Photo Credit: Pornpak Khunatorn

The following is a summary of “Shortages of agents used to treat antimuscarinic delirium,” published in the May 2023 issue of Emergency Medicine by Whitledge, et al.

Antimuscarinic delirium (AD) is a potentially life-threatening condition caused by poisoning with antimuscarinic agents. Emergency physicians frequently encounter this condition and rely on treatment with physostigmine, benzodiazepines, dexmedetomidine, and non-physostigmine centrally-acting acetylcholinesterase inhibitors (cAChEi) such as rivastigmine. However, these medications were subject to drug shortages, which can hinder the appropriate pharmacologic treatment of patients with AD.

Data on drug shortages were obtained from the University of Utah Drug Information Service (UUDIS) database, covering January 2001 to December 2021. The shortages of first-line agents (physostigmine and parenteral benzodiazepines) and second-line agents (dexmedetomidine and non-physostigmine cAChEi) used to treat AD were examined. Information including drug class, formulation, route of administration, the reason for the shortage, duration of shortage, generic status, and whether the drug was a single-source product (manufactured by only one company) was extracted. Shortage overlaps, and median shortage durations were calculated.

During the study period, 26 shortages affecting drugs used to treat AD were reported to UUDIS. The median duration of shortages for all medication classes was 6.0 months. Four shortages remained unresolved at the end of the study period. Dexmedetomidine was the most frequently affected medication, while benzodiazepines were the most commonly affected medication class. Twenty-five shortages involved parenteral formulations; one involved the transdermal patch formulation of rivastigmine. The majority (88.5%) of shortages involved generic medications, and 50% of the products were single-source. Manufacturing issues were the most commonly reported reason for shortages (27%). Shortages often persisted for extended periods; in 92% of cases, they overlapped temporally with other shortages. The frequency and duration of shortages increased in the second half of the study period.

Shortages of medications used to treat AD were common during the study period and affected all agent classes. These shortages often persisted for prolonged periods, and multiple shortages were ongoing simultaneously. The occurrence of multiple concurrent shortages involving different agents could impede substitution as a means of mitigating shortages. Healthcare stakeholders need to develop innovative solutions tailored to individual patients and institutions during times of shortage. Efforts should also be made to enhance the resilience of the medical product supply chain to minimize future shortages of drugs used to treat AD.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001043