Crown
 

Laura,
The original announcement by Merck was an EU wide announcement, that said there would be a 'world wide' shortage running from late 2009 through till 2011. We are unaware of what is happening in non-english speaking countries, or countries that have no socialized or insurance based health systems. I do not believe that this is a matter relating to ex british territory as the the notices relating to shortage appear to come from Merck and it's subsidiaries. It would seem likely at the moment that this is some kind of bidding up strategy that pharma is using. The possible connection to Britain is health service style, with Canada having something fairly similar to the UK, and Australia having something halfway between the US and UK model. If there is no real shortage, and this is bidding up, then surely there should be some kind of regulatory org, perhaps the WHO, with some kind of watchdog capacity. I am as stated in other posts, completely bewildered by this. At this time none of it makes sense.

While there are other levodopa based medications available the problem comes for those patients who are settled on a particular regime AND who have not found benefit from generic substitutes, OR who have great difficulties changing medications resulting in weeks of adjustment. Also for the elderly who may not be in charge of their own regimen of drugs, in whom any deterioration may not even be connected by their carers to a change in medication.

Down through the rabbit hole again.............

Britain: a call for a public investigation
 

Still no info about Europe, or South America, Asia, etc. In Britain, demand for an investigation:

• The Pharmaceutical Journal 2010; 284:41 (UK)

In mid-November, 2009, 10 major players in the medicines supply chain and the Department of Health issued joint guidance reminding stakeholders of their legal and ethical obligations to meet the medication needs of UK patients.
From the patient’s perspective, stock shortages are not just an economic matter. Out-of-stock medicines can lead, at best, to increased visits to pharmacies to complete the supply and, at worst, to increased adverse reactions. The PSNC quotes US research that finds that when alternatives are prescribed this can cause confusion and decrease compliance.

Taking the issue to a national level, the PSNC has also asked the Department of Health to impose information requirements on branded medicines manufacturers to support the ongoing monitoring of supply problems and has recommended that it should institute a review in conjunction with manufacturers, distributors and community pharmacy to consider what measures can be put in place to address supply issues.
It will be using evidence supplied by contractors of supply issues linked to changes in manufacturers’ distribution arrangements to support this. The Society, meanwhile, has written to the Secretary of State demanding a public inquiry.
.... it is still the view of the BAPW that there is a fundamental fragility in the supply chain, caused by a combination of factors, including just-in-time ordering, which has reduced the amount of buffer stock in the system, a reduction in the number of full line wholesalers, and a rise in the number of entrepreneurs in tune with foreign currency exchange rates.
He describes the medicines shortages that pharmacies see today — and which they may still see tomorrow — “as the price paid for the efficiencies that have resulted in cost savings for the NHS”.

Curiouser and curiouser
 

Sorry, didn't mean to make light of it by suggesting alternatives...I know some of us really only respond to the brand name variety and have very little room for tweaking drugs in an efficacious way.

I guess I'm going on the the omissions in this official notice. I don't see this notice anywhere on the US PD org sites and nothing from the FDA- they would surely issue some sort of warning. Maybe I overlooked something? Also checked the official PD org in France, as that's the only other language I can read with some fluency- no mention there either and they are on socialized system- though hardly an indicator of the entire pharma situation in the EEC. Maybe my suspicious nature wonders that they didn't term it "global supply shortage", whether true or not, to cover their *****? I see a legal team hard at work behind this.

I suspect what you say about the bidding may be true; largely, it seems mostly smoke and mirrors at this point - that is even more reprehensible than economics.

I know the EPDA has issued a statement and that there seems to be a buzz on the UK PD forum, has anyone been able to phone them for more info? Seems likely they would have an inside scoop of some sort...not that they would willingly share it!

Anyway, thank you for the clarification :)

Laura

I did find a little information on the Canadian shortage from Health Canada and the Parkinson's Society. The situation in Canada seems somewhat different than what was reported in Europe and Australia, and it was predicted to be resolved sooner. But the fact that these announcements of shortages all were made around the same time is suspicious. Still no real answers. If you haven't already seen these web pages:
Questions and answers
http://www.parkinsons-society.org/pd...etShortage.pdf
Health Canada update
http://www.hc-sc.gc.ca/ahc-asc/media...010_14-eng.php
Bristol Myers Squibb
http://www.bmscanada.ca/bms/news/imp...s/?imp_id=2601

Manufacturing of Apo-Levocarb CR
 

I called the company listed on the Health Canada web site:
Apotex Inc. has information on its generic product, Apo-Levocarb CR (200/50) on its website or call 1-877-427-6839.
http://www.hc-sc.gc.ca/ahc-asc/media...010_14-eng.php
The individual answering the phone maintained there is a shortage of their product only in the US--that inspection of their manufacturing site in the US did not meet FDA requirements and the sites were temporarily shut down. That there is no shortage in Canada and the manufacturing of the product for Canadians continues. This individual did shunt me to another phone number for which I received a prompt to "leave a message", which I did. Really surprised I have yet to receive a return phone call. I cannot vouch for the veracity of this person's explanation.
In additon , the phone # for Bristol-Myers Squibb listed in the article is a "non-working number".....
Will continue my attempts tomorrow. madelyn

Canadian shortage experience
 

2 weeks ago I had a prescription for APO levo/carb 200/50 to be renewed

NO APO product available...

Presription filled with brand name Sinement 100/25 with twice # of pills..

take care ,,, ken

Australia: shortage upgraded to none at all.
 

Update:
The Pharmaceutical Society of Australia has received updated advice from Merck Sharp & Dohme (MSD) regarding the supply shortage of Sinemet CR (levodopa/carbidopa). The supply situation is such that the distribution of Sinemet CR to pharmaceutical wholesalers has ceased until 2011. It is expected that the majority of pharmacies will not be able to fill prescriptions from March 2010 for approximately 12 months.
Pharmacists can assist by recommending all patients currently on Sinemet CR to make an appointment with their prescribing doctor as soon as possible to consider alternative arrangements.
Pharmacists with any queries can contact the MSD Medical Information group on 1800 645 712.

So, Aussies, consider your alternative arrangements. How about handing the whole problem over to the Crown Prosecutor? That would be an alternative.

DH Guidance UK
 

For reference relating to uk shortage and supply guidelines

http://www.dh.gov.uk/dr_consum_dh/gr.../dh_108527.pdf

Euphemism of the century...
 

Consider the alternatives?!? That's the best euphemism yet for "sorry, but you are SOL (s**t out of luck)"

I was thinking that if regular Sinemet too ceases production that maybe alternative arrangements means... they will offer on a free and temporary basis DBS surgery which may or may not work? Or maybe there is some sort of experimental brain transplant treatment they are wanting to try? a Russian black market? a Golden Ticket?

Any other grand ideas? My, oh, my what a world we live in. Sham surgeries and no gold standard which sucks when there is no silver standard to fall back on.

-Laura

the wonderful wizards.......
 

so are they giving the canadians what oz should be getting LOL this simply gets more and more bizarre............ but interesting that it should be cr that falls first, what is the next best to cr one wonders, what will all the complicit people prescribe, advise patients to take - that is of course if any of this is real - but maybe it will change prescribing habits yet - does anyone know if patients are actually experiencing shortage yet in oz, i keep wondering exactly when this hammer is going to descend..... and where....... and if..........