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Florinef and Solu-Cortef Shortage Update

Posted August 22/19
Drug Shortage Status Inquiry (Reply from Health Canada, Courtesy of Mr. Ali Ehsassi, MP)

As of August 21, 2019

  • Health Canada recognizes the significant impact that drug shortages can have on patients and is committed to doing its part to address them when they occur.

  • According to www.drugshortagescanada.ca, the following information is being reported:

    • For SOLU-CORTEF products, as of August 5, 2019, Pfizer Canada Inc. has resolved their shortages for the 100 mg, 250 mg and 1 g strengths. Currently, there are no actual or anticipated shortages being reported for SOLU-CORTEF products.

    • As there are no shortages currently reported for SOLU-CORTEF products, intervention such as the use of an Interim Order is not being considered.

    • For CORTEF products, Pfizer Canada Inc. is not currently reporting any actual or anticipated shortages.

    • For FLORINEF, Paladin Labs Inc. is currently reporting an actual shortage with an estimated shortage end date of September 23, 2019. Paladin has implemented a measured national allocation strategy to conserve existing supply.

  • Regarding the recently resolved shortages of SOLU-CORTEF products and the current shortage of FLORINEF, Health Canada has been engaged with the companies and will continue to monitor the situation and take action as required.

  • When a critical national shortage occurs, Health Canada works with stakeholders across the drug supply chain to coordinate information sharing and identify mitigation strategies. Factors such as whether the shortage is national in scope, whether alternative supplies are available and whether the product is considered medically necessary are all considered in determining the potential impact and any necessary actions by Health Canada.

The Canadian Addison Society will continue to contact Health Canada and political representation in the event of future shortages.


Florinef Shortage Update - see most recent update above

At the time of writing, Paladin Labs continue to say they do have inventory of Florinef in limited quantities and are shipping allocated quantities on a regular basis.
Regardless we continue to hear of situations across Canada where patients have been unable to have their Florinef prescriptions filled at their usual pharmacy.
We also hear from patients who have had their prescription filled without issue. The writer had such an experience and received a prescription refill in late July, without any indication of a supply issue.
The Health Canada Drug Shortage Report states that Paladin does have "Limited Inventory. Stock available on allocation".
https://www.drugshortagescanada.ca/shortage/87124

The following link will take you to the website of The Canadian Society of Endocrinology and Metabolism where a message on this topic may be found:
https://www.endo-metab.ca/53-front-page/237-florinef-shortage

We suggest that you consider asking your pharmacy to call other distributors as clearly some of them have Florinef inventory. Alternatively try pharmacies of other chains, or independent pharmacies.


Brochures & Holder Program

We are pleased to introduce our complimentary Brochures & Holder Program, an important element of our ongoing Awareness Campaign. If you are an AI patient and feel your Doctor(s) may be interested in contributing a little bit of counter space for our Brochures, please take this info sheet to your next appointment.

If you are a Healthcare provider and have a little bit of counter space for us in the patient area of your facility, please email to place an order. There is absolutely no charge of any sort, including refills of brochures. You may view the Brochure on our website by following this link:
http://www.addisonsociety.ca/pdfs/cas-brochure.pdf

Brochures & Holder ProgramSmall countertop footprint
12 cm W x 8.25 cm D
4-3/4" W x 3-1/4" D

UNTOLD STORIES OF THE ER - "ICE COLD MOM"

The video you are about to see is titled “ICE COLD MOM” and was originally a segment on the popular TV series UNTOLD STORIES OF THE ER. We are grateful to the Executive Producers, Bob Niemack and Allan Harmon, for use of this segment highlighting the life or death nature of an adrenal / Addisonian crisis. The video also outlines the challenges emergency doctors face in diagnosing Addison’s disease and/or Adrenal Insufficiency and treating an adrenal crisis.

The woman brought into the ER and played by an actress is depicting the experience of Shannon Meister, a longtime member of our South/Central Ontario Support Group.

The emergency events that unfold are not necessarily unique. Many ER Physicians may have never faced what is eventually diagnosed as Addison’s disease/Adrenal Insufficiency. All of the symptoms exhibited in this scenario are not necessarily typical of an Addisonian or adrenal crisis.

Enjoy the Video!

Spoiler Alert...
The following information will divulge the outcome but the video is certainly still worth watching to see the process that was followed and how diagnosis was eventually made.

In an ideal world, CBC (Blood tests) and Electrolytes would initially be tested. The testing of electrolytes is often overlooked and may dramatically reduce the time to diagnosis and prevent unnecessary tests not relevant to treatment.

