Oxycodone shortage ???

[Pharmacist.steve]

http://www.kptv.com/news/18625382/detail.html

[Kira]

I take oxycodone as my breakthrough med. I am doing a small reduction in my long-acting dose this month and so really needed the oxycodone this month to help with a smooth taper (sometimes I don't use much of it and a "month" supply will last a couple of months).

Anyway, when I to the pharmacy last week to get my scripts filled, they did tell me about this. They didn't have enough oxycodone tablets to fill it but were able to give me oxycodone capsules (which I have never had before). Hopefully this will get sorted out soon... this is a widely used drug and it is strange for them to have shortages of something so widely prescribed.

[Mark N]

Steve, thanks for the heads up.

[debhun]

I to am on it for B/T pain. But I have to ask how would one know who really needs the meds? I am about to go to Fl and in my stay I will have to get my med refilled down there. They do not know me. So will I have trouble? But I will go to a walgreens who I go to here and they should be able to look at my files to see I get them each month.

[Pharmacist.steve]

I to am on it for B/T pain. But I have to ask how would one know who really needs the meds? I am about to go to Fl and in my stay I will have to get my med refilled down there. They do not know me. So will I have trouble? But I will go to a walgreens who I go to here and they should be able to look at my files to see I get them each month.

I would talk to your Walgreen's Pharmacist at home and/or call ahead to the Walgreens you are going to in Florida and make sure that you will not encounter any problems. This should give you some idea of what you will or will not encounter

[Ragtop]

OH GREAT!!
First I find out that I can't get my Duragesic brand patches this
month, now I find out I probably won't get my BT meds either?
Come on, you might as well whip me!
I don't like the generic patches, they just don't work as well for me, so I figured at least I would have the oxy's to get me through the month, now this. ARGHH!
I feel more and more at the mercy of the drug companies all the time
lately!
Not looking like this will be a good month at all. :(
Rags

[Sara1979]

I am in WA and I can't find anyone to fill my b/t script for Oxycodone 5mg. The soonest my Pharmacy said they could have it is next Thursday.

[Diandra]

Hi Steve,
I was just at my local mom/pop pharmacy getting a script filled for Oxy-IR 5mg capsules. I have taken them for awhile and noticed they looked different and the label on the bottle said Oxycodone 5mg tab. I questioned the pharmacist and he said that he could not get the Oxy-IR tablets for months now and the Oxycodone 5mg tablets he gave me are the exact same thing. The Oxycodone-IR that I have always taken is made by Ethex Corp and they are capsules that are 1/2 white and 1/2 light orange/peach color and say Ethex and 041. The new Oxycodone 5m tablet are made by Mallinckrodt with an M stamped on one side and I think an 05/52 on the other side.

First, isn't there a difference between "Oxycodone Instant Release" and "Oxycodone" and
second, is it perhaps because of the shortage that my pharmacist is giving me the next closest thing to what the doc scripted?

Thanks, Diandra

[Pharmacist.steve]

Hi Steve,
I was just at my local mom/pop pharmacy getting a script filled for Oxy-IR 5mg capsules. I have taken them for awhile and noticed they looked different and the label on the bottle said Oxycodone 5mg tab. I questioned the pharmacist and he said that he could not get the Oxy-IR tablets for months now and the Oxycodone 5mg tablets he gave me are the exact same thing. The Oxycodone-IR that I have always taken is made by Ethex Corp and they are capsules that are 1/2 white and 1/2 light orange/peach color and say Ethex and 041. The new Oxycodone 5m tablet are made by Mallinckrodt with an M stamped on one side and I think an 05/52 on the other side.

First, isn't there a difference between "Oxycodone Instant Release" and "Oxycodone" and
second, is it perhaps because of the shortage that my pharmacist is giving me the next closest thing to what the doc scripted?
Thanks, Diandra

To the best of my knowledge all 5 mg Oxycodone doses are Instant release and/or NOT sustained release. Since there is apparently a manufacturing problem at Ethex and/or they have met their DEA "production quota" for the quarter..

