors may contribute to drug shortages, including the following:
- manufacturing problems
- shortage of active ingredients, or APIs
- increased demand
- drug recalls
- natural disasters
- business decisions
- regulatory issues
Many of the current drug shortages are due to manufacturing problems, shortage of APIs, and an increase in demand for drugs used in the treatment of COVID-19.
China and India are the two top suppliers of active ingredients and generic medicines, which account for 90% of the medications sold in the United States. Forty percent of generic and over-the-counter drugs used in the United States is supplied by India.
The shutdown of manufacturing plants in both China and India has interrupted the production of active ingredients necessary for the development of many medications in the United States and other parts of the world. Even as some of these plants begin to reopen, they will operate with limited capacity for some time, and shipments of raw materials will be slow.
China makes the active ingredients for the majority of the antibiotics sold in the United States, as well as vitamin C, hydrocortisone, acetaminophen, ibuprofen, heparin, antidepressants, drugs used to treat HIV and AIDS, birth control pills, diabetes medicines, and more. India imports 70% of active ingredients from China to supply the United States with antibiotics, pain medication, hormones, antiviral drugs, and vitamins B1, B6, and B12.
The U.S. Food and Drug Administration (FDA) and the American Society of Health-System Pharmacists (ASHP) maintain lists of drugs that are in short supply. Although both lists are long, not all drug shortages are due to COVID-19 worldwide shutdowns. The following is a sample of some of the drugs with supplies affected by the coronavirus outbreak. A full list is available from the FDA and ASHP.
- Albuterol sulfate metered-dose inhalers. These inhalers have an increased demand for patients with COVID-19. Several manufacturers are allocating their supplies to high-need areas.
- Azithromycin tablets (Z-Pak): Azithromycin is one of the drugs studied in clinical trials for the treatment of COVID-19. Its shortage is a result of increased demand.
- Hydroxychloroquine (Plaquenil): Manufactures report a delay in shipping as the reason for the shortage. This drug is also under study for COVID-19 treatment.
- Fentanyl citrate injection: Fentanyl injection is used as a sedative and treats severe pain in patients on ventilators. Manufacturers report an increase in demand as the reason for the shortage.
- Midazolam injection: Midazolam is used as a sedative in patients on ventilators. Manufacturers report increased demand as the reason for the shortage.
- Vecuronium bromide injection: Vecuronium is used as a muscle relaxant during ventilation. This medication is in short supply due to increased demand.
Although the United States relies heavily on supplies from overseas for drug manufacturing, government agencies are taking steps to address drug shortages caused by the COVID-19 pandemic.
The Strategic National Stockpile was created in 1999 to ensure the United States has an adequate supply of drugs and other resources in the case of public health threats, such as natural disasters, national security threats, and disease outbreaks. The Operational Logistics Branch is responsible for obtaining medicines and supplies for the stockpile, ensuring there is an adequate amount of medications and supplies to respond to emergencies, and ensuring the stockpile can supply states and public health agencies when medications and other supplies are needed.
As of May 13, 2020, the U.S. Department of Health and Human Services has increased staffing in the stockpile operation center and partnered with private industry to help with the medical supply chain and product delivery.
Additionally, the DEA has allowed increased production of controlled substances in high demand during the COVID-19 pandemic. The FDA has also proposed an initiative to lengthen expiration dates on drugs to increase the current supply.
Your pharmacist can discuss alternatives with your doctor if your medicine is in short supply at your local pharmacy. The medication may be available in different strengths. Your pharmacist can explain if you need to increase the number of pills that you take or cut them in half. Sometimes, your doctor may change the medication to another one in the same class. The name of the drug, the strength, and the directions may differ, so be sure to talk to your pharmacist about taking your new medication.
Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.