COMMENTARY

When Drug Shortages Hit Home for a Doctor-Journalist

Ivan Oransky, MD

Disclosures

May 01, 2019

Hey, brother, can you spare some olmesartan?

For the second time in 18 months, one of the medications I take is on backorder, meaning I'll go without it for some unclear period of time.

In late 2017, it was atenolol, which I'd been taking for more than a decade for essential hypertension. After consultation with my internist, the drugstore had switched me to metoprolol. It controlled my blood pressure well enough, but after a few weeks I could swear I was throwing premature ventricular contractions as I was about to fall asleep. The only other change I'd made in the recent past was to stop drinking Diet Coke—hey, if Harlan Krumholz, MD, quits diet soda, that's good enough for me—but neither my internist nor I thought that was the culprit.

So off to my new cardiologist I went. That referral was somewhat inevitable, given my family history. He ran me through the gamut, including an exercise stress test and a Holter monitor. (Bonus: The day of the Holter, I forgot I had Yankee tickets, which meant explaining to security why I looked as though I was strapped with a bomb.)

By the time the Holter happened, I was back on atenolol and there was nothing of interest in the report. Neither was there anything of note on the stress test, except for some slight thickening that had been there before. But my new cardiologist decided that it was time to add another class to my regimen of a beta-blocker and a diuretic, and put me on olmesartan, an angiotensin II receptor blocker (ARB).

That was a year ago, and it seemed to be working quite well. When I saw my internist last month, he and I both did a double-take at my blood pressure of 115/70 mm Hg. I couldn't remember when it had been that low.

Then, last weekend, I received a text from my drugstore, one of the big chains. My atenolol refill was ready for pickup, but "Rx O is on order and we will text when ready." When I picked up the atenolol, they said they had no idea when the olmesartan would come in. I transferred the prescription to a drugstore in New York and they had no olmesartan either. They even recommended calling a few of their competitors to see if they had any remnant supplies.

There is definitely an olmesartan shortage, and there has been since mid-March, according to the US Food and Drug Administration (FDA), but some manufacturers do have some available. The best I can tell, the drain on olmesartan is a knock-on effect of so many other sartans being recalled because of contamination with cancer-causing nitrosamines. And as Medscape Medical News has reported, doctors are shifting their patients to ARBs deemed safe by the FDA, straining supplies in the process.

Meanwhile, I'll just have to wait. When it comes to drug shortages, none of us is immune. Hopefully it won't happen again with some other drug I'm taking, but let's face it—it probably will, if history is any indication.

It's enough to raise your blood pressure.

Ivan Oransky, MD, is vice president of Medscape Editorial.

Follow him on Twitter: @ivanoransky

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