Your options are fairly limited... if the pharmacy does not have it in stock.. the only way that you will find if any other store has some remaining in stock is to go store to store with a paper Rx and ask. Probably not a real good idea... accept/take the generic that your Pharmacist provided ... find some alternative drug... probably not a good idea... or wait until Ethex can provide the product once again... which could be one or more months .. depending on the reason behind the shortage... probably not a good idea..

Everyone is trying to run with tighter inventories .. manufacturer on down.. the average Pharmacy has an overall inventory of 30 days level... meaning that some of the high volume items there will only be a 7-15 days inventory level..

I have worked at a couple of specialty pharmacies that anything above a 15 days overall inventory level was UNACCEPTABLE and you would be hearing from the CFO. Meaning that the high volume items had to be in the 3-5 day inventory level... With these inventory levels .. if there is a distribution problem.. you were going to be out of stock in a matter of days..

[Kira]

They gave me the oxycodone 5 mg capsules this past month, about 3 weeks ago (also Ethex... peach & white... sounds the same as yours). I normally take oxycodone 5 mg tablets for breakthrough... use whatever generic manufacturer they happen to have at the time for those (don't really pay too much attention... I've had Mallinckrodt, Ethex, Amide, etc for generic oxy tablets). For me, these are ALL the immediate release.

As far as I can tell, there doesn't seem to be any difference at all between the 5 mg oxy tablets and the 5 mg oxy capsules. It has been 3 weeks. Both forms are immediate release.

I have to get refills, etc in about a week... I'm curious to see if they have resolved their oxy shortage issues or not by then.

Hope you have a similar experience with the capsules vs tablets... for me, there was no noticeable difference.

[Diandra]

Steve and Kira,
Thanks for being so informative. This is why I love this forum...I get a prompt and knowledgeable response from a pharmacist and someone who it taking the exact same meds and gives her experience....what more could I ask for.

I will run out of the Ethex this week and will start the other so Kira, I hope I have the
same response you did. It was given to me for breakthrough as well.

With appreciation,
Diandra

[Sara1979]

Kira, I haven't noticed a difference between the capsules or tablets either. There is still a huge shortage here and it is leaking into other medication as people switch b/t.

[Kira]

Diandra, that's one of the best things about this forum... knowing that the people responding to your questions have actually been there/done that... Glad I could help :)

Sara, I am thinking that I will call the pharmacy before I go to my pain clinic appt next week, to make sure that they still have enough oxy capsules to cover my script. That way, if they say they're having problems with it, I can tell my pain doc and we can come up with an alternate plan. Also, luckily, this month's pain clinic appointment actually falls a couple of days before my scripts will run out, so if there is some problem with getting my breakthrough meds filled we will have some time to fix it.

Has anyone heard anything about why this shortage even happened? I know that there is speculation that it has to do with DEA/diversion/control/etc... but just wondering if any of the drug companies have come out and presented a "for the record" reason that this is happening lately...???

For me, the oxy is not really that central to my pain mgmt and is just my breakthrough med, so this doesn't affect me as much as it would if it were happening with, say, my fentanyl patches or my baclofen or even one of my other, non-controlled substance meds that I need daily (such as my beta-blocker, atenolol). If they just started having unexplained shortages of my atenolol and expected me to substitue random other drugs for it or just do without... they would never, ever get away with that (can you imagine the rage of a country full of cardiologists & PCPs whose post-MI and HTN patients suddenly had to stop their beta-blockers cold-turkey because of drug company nonsense & regulatory bull?)...

[NicoleT]

This has now hit Arizona. I am on Oxycodone capsules instead of Oxycontin because I have an iletostomy and therefore cannot take time release medications. Apparently last month I got the last of supplies. All pharmacies say they have no idea when they will be able to get it again. I would take a guess some of you who were forced to go from 5MG IR tabs to the capsules have now used up the supply. So where does a person go from here?

