Amid shortages going again months to over a yr of dextrose syringes and intravenous fluid baggage to deal with all kinds of emergency circumstances, US emergency medical companies (EMS) are scrambling to adapt treatment protocols and conduct trainings on the right way to use them.
Dextrose is a important drug used to deal with circumstances equivalent to low blood sugar (hypoglycemia), dehydration, acute alcohol poisoning, and excessive potassium ranges, or as a carbohydrate in parenteral vitamin, in keeping with David Margraf, PharmD, PhD, pharmaceutical analysis scientist on the Resilient Drug Provide Challenge (RDSP), a part of the College of Minnesota’s Middle for Infectious Illness Analysis and Coverage (CIDRAP), writer of CIDRAP Information
Whereas oral glucose may very well be substituted for dextrose injections, Margraf mentioned, “There might be many sufferers who cannot take something by mouth, so that they want intravenous or intraosseous dextrose. The opposite choice is intramuscular or intranasal glucagon, however this drug is dear, in scarcity, and is probably not the suitable therapy for some sufferers.”
Glucagon additionally has the disadvantages of getting a slower onset of motion and being tougher to manage than dextrose. “Prefilled dextrose syringes are most popular, however many occasions EMS use dextrose from massive baggage,” Margraf mentioned. “This provides time and complexity.”
And since provides of glucagon, a hormone that stimulates the manufacturing and launch of glucose, have not shipped for greater than 6 months and are on backorder, many EMS businesses now not even embrace it of their therapy protocols, in keeping with EMS1.
Some merchandise backordered till 2023
Per the US Meals and Drug Administration (FDA), dextrose formulations in scarcity embrace dextrose 25% injection (producer Hospira/Pfizer, reported on February 2022) and dextrose 50% injection (Amphastar Prescription drugs and Hospira, January 2022). The American Society of Well being-System Pharmacists (ASHP) reviews the identical shortages, with the addition of dextrose large-volume 70% injection (B. Braun Medical and ICU Medical, July 2022).
Whereas B. Braun, Baxter Healthcare, Fresenius Kabi, and ICU Medical report backorders or very restricted portions of dextrose 5% injection and small-volume dextrose 10% injection (for which there was a traditionally low demand), and Pfizer reviews restricted portions of dextrose 25%, provide is anticipated to far outstrip demand into the autumn. Causes cited by the producers are both “demand enhance for the drug” or “different.”
In a Mar 4, 2022, letter to emergency-syringe clients, for instance, Pfizer attributed product shortages to “a fancy mixture of things, together with vital and sustained will increase in demand for merchandise throughout our portfolio, largely as a consequence of competitor shortages in addition to different COVID-19 associated impacts and remoted manufacturing delays, lots of which have now been resolved. Whereas Pfizer has labored to satisfy this elevated demand, which is nicely above historic volumes, the market want continues to outpace Pfizer’s manufacturing capability.”
Within the letter, Pfizer had estimated that its dextrose 25% formulation can be again in inventory in June 2022 (though as of Aug 4, 2022, it stays in scarcity) however that the 50% product isn’t anticipated till January 2023.
Whereas the FDA is aware of of the dextrose and glucagon shortages, EMS1 reviews that the probability of producing capability to supply these merchandise anytime quickly could be very low. “And if the merchandise are being manufactured in a website vulnerable to tropical climate, there’s all the time the potential that scarcity might worsen additional, as occurred in 2017,” the article said.
Downstream influence, elevated prices
Stephen Schondelmeyer, PharmD, PhD, co-principal investigator for RDSP, mentioned that dextrose is a cornerstone amongst EMS provides.
“The latest shortages of dextrose are having a far-reaching influence on just about all firefighters, paramedics, and EMS technicians nationwide,” he mentioned. “Emergency kits have to be tailored to incorporate completely different types of dextrose or different merchandise which might be presently obtainable. This variation is not any small job, since therapy protocols have to be revised and up to date, and new coaching could also be wanted.”
New sources for these different merchandise should be recognized and stock ranges established and maintained, in keeping with Schondelmeyer. “Collaboration amongst healthcare techniques and regional distributors is required to effectively purchase different provides,” he mentioned. “All of those changes are triggered by the scarcity of dextrose and add extra prices and complexity to emergency medical techniques.”
“The scarcity of dextrose options gives yet one more illustration of the profound cascading influence from failures out there and the downstream provide chain for important medicines,” Schondelmeyer added.