SU112. The Dark Side of Haloperidol Decanoate Shortage in Canada

Abstract

Background: Drug shortages have become an issue of growing interest for health care providers and patients. The number of drug shortages has been rapidly escalating in the last decade all over the world and affecting all types of drugs. In July 2015, American Society of Hospital Pharmacy (ASHP) reports 265 active-drug shortages. Among impacts of such shortages are safety risks, including compromised effcacy, increased side effects burden, more frequent medication errors, and that lead to higher hospital expenses, spanning higher costs for substitute drug, increased costs for health care professionals to deal with switches and rehospitaliza-tion. Subsequent shortage of the alternative drug may add to the complexity of the situation over time. In treatment of schizophrenia (Sz), it is only in the recent years that drug shortages became an issue in Canada (Piportil, 2014; Haldol, 2015; Modecate, 2016). In such population, long-acting injectable antipsychotic (LAIAs) are traditionally used in nonad-herent, so called “diffcult to follow” patients even though, there is a lot of recent literature favoring earlier use of LAIAs in the course of treatment. Haloperidol decanoate (HD) is a frst-generation LAIA indicated in the treatment of schizophrenia. In Canada, in 2015, a 6-month shortage of HD led to the obligation of switching patients from this antipsychotic to another drug. Methods: We report a retrospective chart-review mirror study of the 6 months before and after switching HD in 61 patients followed in a third-line psychiatric hospital facility in Quebec city. Results: Patients were mainly suffering from Sz (80%; BP 20%). A signifcant proportion of patients were also suffering from comorbid personality disorders 46% and/or 57% substance use disorders. Mean age was 50 years old. For 30% of the patients, extrapyramidal syndrome (such as tardive dyskine-sia) was described with use of HD before switching. For 60% of patients, HD had been used for more than 10 years. Fifty-eight percentage of the cohort had not been hospitalized during the previous 2 years. A third of the patients were switched to fuphenazine décanoate (FD), while another third were switched to oral haloperidol, the others to various other antipsychotics (only 1 patient to clozapine). Over all, in the 6 month before switching, number of hospitalization days required for this cohort was 800 days compared to 1185 days in the 6 months after, with an individual “mean hospitalization duration of 31 days before compared to 40 days afterwards, corresponding to cost increase of $180 000, only including hospitalizations”. Conclusion: HD shortage had signifcant impacts, particularly on hos-pitalizations, in this cohort according to our retrospective chart review. Moreover, in summer 2016, FD itself became back-ordered meaning a new switch for many of those vulnerable patients. These results call for a more vigorous and coordinated reaction from our health care authorities to avoid such situations.