I cannot walk without pain medication. I am housebound as it is except for monthly trip to doc and weekly walmart trip for food/household. This means bed ridden and on crutches to get to bathroom and kitchen. I am unable to take other meds except hydrocodone which I was using as BT from time to time (about 10-12 a month) I will probably have to go on these until this problem is resolved, but I hate the med as it makes me drugged out where I never got any drugged feeling from Oxycodone. It took years to find the med and doctors that worked for me (and much help from members who were here years ago! 2001-2003) This so sucks.

Are people writing their congressmen and senators? I did. Even wrote Obama. lol If the quota put on manufacturers is to discourage street use this only makes it worse as some patients are resorting to street drugs for their loved ones. I'm too scared to take that route and would not know how anyway, but feel for those that have to. I am fortunate that I have never been in this position before. The fact that fewer manufacturers are now making this med makes the previous DEA quotas unrealistic.

All suggestions and comments appreciated!

Steve?

__________________________________________________ ______
DX: Fibromyalgia, Peripheral Neuropathy, Osteroporosis, CFS, Hypersensitivity to Drugs, Allodynia

[Pharmacist.steve]

All I can run across is that there was a recall.. and/or just stopped distribution because of some manufacturing problem. It is becoming more apparent that more and more generics are being produced by just ONE or TWO MANUFACTURERS .. irregardless of what is printed on the label... and when one goes down... there is a huge disruption.. last year it was digoxin

You might try and see if there is a liquid available... that should be comparable to IR tabs.

Apparently Mallincrot (sp) is apparently trying to ramp up production of their product to fill the void... but not sure if they will hit up against their quarterly production limit before the end of March.

IMO.. this is just another example of the consequences of the impact of the multi-faceted interference by the DEA - Insurance companies - Medicaid - Medicare - FDA and a whole array of other outside influences.. all interested in cutting their expenditures... increasing their profits ... or maintaining their power base..

Unfortunately, patients with chronic conditions are the ones that are impacted the most.

[Kira]

I got my refills today and once again they had to substitute oxycodone IR capsules for the oxycodone IR tabs. The capsules seem to work as well as the tabs for me, so no complaints there... Just seems to indicate that there are still some shortage issues with the tabs.

We just re-increased my patch dose back to what it was in December/January, so hopefully I won't need much of the oxycodone this month anyway, since it is just for breakthrough. (The patch dose stuff is a whole other story... trying to balance central sleep apnea vs pain, while waiting for a sleep clinic appt).

Nicole, hopefully they will be able to fill your prescription for capsules just fine. They don't seem to have trouble with the capsules around here... just the tabs. I do understand what you're saying though, about how now what if they run low on capsules because they are giving them to those of us who usually get tabs.

Steve, I have used the liquid before, and FWIW it also seems to work about the same as the tabs & capsules, for me.

[NicoleT]

Nicole, hopefully they will be able to fill your prescription for capsules just fine. They don't seem to have trouble with the capsules around here... just the tabs. I do understand what you're saying though, about how now what if they run low on capsules because they are giving them to those of us who usually get tabs.

Steve, I have used the liquid before, and FWIW it also seems to work about the same as the tabs & capsules, for me.

Unfortunately they have been out of the capsules for weeks and have no date in sight for more coming in, This is all pharmacies in Phoenix as I called them all. I consider myself lucky for getting my full Rx (minus 5 caps) last month. I was not aware of a problem at that time, and my doctor was not either until this month.

Thanks for the info on the liquid as I can take liquid - just not time release - so this may be a temporary solution as long as this too is not having probs. I will call pharmacy and ask before contacting my doc. All pharmacies are saying they think it could be a month or more........glad to hear the problem is not as bad elsewhere.

Thanks for your help :)

_________________________________________________
Fibromyalgia, Peripheral Neuropathy, Osteroporosis, CFS, Hypersensitivity to Drugs, Allodynia

[NJPain]

So, are you saying my pharm could have this in capsule form??? I doubt it cause they would have asked if I preferred caps.

I am going to ask tomorrow about the liquid form. Doubt it though.

