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The EpiPen shortage that has been plaguing Canada for the whole of 2018 will possibly hit a breaking point in August and Health Canada is warning we may completely run out. Canada’s sole EpiPen supplier, Pfizer Canada, has communicated to Health Canada that a backlog in auto-injector manufacturing has led to a shortage in the product at the wholesaler, distributor and pharmacy levels. In a statement, Pfizer said that they understand “the importance of this medically-necessary medicine to Canadian patients,” but new shipments of the adult version of the product will not be going out until the end of August.

The EpiPen comes in two sizes — the 0.15 mg EpiPen Jr for children and the 0.3 mg adult version. EpiPen Jr is only meant to work for kids up to 30 Kg (66 lbs), meaning that most people over the age of 10 are likely to be prescribed the 0.3 mg. EpiPen is currently the only product of its kind offered in Canada and the product has a relatively short shelf life so demand is high; Health Canada projects they may run out of the 0.3 mg EpiPen within the “coming days or weeks.” Pfizer has said that Health Canada and health care professionals will “help manage supply for patients” and pharmacists will fill “prescriptions with the temporary supply interruption in mind.”

Bad timing

According to Phil Emberley of the Canadian Pharmacists Association, August is one of the months during which EpiPens are in highest demand. Not only are seasonal allergies and insect-related allergic reactions more common during the summer, people are in more situations when they might want an EpiPen handy. Kids are going to camp, people are heading out to the woods or to the cottage where access to immediate health assistance might be limited and parents are prepping their kids to go back to school. All these factors have compounded this month to make the EpiPen shortage even more dire.

What do we do?

Health Canada has instructed people who have expired EpiPens to still use them in an emergency — the medication still has value and it won’t hurt you. They have also suggested that if you need to fill a prescription for a Pen, consider just getting one at a time (keeping in mind about 20 per cent of EpiPen users require two doses to counter an anaphylactic reaction so limiting your prescription isn’t possible in all cases).

Some pharmacists are issuing two EpiPen Jrs to patients and instructing them to use a double dose of the 0.15 mg injectors to equal a full 0.3 mg dose. However, EpiPen Jr is also in limited supply and health care professionals are being selective about their prescriptions of that as well.

In some locations, including Saskatchewan, pharmacists are being instructed to put together syringe kits with epinephrine as a temporary alternative to the pen. These kits are not as simple to use as the EpiPen, but they will have the same effectiveness in an emergency.

Health Canada is also reminding people that in any anaphylactic situation, consumers should immediately call 911 regardless of if they’ve been treated with their regular EpiPen dose, an expired EpiPen, an EpiPen Jr, a syringe kit or nothing. Paramedics are also supplied with EpiPen alternatives and are best equipped to handle anaphylactic reactions.