Antipyretic for children not available

Pharmacists are worried
:
Fever juices for kids are no longer available – and asthma medicines are in short supply too

A wave of colds, which is unusual in the summer, and many corona infections lead to a shortage of cold medicines. Children with pain or fever in particular remain untreated. Asthma medications are also becoming scarce. What funds have been affected and what can be done?

Pharmacists dread their work shifts on the weekend and at night for fear of having to send parents of children with high fevers home without sedative medication. Because of an emergency situation – especially with some children’s medicines. Thomas Price, president of the North Rhine Pharmacists Association, says such an increasingly dramatic situation has not existed before. If drug manufacturers’ production does not work reliably again soon, winter will be tough.

What it means: Many cold medicines are becoming rare. Children’s medicines are particularly affected. According to information from pharmacists’ associations, pain and fever medicines for children containing the active ingredients paracetamol and ibuprofen are no longer available.

Not only does Ratiopharm report delivery problems

However, the list of increasingly rare and over-the-counter medicines for when you have a cold is much longer: as other dosage forms are used as an alternative to pain relievers and fever syrups, there are also primary delivery issues with some. Baby suppositories. Bryce says wholesalers are currently unable to supply the very small (75 milligram) suppositories. Some sore throat sprays for adults are also no longer available. “One manufacturer of cough medicine for children and adults has announced that they will no longer be able to give birth,” Press says.

Ratiopharm – the market leader in children’s nasal sprays – canceled all drugstore pre-orders for the upcoming winter season last week. According to information from the industry magazine “Apotheke Adhoc”, there is “currently no stock in stock” at Teva – the global market leader in the manufacture of generic drugs, to which Ratiopharm also belongs. Klosterfau, the maker of rival Nasic’s product, told the trade magazine it could deliver in full despite rising demand and had ramped up production for the upcoming fall and winter. However, industry experts predict that alternative manufacturers will not be able to absorb the sudden increase in demand and that the domino effect will continue. Children’s decongestant nasal sprays that contain the active ingredient xylometazoline can become rarer in the fall.

“In addition, the manufacturer of cough medicine for children and adults has announced that it will not be able to give birth,” says Thomas Price. Pharmacies don’t expect to deliver it again until August. It comes to products from the manufacturer Sanofi. This states that “some Mucosolvan products are in greater demand,” but the company did not specify a bottleneck in the offer when we asked it.

Adult medications are also affected

Several adult prescription drugs are also on the list of concerns: cholesterol-lowering drugs, and some asthma inhalers that contain cortisone. If you switch to alternative products – if available – they will also be sold out within minutes. In view of the situation, it will only be possible to change the remedy to other active ingredients. But if 80 percent of patients are adjusted to one active ingredient because of the good efficacy of the treatment and then everyone has to switch, the other manufacturer won’t be able to make up for it so quickly. So pharmacists fear the domino effect.

Supply bottlenecks have been one of the biggest challenges for pharmacies for decades, according to the Pharmacists Association of Westphalia-Liby. Currently, approximately 260 cases of delivery asphyxia are listed by the Federal Institute for Drugs and Medical Devices. In recent years, blood pressure medications have topped the list of mostly unavailable medications, followed by pain relievers and antidepressants.

One of the reasons for the frequent supply bottlenecks of painkillers and fever relievers that currently affects children most: of the eleven suppliers that have been producing paracetamol juices for twelve years, only two remain, according to the report of the specialized service “Arznei-Telegramm”. [https://www.arznei-telegramm.de/01index.php3]Apart from Ratiopharm, only Bene-Arzneimittel still produces this juice.

Another reason for delivery problems: the demand has increased excessively. Due to the cold and flu epidemic in 2021 and early 2022, the demand for antipyretic in juice form increased dramatically. Ratiopharm made it clear to Stiftung Warentest that it was not ready for such high demand. Also last May, the company said that due to certain lead times, production was not able to respond very quickly to the increase in demand. But now another week has passed, as an unprecedented wave of colds sweeps through Germany.

Means are used to treat the symptoms of cold and corona

For weeks, the Robert Koch Institute’s weekly reports have shown an above-average number of respiratory infections compared to the pre-Corona period. According to experts, this is mainly due to the omission of corona rules such as the obligation to wear masks. In addition to this, there are many current infections with corona. In the case of light and moderate walking, the symptoms caused by corona are also treated with pain and antipyretic drugs. Cough syrups, throat sprays, or nasal sprays are also used to soothe common cold infections.

The fact that the information provided by drug manufacturers about supply bottlenecks is based solely on a voluntary commitment to the Federal Institute of Medicines and Medical Devices does not help solve the problem. Thus notification is not required by law. The manufacturer’s formulation often mentions “temporary delivery bottlenecks”.

In the case of primary care medicines, manufacturers must also be held responsible for supply liability in a similar way to providing vaccines. On the other hand, political conditions must also be created for companies to obtain a purchase guarantee of pre-ordered units, says the North Rhine-Westphalia Association of Pharmacists.

What can those affected by the bottlenecks do now

Ask the pharmacy when the medicine is expected to be available again. Sometimes the inventory in your medicine chest is enough to fill this time window. Get a prescription as soon as possible and get it back as soon as possible and not just when you run out of needed medication the next day.

Ask your doctor or pharmacist about alternative products. Preparations from other manufacturers or in other dosage forms often remain available. With fever juice for children, for example, there is an alternative to paracetamol or ibuprofen suppositories. The lowest dose is 75 milligrams. Paracetamol suppositories in this dosage are suitable for children weighing between three and six kilograms. According to Stiftung Warentest, suppositories have a disadvantage that their introduction can lead to bowel movements. The suppository is also carried out with this. In addition, the drug in the form of a suppository does not fully enter the blood.

According to “Apotheke Adhoc”, Ratiopharm itself indicated a partial solution. It is related to the drug Paracetalgin, which was approved a year ago and can be a solution for children weighing 17 kg or more (children aged 4 to 8 years). You can make a suspension for this yourself from a single dose of the drug by letting the tablet dissolve into granules in water.

The problem, however, is that the exact dosage is uncertain for parents. One tablet contains 500 milligrams of the active substance. However, children over 17 kilograms may take a maximum of 250 milligrams as a single dose and no more than 1,000 milligrams per day. You will have to cut the disk in half and make sure that the child takes the self-made granules at all. Because in comparison to ready-made fever and pain relievers, which are flavored to make it easier for children to take in, a liquefied home remedy offers no such stimulation of taste.

Also important: children weighing less than 33 kilograms should not take paracetamol tablets. According to Stiftung Warentest, these usually contain a lot of active ingredients. An overdose can cause paracetamol poisoning in children.

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