My question is for pharmSteve or anyone, does anyone have a good replacement for the oxycodone? It's my breakthrough med so maybe morphine sulphate? I know they make an MSContin but that of course is for baseline not breakthrough meds.

Would like to have a few suggestions in the bullpen before I talk to my doc tomorrow.

[Pharmacist.steve]

They should be able to get Morphine IR in 15mg -30mg-60mg-100mg... conversion should be in the 1mg oxycodone = 1.5 mg Morphine ball park.

[Bahamaroot]

the consequences of the impact of the multi-faceted interference by the DEA - Insurance companies - Medicaid - Medicare - FDA and a whole array of other outside influences.. all interested in cutting their expenditures... increasing their profits ... or maintaining their power base..
And you KNOW they are all working together in these problems, scratching each others back.

[NJPain]

So, I ended up having my doc swap on my prescription for 30mg MS. Yeah, MS is defintely weaker than oxycodone. Can't believe the price difference.

120 count of 30mg roxicodone brand name cost $340, generic $180.

120 count MS costs $20. Great savings but at a cost cause MS is way weaker than oxycodone.

My doc made a mention of either hydromorphone (dilaudid) or oxymorphone. The phramacy I go to stocks hydromorphone cause I asked while they filled MS prescription. Pharm Steve, would you say that 8mg dilaudid = 30mg oxycodone? Is it close?

btw.....the pharmacist knew about the shortage and said he heard it was because just one company is making all of the pure oxycodone and it just got strained.

[Pharmacist.steve]

So, I ended up having my doc swap on my prescription for 30mg MS. Yeah, MS is defintely weaker than oxycodone. Can't believe the price difference.

120 count of 30mg roxicodone brand name cost $340, generic $180.

120 count MS costs $20. Great savings but at a cost cause MS is way weaker than oxycodone.

My doc made a mention of either hydromorphone (dilaudid) or oxymorphone. The phramacy I go to stocks hydromorphone cause I asked while they filled MS prescription. Pharm Steve, would you say that 8mg dilaudid = 30mg oxycodone? Is it close?

btw.....the pharmacist knew about the shortage and said he heard it was because just one company is making all of the pure oxycodone and it just got strained.


Most likely will be in the 11-12mg range Hydromorphone ~ 30mg oxycodone

Morphine is only WEAKER than oxycodone when it is dosed on a mg/mg basis.. when dosed 1.5mg morphine to 1mg oxycodone.. it should be comparable pain management.

Therapeutic equilvalents cannot be done on a mg/mg basis

Typical dose if Librium is 10mg --- Valium is 5mg --- Xanax is 0.5mg --- Klonopin is 1mg but they are ALL BENZOs

Just like oxycodone - morphine - hydrocodone - hydromorphone - fentanyl are all OPIATES

1mg of fentanyl will probably kill you and probably couldn't tell anything if you took 1mg of the others - unless IV - then maybe!

[Domzy]

Hi Everyone.

Oh geez, I had an appointment with my o/s yesterday and I finally got the nerve up to ask for breakthrough medicine. He gave me a prescription of Oxy IR 5 mgs and you got it, went to 4 pharmacies last night and no one had any at all and didn't know when it would come in. I was reading the other post on this subject and Steve said there is a liquid form of the medicine also. My job for today is trying to find a pharmacy that still has some in stock. Would I need a whole new prescription for the liquid form?

Take Care,

Kathy *butterfly

[Diandra]

Hi All,
I just logged onto the Ethex Co. website to see if I could email them to ask why there is shortage of their Oxy-IR 5mg capsules. They make the Oyx-IR 5mg that I have been taking. Perhaps it is mentioned somewhere on this thread but, I did not realize there was a recall on the product and that was one of the reasons for the shortage.

Here is the link to ********* recall:
http://www.ethex.com/news/pdf/recall_*********.pdf

Here is link to recall letter:
http://www.ethex.com/news/pressRelease012809.aspx

Diandra

[mrsdoubtfyre]

Roxicodone liquid is a concentrate. 1 milliliter (1 cc ) is 20 mg! Most retail community pharmacies do not carry it, unless they supply hospice patients.

