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Managing drug shortages

An (imminent) drug shortage is becoming more and more common, including at Máxima. Together with the pediatric oncologists, the pharmacists choose the best solutions. How does this work for vinblastine, aprepitant and antibiotics?

Drugs are not always available for various reasons. In recent years, the number of (imminent) shortages has increased. The pharmacists' organization KNMP reported 2292 drug shortages in 2023, compared to 1514 in 2022. This includes important medicines for children with cancer. Commonly used drugs such as methotrexate infusion fluid, co-trimoxazole suspension, aprepitant suspension, ondansetron syrup and tramadol drops were in short supply on the Dutch market for several weeks or months,’ says hospital pharmacist Jeroen Hassink. Together with his fellow pharmacists, especially Sjoukje Velthuijs, and the pharmacy staff and pediatric oncologists, he solves the problem with creativity and expertise. Sjoukje Velthuijs: ‘Through early recognition, joint problem solving and good communication, we have so far managed to cope with impending drug shortages. But it is becoming more and more complex.’ Jeroen adds: ‘We are now even seeing shortages of essential medicines that are on the WHO list.'

No waste
It's a common situation, but far more drastic was the situation last November, a worldwide shortage of vinblastine. The drug is used to treat lymphoma, as well as children with brain and soft tissue tumors and Langerhans cell histiocytosis. Given the impact of the shortage, a national working group was convened to develop a strategy, which included Cor van den Bos and Jeroen.  ‘We then sat down with a number of pediatric oncologists We wanted to make good use of the limited supply for all 50 children who need it every month,’ says Jeroen. ‘This meant wasting as little vinblastine as possible by taking several doses from one vial.’ A temporary decision was made to administer doses at the Máxima Center, rather than at a community care center, when medically justified. The parents were quickly informed. Jeroen: ‘Such a change in the organization is drastic and of course we want to avoid it. Since mid-February, the shortage has been resolved and the children are again going to a shared care center for their vinblastine donation whenever possible.’

‘Fortunately, we have never had a ‘no’ sale.  We always find a solution.’ Jeroen Hassink - Hospital pharmacist

Not selling ‘no’
Several types of antibiotics were limited or unavailable. So far, the Máxima Center has fortunately been able to maintain sufficient stocks by purchasing them in time or importing them from abroad with the permission of the IGJ. Jeroen gives another example: ‘Take for example aprepitant, a drug for nausea. The only supplier on the Dutch market cannot deliver the suspension powder for weeks. We had an alternative manufactured. The product has a different concentration and is white instead of the usual pink. At a time like this, you have to inform the nurses and parents.’ Sjoukje: ‘Then recently there was a shortage of cotrimoxazole suspension. By restricting dispensing, this situation was managed with a good explanation to the parents from the pharmacy. For parents, this means a very limited supply at home. There was also a recent shortage of ondansetron, also a drug used to treat nausea. Jeroen: 'Together we adjusted the treatment protocol. Almost all children now receive granisetron. That works just as well. The best thing about the pharmacists' work in the face of impending shortages? Jeroen and Sjoukje in unison: ‘That fortunately we have never sold ‘no’ to children and parents. We always find a solution!’