Antipyretic for children not available

Pharmacists worry
Fever juice for children is no longer available – also lack of asthma medicine

A wave of colds, which is unusual for the summer, and many corona infections lead to a lack of cold medicine. Especially children with pain or fever remain untreated. Asthma medicine is also becoming scarce. What funds are affected and what can be done?

Pharmacists fear their weekend and night shifts out of concern that parents of children with high fever should be sent home without sedatives. Because there is a state of emergency – especially with some children’s medicines. Such an increasingly dramatic situation has never existed before, says Thomas Preis, chairman of the North Rhine Pharmacy Association. If the pharmaceutical manufacturers’ production does not work reliably again soon, the winter will be difficult.

What he means: Many cold medicines are becoming scarce. Pediatrics is particularly affected. Pain and fever syrups for children with the active substances paracetamol and ibuprofen are no longer available according to the information of the pharmaceutical associations.

Not only Ratiopharm reports delivery issues

However, the list of increasingly rare over-the-counter over-the-counter medicines when you have a cold is much longer: Because other dosage forms are used as an alternative to painkillers and fever syrups, there are also initial delivery problems with some children’s suppositories. Wholesalers are currently unable to supply suppositories to the very young (75 milligrams), Preis says. Certain sore throat sprays for adults are also no longer available. “A manufacturer of cough medicine for children and adults has announced that it will no longer be able to deliver,” says Preis.

Ratiopharm – the market leader in children’s nasal sprays – last week canceled all pre-orders from pharmacies for the coming winter. According to information from the industry magazine “Apotheke Adhoc”, there are “currently no stocks available” at Teva – the world market leader in generic manufacturers, to which Ratiopharm also belongs. Klosterfau, producer of the competing product Nasic, tells the trade magazine that it can deliver fully despite increased demand and has stepped up production for the coming autumn and winter. Nevertheless, industry experts expect that alternative producers will not be able to absorb the sudden increase in demand and that the domino effect will continue. Exfoliating baby nasal spray with the active substance xylometazoline can then become a scarce commodity in the fall.

“In addition, a manufacturer of cough medicine for children and adults has announced that it will no longer be able to deliver,” says Thomas Preis. Pharmacies do not expect deliveries again until August. These are products from the manufacturer Sanofi. Here it says that “some Mucosolvan products are more in demand”, but that the company did not identify a supply bottleneck when we asked them.

Adult medicine is also affected

Various prescription drugs for adults are also on the list of concerns: cholesterol-lowering drugs, some asthma sprays containing cortisone. If you switch to alternative products – if they are available – these will also be sold out within a few minutes. In light of the situation, only a change of therapy to other active ingredients would be possible. However, if 80 percent of the patients are adapted to one active ingredient due to the good effectiveness of a therapy, and then everyone has to switch, the other manufacturer will not be able to compensate for this so quickly. Pharmacists therefore fear a domino effect.

According to Apotekerforeningen Westfalen-Lippe, supply bottlenecks have been one of the biggest challenges for pharmacies for decades. Nearly 260 supply bottlenecks are currently listed by the Federal Institute for Drugs and Medical Devices. In recent years, the list of unavailable has mostly been topped by blood pressure medication, followed by painkillers and antidepressants.

One reason for the recurring supply bottlenecks for the painkillers and antipyretics currently most affected for children: Of the eleven suppliers that produce paracetamol juice twelve years ago, only two remain, as the special service “Arznei-Telegramm” reports. []Apart from Ratiopharm, only Bene-Arzneimittel still produces this juice.

Another reason for the supply problems: Demand has risen sharply. Due to the cold and flu epidemic in 2021 and early 2022, the demand for the antipyretic in juice form increased significantly. The company Ratiopharm explained to Stiftung Warentest that they were not prepared for such a high demand. Due to certain delivery times, production was also unable to respond so quickly to the increase in demand, it said in May. But now several weeks have passed where Germany has been gripped by an unprecedented wave of colds.

Remedies are used to treat cold and corona symptoms

For weeks, weekly reports from the Robert Koch Institute have shown an above-average number of respiratory infections compared to the pre-corona period. According to experts, these are mainly due to the omission of corona rules such as the obligation to wear masks. In addition, there are many current corona infections. In a mild and moderate course, the symptoms caused by Corona are also treated with painkillers and antipyretics. Cough syrup, throat spray or nasal spray are also used to relieve normal cold infections.

The fact that the information provided by the drug manufacturers about bottlenecks in the supply is based solely on a voluntary commitment to the Federal Institute for Drugs and Medical Devices does not help solve the problem. The notification is therefore not required by law. The wording of the manufacturer often mentions “temporary delivery bottlenecks”.

In the case of primary medicines, manufacturers should also be held accountable for their supply responsibilities in the same way as the supply of vaccines. On the other hand, the political conditions should also be created for companies to have a purchase guarantee on pre-ordered quotas, says the Pharmacy Association North Rhine-Westphalia.

What can those affected by bottlenecks do now

Ask your pharmacist when the medicine is expected to be available again. Sometimes the inventory in your own medicine chest is enough to bridge this time window. Get a prescription as early as possible and redeem it as soon as possible and not until the necessary medicine runs out the next day.

Ask your doctor or pharmacist for alternative products. Preparations from other manufacturers or in other dosage forms are often still available. With fever juice for children, for example, there is an alternative to paracetamol or ibuprofen suppositories. The lowest dose is 75 milligrams. Paracetamol suppositories in this dose are suitable for children weighing three to six kilograms. According to Stiftung Warentest, however, suppositories have the disadvantage that their insertion can trigger bowel movements. This also transports the suppository back outside. In addition, the drug in suppository form does not completely enter the bloodstream.

According to “Apotheke Adhoc”, Ratiopharm itself pointed to a partial solution. This is the drug Paracetalgin, which was approved a year ago and could be a solution for children weighing 17 kg or more (children between four and eight years). You can make a suspension for this yourself from a single dose of the drug by letting a tablet disintegrate into granules in water.

The problem, however, is that the exact dose is uncertain for parents. One tablet contains 500 milligrams of the active ingredient. However, children over 17 kg may take a maximum of 250 milligrams as a single dose and no more than 1000 milligrams per day. One should halve the tablet and be sure that the child is taking the self-made granules at all. Because compared to ready-made fever and painkillers that are flavored to make it easier for children to take them, the liquid homemade remedy does not offer such a flavor stimulant.

Also important: Children weighing less than 33 kilograms should not take paracetamol tablets. According to Stiftung Warentest, these usually contain too much active ingredient. Overdose can cause paracetamol poisoning in children.

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