I personally would not substitute this. I would ask the patient to get a new RX.
There is huge liability involved and it IS a CII.

The doctor should decide if the patient is trustworthy and will not make an error or that the drug may fall into other hands at home (like a teen raiding the medicine cabinet!). I personally have seen ERRORS involving oxycodone liquid labels, that could kill someone!

I would switch tabs IR for caps IR...since no risk is involved.

[Domzy]

Hi everyone:

I did find the Oxy IR 5 mgs at a mom and pop drugstore. The pills are very tiny, almost mustard color. I wanted to put one in my purse in case I need it. well I dropped it :eek: it took forever to find it! I called a lot of stores, none of the Rite Aids had any or Walgreens.. I have a Medicine Shop close by and they also had them as well one CVS.

Sweet Dreams,


Kathy *butterfly*butterfly

[Diandra]

Hi everyone:

I did find the Oxy IR 5 mgs at a mom and pop drugstore. The pills are very tiny, almost mustard color. I wanted to put one in my purse in case I need it. well I dropped it :eek: it took forever to find it! I called a lot of stores, none of the Rite Aids had any or Walgreens.. I have a Medicine Shop close by and they also had them as well one CVS.

Sweet Dreams,


Kathy *butterfly*butterfly

Hi Kathy,
Who is the maker of the ones you got?
Thanks, Diandra

[krashleen]

I get the 5mg mallinkrodt(sp>) and the pharmacy was out of them, so the doctor wrote for 15mg and break them in half. I was prescribed 6 of the 5mg a day for b/t, and now with the 15mg, well I think I got close to the last of them... the pharmacist told me that they are out of the 5mg, and a little left of the other strengths.
I don't know what will happen in about 9 days when I go for my appt/refill.

Hopefully they won't be prescribing percocets, they don't work well, and give me a headache!

PS the Mallinkrodt brand 5mg is white.

[PAINJOURNEY]

Hey Steve-


What are your thoughts on hydromorphone? My pharmacist says it's easier to get than oxycodone. How are they different? Is it a good breakthrough med? Do several manufacturers make it? Ethex, Watson?

Thanks for your time
PAINJOURNEY

[Pharmacist.steve]

There is no one promoting (or detailing) Hydromorphone to docs and it is a C-II .. so it can't be refilled... I would suspect that the available supply is seldom over-ran.. It is a short-acting opiate and could be a option for BT pain. Like everything else .. if the pt tries it and it works - GREAT .. if it doesn't... you try something else.

[Kira]

Mrs D, liquid oxycodone is available in 1 mg/mL as well... 5 mL (1 tsp) equals a 5 mg tablet. The more concentrated 20 mg/mL version is used for patients who are on higher doses. See http://www.rxlist.com/roxicodone-drug.htm .

When I tried the liquid version, my pain doc specifically wrote the script for the 1 mg/mL liquid version. I do not think my pharmacy would substitute liquid for pills without the doctor's input, though... especially for a schedule II. My pharmacy did substitute capsules for tablets without needing a new script, though.

[NJPain]

I've seen the liquid version of oxycodone a long time ago. It came with what looked like an eye dropper and had markings on the side to tell you what level of liquid equaled what mg of product. You were to suck up the proper amount and shoot in under your tongue and let it absorb.

[mrsdoubtfyre]

Mrs D, liquid oxycodone is available in 1 mg/mL as well... 5 mL (1 tsp) equals a 5 mg tablet. The more concentrated 20 mg/mL version is used for patients who are on higher doses. See http://www.rxlist.com/roxicodone-drug.htm .

When I tried the liquid version, my pain doc specifically wrote the script for the 1 mg/mL liquid version. I do not think my pharmacy would substitute liquid for pills without the doctor's input, though... especially for a schedule II. My pharmacy did substitute capsules for tablets without needing a new script, though.

I have seen the this one too.

