TABLE 1.
Medicines involved in shortage.
| Therapeutic class | Agents involved | ATC code | Countries affected | Reasons for shortage | Impacts |
|---|---|---|---|---|---|
| Antibiotics | Ticarcillin/Clauvulanate Quilty (2014) | J01CA13 | Australia | Unknown | Use of alternative drugs with greater risk |
| Piperacillin-tazobactam Gross et al. (2017), Hsueh et al. (2017) | J01CA12-J01CG02 | United States | Manufacturing issues | First-line agent for many nosocomial infections, alternative drugs with greater risk | |
| Meropenem, imipenem Hsueh et al. (2017), Gundlapalli et al. (2018) | J01DH02 J01DH56 | United States | Procurement failure | Compromised treatment due to the use of alternative drugs | |
| Penicillin G Yellapu et al. (2019) | J01CA | Globally | Single manufacturer, quality issues | First-line agent for neurosyphilis: Use of other antibiotics cause rheumatic heart disease | |
| Cefotaxime Banerjee et al. (2018) | J01DD01 | United States | Price increasing of raw material | Use of alternative drugs | |
| Sulfamethoxazole trimethoprim Griffith et al. (2012) | J01EE01 | United States | Production interruption | First-line treatment for pneumocystis jiroveci pneumonia and Stenotrophomonas maltophilia infection | |
| Cefazolin Honda et al. (2020) | J01DB04 | Japan | Contaminated API from Italy | First-line for common infection, shortage led to the use of other antibiotics with related adverse effects and resistance | |
| Erythromycin ophthalmic ointment | D10AF02 | United States | Production interruption, increased demand | Ophthalmic neonatorum prophylaxis, alternative drugs with adverse effects | |
| Anti-retroviral drugs | Acyclovir Mclaughlin et al. (2017) | United States | Multiple reasons | Managed through oral Val-acyclovir with extra efforts of staff for dose calculation | |
| Nevirapine (NVP), Lamivudine (3TC) Meloni et al.( 2017) | J05AG01 J05AF05 | Nigeria | Economic issues | Mutation resulting in drug resistance | |
| Anti-protozoal | Chloroquine, Sulphadoxine/Pyrimethamine Malik et al. (2013) | P01BA01 P01BD01 | Pakistan | Multiple reasons | Appropriate alternative drug use |
| Pyrimethamine Dave et al. (2018) | P01BD51 | United States | Multiple reasons | Prices increased | |
| Artemether/Lumefantrine Kangwana et al. (2009), Tren et al. (2009), Malik et al. (2013) | P01BF01 | Kenya, Uganda, Saharan Africa | Delayed tendering/procurement process, economic issues | Delayed treatment and associated loss | |
| Antineoplastic agents | Melphalan Said et al. (2018) | Germany | Unknown | Alternate drug | |
| Cytarabine Ventola (2011) | L01BC01 | United States | Raw material shortage + quality defects | Compromised and delayed treatment | |
| Cardiovascular medicines | Metoprolol (beta-blocker) Said et al. (2018) | C07AB02 | Germany | Unknown | Compromised treatment |
| Digoxin, pyrimethamine Dave et al. (2018) | C01AA05 P01BD51 | United States | Unknown | Prices increase | |
| Abciximab Clark et al. (2020) | B01AC13 | United States | Quality issues | Relay on alternative drug | |
| Furosemide Tan et al. (2017) | C03CA01 | Canada | Slow production | Appropriate alternatives | |
| Anti-coagulants | Heparin Benge and Burka (2019) | B01AB/B01AC | United States | African Swine fever | Compromise alternative therapy |
| Analgesics | Oral morphine, injectable morphine, hydromorphone, fentanyl Clark et al. (2020) | N02AA01 N02AA03 N01AH01/N02AB03 | United States | Opioid epidemic quality issues | Switch to other dosage forms |
| Salsalate 500 mg Dave et al. (2018) | N02BA06 | United States | Unknown | Price increase | |
| Anesthetics | Midazolam Choo and Rajkumar (2020) | N05CD08 | United States | Pandemic, increased demand | May put patients’ health in severe condition as both medicines are for ventilator patients |
| Propofol Choo and Rajkumar (2020), Siow et al. (2020) | N01AX10 | United StatesSingapore | Pandemic, increased demand | ||
| Bupivacaine Sun et al. (2020) | N01BB01 | United States | Unknown | Used of preservative-free isobaric bupivacaine and adjuvants cause increased side effects | |
| Psychotropic medicines | Lorazepam, Diazepam Clark et al. (2020) | N05BA06 N05BA01 | United States | Manufacturer shortage | Use alternative drugs |
| Anti-epileptic drugs | Topiramide Benhabib et al. (2020) | France | Unknown | Compromise effects with an alternative drug | |
| Vaccines | Hepatitis B, pediatric/Adult Hepatitis A, Zoster vaccines Liang and Mackey (2012) | J07BB04 J07BC02 J07BK02 | United States | Unknown | Online purchasing |
| Radiopharmaceuticals | 99MO Ballinger (2010) | United Kingdom | Cost raise | Rest of the reactors had to struggles to ensure continuity of supply | |
| Molybdenum 99 | |||||
| Electrolyte nutritional support | Amino acid preparations Clark et al. (2020) | B02AA/B05BA01 B05BB02 | United States | Hurricane Maria, 2017 | Alternative therapies with chances of medication error |
| Electrolytes Ventola (2011) | Quality issues | ||||
| Parenteral nutrition therapy Holcombe et al. (2018) | B05BA | United States | Production interruption, quality issues | Component shortage impacts all stakeholders, especially patients up to death | |
| Hormonal drugs | Norepinephrine Donohue and Angus (2017), Vail et al., (2017), Siow et al. (2020) | C01CA03 | United States | Production interruption | Increasing mortality, leading to septic shock |
| Singapore | |||||
| Musculoskeletal agents | Atracurium Siow et al. (2020) | M03AC04 | Singapore | Unknown | Alternatives with side effects |
| Pediatric drugs | IV Sodium bicarbonate Visage et al. (2019) | B05CB04/B05XA02 | United States | Unknown | Delay in treatment |
| Anti-diabetic drugs | Insulin Elbagir et al. (1995) | A10A | Sudan | Manufacturing interruption | Dose reduction, increase times of injection |
| Oncology drugs | Cytarabine Ventola (2011) | L01BC01 | United States | Raw material shortage and quality defects | Compromised and delayed treatment |
| Anti-spasmodic agents | Papaverine Ricci et al. (2016) | A03AD | Israel | Unknown | Microsurgical lefts had to select other agents with less clinical evidence |