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Sunday, March 23, 2008

South Africa - running low on antidepressants

Thanks to Steph Gatchell for sending this on to me.

Medication shortage hits patients

Source iol.com.nz

A nationwide shortage of medications, including those used to treat chronic ailments like depression and schizophrenia, has pharmacists and patients on edge.

Manufacturers have been tight-lipped over the exact reasons except to say there is a global shortage of certain raw ingredients.

A Cape Town woman said she had battled to find her chronic medication for bipolar disorder, called Solian. Her Sea Point pharmacist said they had phoned everywhere but the whole of South Africa appeared to be out of stock. And a number of other medications, including some anti-retrovirals and anti-depressants, were also unavailable. "Eventually they found some of a much higher dosage which they cut up into quarters."

She said not to take the tablets for bipolar disorder was bad, but for people with schizophrenia it could be a disaster.

Cape Town psychiatrist Dr Jeff Mullan said reasons for the shortages appeared shrouded in secrecy and denial. "Everyone is passing the buck and there are all sorts of different stories."

Patients on drugs like anti-depressants couldn't simply stop taking them. They needed to be weaned off after completing the pre-requisite course which was usually six months to a year. "Those who are forced to suddenly stop could face side-effects."

Both the chemical and psychological dependency needed to be taken into account. "A person who suddenly has to stop can experience psychological panic, which can be as powerful and impactful as the chemical dependency."

Peter Eagles, president of the SA Pharmacy Council, said there could be many reasons for the shortages, including inadequate standards at facilities producing the drugs.

This was what caused the recent Disprin shortage, when Enaleni Pharmaceuticals was forced to upgrade its Durban facilities and there was a disruption in supply.

Many pharmaceuticals were produced in countries such as India, Iceland and Puerto Rico. Sometimes after inspections these facilities were closed down.

Eagles said competing markets and economics could also be contributing reasons.

A pharmacist at Dischem said the shortages had not only increased their workload but had annoyed customers who had to return to get their medication. "People on anti-depressants also can't just swap their medication, so they are getting upset."

Among the items out of stock at their pharmacies were the anti-depressant Trepeline, and Buto-Block for high blood pressure. One of their lines of anti-retrovirals was also in short supply, and there were shortages of cold and flu medication containing ephedrine.

The pharmacists said on one occasion robbers in Johannesburg had hijacked a truck containing more than 500kg of ephedrine, which is a chemical commonly used in the manufacture of cat and tik (methamphetamine). This had possibly contributed to the shortage.

A Johannesburg pharmacist said they were also experiencing several shortages of drugs at the moment. Aropax, an anti-depressant produced by GlaxoSmithKline, hadn't been available for some time while Molipaxin, also an anti-depressant produced by Sanofi Aventis, was "totally unavailable".

He said people on anti-depressants couldn't simply swap their medication for something else. "We also can't get Disprin or Codis. The manufacturers either say they are battling to get raw ingredients or there are problems with packaging."

A pharmacist in Tokai said since the end of last year they had experienced many problems with items being unavailable for weeks at a time.

"It is extremely frustrating because we are not told why there is a shortage. And it is not just a particular class of drugs but across the board."

She said it seemed to be getting worse daily. "Previously we were out of stock for maybe a week, but now it can be months."

Allison Vienings, the executive director of the Self Medication Association of SA, said there were many reasons for medicine shortages. "Sometimes the formula is required to change and these changes have to be approved by the Medicines Regulatory Authority."

An application for change had to be submitted and it often took some time to be approved. Manufacturers could also face a shortage of ingredients.

Mary Termets, of Sanofi Aventis, said they had been out of stock of the anti-depressant Molipaxin 50mg capsules since last year as a result of a global shortage of one of the raw ingredients, and were unlikely to get stock before the end of April. GlaxoSmithKline failed to provide reasons for the shortages, while Bayer did not respond to calls.

This article was originally published on page 5 of Cape Argus on March 22, 2008



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