A nationwide shortage of a fast-acting heart medication is getting worse as tight supplies of one form of the drug have depleted stock of another.
Health Canada issued an advisory this week stating that, in addition to an ongoing shortage of nitroglycerin spray, the tablets are now in short supply, too.
Both are used under the tongue to treat angina (chest pain) and improve blood flow in people who have coronary artery disease.
“This medication does help [heart patients] and if they can’t relieve this pain, that increases their risk for heart attack, potential complications, potential risk of death,” said Dr. Anmol Kapoor, a Calgary cardiologist.
“This is a very important medication.… We don’t have much options.”
Kapoor has been trying to source nitroglycerin for his patients since the spray shortage started earlier this year, without much luck.
He’s telling his patients, if they have no medication and they have chest pain, to call 911.
And according to Kapoor, some patients have resorted to that.
“It’s not worth the risk anymore. Just go to the hospital and get some help,” he said.
Kapoor said he hasn’t seen much evidence of the pills being available for a long time.
Increased demand for tablets
In an effort to conserve supply, the Canadian Pharmacists Association is recommending its members limit dispensing these drugs.
At Cambrian Pharmacy, in northwest Calgary, pharmacy manager Mathieu Giroux said the nitroglycerin spray shortage has been causing problems for months.
And that increased the demand for the less popular tablets, triggering the latest stage of the shortage.
“This one is now also on back order. The only thing I can see so far is maybe one brand coming back in August. That’s for the spray, so a few months still,” said Giroux.
“It’s a pretty precarious situation. There’s really no other option on the table for now.”
In its advisory, Health Canada also attributes the tablet shortage to increased demand, adding it’s “looking at ways to conserve existing supply, expedite resupplies to hospitals and pharmacies and access foreign-authorized supply or alternatives, where possible.”
It’s urging patients to talk to their health-care providers about how to manage the shortage and to avoid stockpiling the medication.
In February, the nitroglycerin spray shortage was classified as “Tier 3,” which Health Canada defines as having the greatest potential impact on Canada’s drug supply and health system.
A list of nitroglycerin sprays deemed safe to use beyond their expiry dates is posted on the Health Canada website.
Alberta Health Services said it’s monitoring the shortage but hospitals in the province are not affected at this time.
“AHS has a well-developed provincial process to manage drug shortages and do our best to minimize or completely avoid any impact to patient care,” spokesperson Kerry Williamson said in an email.
“Our provincial pharmacy team has oversight of medication stock inventories and co-ordinates the movement of stock to sites in greatest need for the duration of a drug shortage.”
On the database, Drug Shortages Canada, the tablet manufacturer lists “increased demand” as the reason for the shortage and estimates the supply issues will end in late July or late August, depending on the medication strength.
The nitroglycerin spray manufacturers list estimated end dates as the end of June, end of July, or unknown.
According to Kapoor, some patients can use nitroglycerin patches that are designed to prevent angina. But they’re not a replacement for the spray or tablets, which are used for emergencies, once the pain has started.
“It increases anxiety. It increases stress among the patient population,” said Kapoor.
“They feel helpless. We feel helpless.”
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