Shannon’s treatment path included: IV fluids, raising her body temperature, giving antibiotics. Electrolyte tests revealed low sodium and high potassium results. It was at this point that Dr. Kapoor suspected Addison’s disease. Her sodium levels were raised slowly to avoid complications. His decision to give hydrocortisone before getting confirmatory lab results (hormone testing) may have saved Shannon’s life. Injectable hydrocortisone was immediately given with this suspected diagnosis.

Various shock states: hypoglycemic (glucose gel given), hypovolemic (fluids), hypothermic (“Ice cold mom”), septic/infectious (antibiotics given), drug overdose (confusion / "incoherent") were considered by Dr. Kapoor up to that point. This video depicts a chain of events whereby the suspicion and/or confirmation of an Addisonian or adrenal crisis resulted in immediate administration of hydrocortisone (glucocorticoid of choice) with saline support. Dr. Kapoor states it well: “As an emergency physician I wanted to ‘get it right’”! The THREE rights for an adrenal crisis: right medication (hydrocortisone) at the right time (immediately) at the right dose (adult dose – 100 mg). Hydrocortisone is the treatment that saved Shannon's life.

This video also aligns with our EMS initiative whereby any individual with Addison's Disease / adrenal insufficiency carrying injectable hydrocortisone will require a pre-hospital injection if an adrenal crisis is suspected (before transport to hospital).

This is the positive outcome in this video: "Thank you for saving my life". Unfortunately, many die because of delayed hydrocortisone treatment for confirmed or suspected conditions of adrenal insufficiency.

The Society also has a description of symptoms posted here.

Thank you for watching!
The Canadian Addison Society
August 2018


Exciting EMS news to report…

We are extremely pleased to share the latest EMS news from Newfoundland & Labrador as of Sept 25, 2018. Following are the intros and links to media reports both print and video, all of which announce and/or discuss the implementation of the new potentially lifesaving EMS protocol for suspected adrenal crisis. We are very grateful to all that helped to make this new protocol a reality.


NTV Evening Newshour Early Edition - Tue, September 18, 2018

LIFE-SAVING MEDICATION TO BE ADMINISTERED BY PARAMEDICS: Paramedics in the province that now able to administer a shot that could save lives.
["Dr. Brian Metcalfe"]


NTV Evening Newshour - Tue, September 18, 2018

THE CARTER FILE: A milestone in our health care system today; paramedics will now be able to administer a life-saving drug.
["Dr. Brian Metcalfe"; "Dr. Carole Joyce"; "Paula Courage"]


“The Last Remaining Light”

We are pleased to participate in the global introduction of a short film “The Last Remaining Light”. A link to the film is located at the bottom of this article. The film was produced and directed by Martin Wallgren and co-produced by Addisonian and Team Addison bicyclist Martin Norrman (Martin Norrman also founded the non-profit Swedish Addison’s Association https://www.addisongruppen.se).

Following is a short intro to the film:
This is the most brilliant, touching and phenomenal movie for Addison's ever, letting the world know more about primary Addison's (it applies greatly to all forms of AI) along with breathtaking cinematography and narration. It is the story of the illness, fight and triumphs of co-producer and actor Martin Norrman, in coordination with producer and director Martin Wallgren. This movie was made with the goal of raising awareness of AI diseases, and we can't thank Martin and his team enough for their years of hard work and dedication to this important project, and for this awesome film.
While some people diagnosed with primary Addison's might not feel they can resume the level of activity Martin does in this amazing film, they will definitely see their own story in his.

PLEASE SHARE THIS MOVIE LINK WITH EVERYONE YOU KNOW:
https://vimeo.com/martinwallgren/thelastremaininglight
The more we can raise awareness of Addison's and other forms of AI, the more we will increase our diseases' funding, research, treatment options and maybe one day find a cure. This will be the best 15 minutes you will ever have with Addison’s. You can view this film in many languages by clicking the “CC” button at the top.

Addison's Disease (Adrenal Insufficiency)

The number of people with Addison's Disease (Adrenal Insufficiency) varies with surveys in different countries depending on how these surveys are done, but in the United States, between 6 and 11 out of every 100,000 people will be diagnosed with this disease. The statistics are probably the same in Canada.

With this low prevalence of the disease, you may not have met anyone else who has this problem and it can be supportive to discuss your experience with others who have a similar problem.

We hope to help educate not only the medical society but also the public to aspects of the disease.

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