Mom unhappy pharmacist said little about drug shortage
Lorrena Clee says she only learned of a drug shortage in June, nine months after it was reported by company
A Nova Scotia woman who desperately searched for medication crucial in keeping her son alive says pharmacists need to do a better job of informing patients about drug shortages and whether a workaround called "compounding" is an option for them.
Lorrena Clee first learned of a shortage of ranitidine tablets sold under the brand name Zantac in late June, about nine months after it was first reported by the manufacturer.
The pharmacist "waited until there was no more to be had and then they told me," said the Lower Sackville resident.
Potentially fatal condition
One of Clee's sons, Presley Clee-Ferguson, takes the medication to block histamines as part of a condition he has called mast cell activation disorder. When he comes into contact with bacteria, viruses or allergens, his body releases large amounts of histamines, which cause hives and anaphylaxis.
Anaphylaxis can lead to shock, swelling of skin and the airways, and can be fatal.
Switching to another ranitidine manufacturer wasn't an option as the GlaxoSmithKline formulation is the only one that doesn't give her son an allergic reaction.
After learning of the shortage from her pharmacist, Clee posted about her ordeal online and placed calls to pharmacies as she searched for Zantac. She said one of the pharmacists she spoke with — not her regular pharmacist — suggested compounding.
What is compounding?
Compounding is a service that some pharmacies offer whereby they manufacture medication for patients by mixing individual ingredients together in the exact strength and dosage form required by the patient.
"That bothered me. It's like, 'Why couldn't you have told me this in the very beginning and I would have went down this route,' instead of another pharmacist and people online telling me," said Clee.
"I don't understand why they didn't say something."
Fortunately for Clee, she was able to track down a short-term supply of Zantac and her son is now taking some medication that was compounded.
According to drugshortagescanada.ca, which is the website where drug shortages and discontinuations in Canada are reported, there are multiple shortages for ranitidine.
Beverley Zwicker, registrar of the Nova Scotia College of Pharmacists, the provincial licensing body, said pharmacists are expected to notify patients about shortages and help them find a permanent solution to any medication problems.
"Pharmacists would be expected to take all reasonable steps to help a patient navigate the health-care system, particularly the system that pertains to medications," she said.
She said pharmacists are expected to find out whether other medication brands would work and if that isn't possible, to discuss with the patient's health-care provider whether alternative drug therapies are an option.
Zwicker said compounding should be part of the discussion, but said it's not usually the first option.
"It would be further down on the totem pole to explore," she said.
Zwicker said there aren't any timelines that dictate when a pharmacist must notify a patient about a drug shortage, but she said the pharmacist should tell a patient as soon as they're aware of it.
"We try not to be too prescriptive," Zwicker said, "we tend to be outcome based. The outcome we would expect of standards is they support the patient in resolving their drug-related problems and that includes doing what they can to ensure the patient gets the drug they need."