Shortages of the drug albuterol are about to get worse, in hospitals

Liquid albuterol has been in short supply since last summer, according to the American Society of Health-System Pharmacists.

A shortage of a drug commonly used to treat respiratory problems is about to get worse in the United States, as a major supplier to hospitals shut down last week.

Liquid albuterol has been in short supply since last summer, according to the American Society of Health-System Pharmacists. Since October it has been on the shortage list of the US Food and Drug Administration (FDA).

News of the plant closure worries some doctors who work with patients with respiratory problems such as asthma.

“This is worrisome, especially as we are coming out of the respiratory season, which was in high demand due to respiratory syncytial virus, covid-19 and influenza, and now we are heading into the spring allergy season, in which many children and adults experience asthma symptoms,” said Dr. Juanita Mora, National Volunteer Medical Spokesperson for the American Lung Association and an allergist-immunologist based in Chicago.

“This is a life-saving medicine and being able to breathe is vital for everyone.” The recently closed manufacturer, Akorn Operating Company LLC, had filed for Chapter 11 bankruptcy in May 2020.

It was the only company that made certain albuterol products used for continuous nebulizer therapy. It’s a staple at children’s hospitals, but it’s been out of stock since last fall. Without that specific form of the product, hospitals have had to look for alternatives.

“Members are forced to either make the product themselves or have a third party make it,” explains Paula Gurz, director of pharmacy recruiting for Premier Inc, a major group purchasing company for hospitals.

With Akorn’s closure, Gurz said products from the only remaining major national source of liquid albuterol, Nephron Pharmacuticals, have been on backorders. Nephron started shipping albuterol last Friday, Gurz said, but to get back on track, “it’s going to be an uphill climb.”

Hospitals cope with shortages
Hospitals across the country said they are closely monitoring the supply chain and their current stocks.

They worry that they will have to delay the discharge of patients because they do not have enough medicines, or that there will be more visits to the emergency room by people with respiratory problems who do not have access to them.

Dr. Eryn Piper, a clinical pharmacist at Children’s Hospital of New Orleans, said her hospital hasn’t been largely affected so far, but for months she has heard of retail pharmacies and other health systems having problems with the albuterol shortage.

“The big problem we’ve heard about is inhalation solutions, not really inhalers, but rather solutions that go into nebulizer machines and are inhaled by patients,” Piper explained.

Without the larger Akorn product, staff at Chicago’s Lurie Children’s Hospital had to squeeze the albuterol contents out of smaller containers.

“It takes a long time and is laborious, since 40 containers have to be opened to obtain 20 ml (each patient receiving continuous albuterol needs between 3 and 5 syringes per day)”, explains Julianne Bardele, a spokeswoman for the hospital, in an email. electronic.

When Nephron was unable to meet demand due to manufacturing issues, Bardele said Lurie had to make another temporary switch to a different strength and use an alternative liquid bronchodilator, levalbuterol.

Most hospital pharmacies are aware of supply issues for many drugs, especially pediatric ones, said TJ Grimm, director of retail and outpatient services at Cleveland University Hospitals Medical Center, and are trying to keep more stocks high, especially for less expensive drugs such as albuterol.