Drug shortages putting patients at risk

Pharmacists are reporting critical shortages in heart and stroke medications, mental health drugs and HRT therapies.

Monash University psychiatry department head Jayashri Kulkarni. Picture: Stuart McEvoy

Pharmacists are reporting critical shortages in heart and stroke medications, mental health drugs and HRT therapies as supply chain blockages leave patients ­unable to access vital medications.

Australia has just over 250 medicines deemed at risk of supply volatility and shortages, ­potentially affecting five million patients.

Many patients have had to swap to different drugs after being unable to secure their scripted medication and psychiatrists are warning that withdrawal effects from antidepressant medication represents a serious threat to the health of those who suddenly stop taking the therapies.

The widely prescribed anti­depressant and anti-anxiety drug setraline, marketed as Zoloft, is one medicine subject to critical supply shortages.

The anti-­psychotic olanzipine, sold as ­Zyprexa, is in short supply, as is the drug Risperidone used for treating schizophrenia and ­bipolar disorder.

Jayashri Kulkarni AM, the head of Monash University’s psychiatry department, said people who had interruptions to mental health medications could experience “profound” neurological impacts, and she was very concerned for her patients.

“We’re dealing with brain medications; the brain is a very delicate organ, so it’s different to sudden cessation of other medications,” Professor Kulkarni said.

“With brain medications, it takes a while for the brain receptors to stabilise so if you make sudden moves in either direction, it can result in quite profound complications and return of symptoms, (and) physical reactions as well.

“The other important thing with brain drugs is that they’re not easily interchangeable. Within the different classes of drugs, there’s significant differences between the medications. So when something goes out of access for a brain drug, it can have significant effects on the patient’s welfare.”

Professor Kulkarni said those who could not access Zoloft and suddenly stopped taking medication could experience serious withdrawal symptoms including heart rate changes, sweating, disorientation, changes in body temperature and the risk of seizures. “There’s quite a major neurological serotonin syndrome withdrawal that can happen,” she said.

There are variety of reasons for the drug shortages. Australia is low down the list on the supply chain for many pharmaceutical companies because of having a smaller market, and other countries are willing to pay higher ­prices for drugs. There have also been interruptions to supply chains caused by Covid-19, with many of Australia’s pharmaceuticals manufactured in China and India experiencing delays at ports.

Pharmacist Steve Kastrinakis, director of a group that is the franchisor representing 380 chemists, said drugs used to treat hypertension, including clopidogrel, which is widely prescribed for stroke patients, ramipril, atenolol and irbesartan, are in critical short supply as well as atorvastin and pravastin used to treat high cholesterol.

“To have patients starts on a regime to only then find out part way through it’s actually not available can be so disconcerting for the patient,” Dr Kastrinakis said.

Christopher Levi, director of the John Hunter Health Innovation Precinct, said patients were able to swap to other medications but there was the risk some might stop taking blood thinners and blood pressure lowering drugs if they could not access their regular medication. “The risks are essentially that they might have an increase in their risk factor profile, with high blood pressure being a key risk factor for strokes and heart attacks,” Professor Levi said.