But...I have also seen many many labeling errors and confusion with various concentrations interchanged, both in long term care and retail (mostly with hospice orders).
The liability issue is much higher for liquid narcotics, as well as the mismeasurement by the patient potential. The concentrate is usually only given when professional staff nurses are the administrators of the drug. And even then errors happen! I have seen techs type one teaspoonful instead of 1cc on this.

Here, BTW is a list of products and their availability as of Feb 09:

http://www.ashp.org/Import/PRACTICEANDPOLICY/PracticeResourceCenters/DrugShortages/GettingStarted/DrugsNoLongerAvailable/bulletin.aspx?id=509

[Calliope]

Steve:


IMO.. this is just another example of the consequences of the impact of the multi-faceted interference by the DEA - Insurance companies - Medicaid - Medicare - FDA and a whole array of other outside influences.. all interested in cutting their expenditures... increasing their profits ... or maintaining their power base..

Hi everyone. I have been reading here for a while but rarely post.

I just want to say that this med is the only thing that has ever worked for me without sedating me into a zombie. It is the only pain med I take. I have Fibro and this med has allowed me to function, though minimally, around the house and go to town for appointments.

I am devastated that this is happening. I tried to get a refill today and it seems the whole state of NM is out.

Why couldn't the pharmacists at least warn us something was happening?
Why did I have to need a refill to find out?

[Pharmacist.steve]

Calliope...

The typical Pharmacy/Pharmacist is so UNDER-STAFFED that you end up dealing with "what's in your face". The reimbursements from the insurers are so low that there is no reimbursement provisions for being PRO-ACTIVE and if you are an employee of Corporate Pharmacy.. don't bother asking for additional staffing... staffing levels are all determined by Rxs filled/hr.. because that is what generates the revenue/profits to pay the staff. I would think that it would not take long for most docs to become aware of supply shortages.. if they write for any volume of a particular drug... and adjust their prescribing habits.. instead of keep writing for drugs that are not generally available... IN your particular situation.. I wonder just how many pts your doc has had to come back to the office to get a substitute med for oxycodone and yet keeps writing for oxycodone?

[Calliope]

Steve, my doc is probably relieved that she doesn't have to write the prescription anymore. She kept trying to prescribe LA which I tried several times but didn't agree with me. Then she pushed Lyrica on me which made me sick.

This is such a huge, bad thing. I am really in shock. Am going to try to see the doc this week. Damn. i can't believe this happening.

Thanks, Steve. XO

[khuiskamp]

So last month I was shorted 160 15mg IR tabs on the promise that they'd send them when they got them in as they have before... Well I just got a phonecall from the Mayo pharmacy, I assume this has to be one of the largest in the world given the stature of the Mayo clinic and was informed that because it's a controlled substance they couldn't give me the rest of my script. Then 10 minutes later the same woman calls me back and tells me that they only have 60 tabs available for not only my 15's but my 10's & 20's as well... This is one weeks worth of medication with NO help or promise to make up for them, I'm so scared of what I'll do, as I am living in Hawaii and I mail the prescriptions back to Mayo Clinic where my doctor is to fill them. Has anyone else had this dilemma? Especially in dealing with Hawaii's laws on scripts from the mainland & if so what do I do???? Any help is greatly appreciated!

Mahalo,

Kelly

[Pharmacist.steve]

According the Fed/State laws... a Pharmacy has 24-72 hrs to finalize a C-II rxs because of a out of stock situation. IF the Pharmacy cannot meet this time frame - LEGALLY - the Rx is null/void for the tabs/caps not provided and the Rx is recorded only for the number of tabs/caps provided. Either the pharmacy should inform the doc of the short-fill or the patient can show the doc the Rx bottle with the number of tablets dispensed. If the pharmacy charged the insurance for the full quantity... you need to make sure that they have reversed the bill and rebilled for the corrected #/days supply or trying to get more tabs/caps will get a insurance reject as a early refill..

I work as a temp in a number of places and this shortage has caused supply problems on other opiates as patients are switched to alternatives