BEIRUT: Lebanon is the latest country to be affected by a shortage of a medicine used to treat epilepsy, which has doctors and patients scrambling for an alternative amid uncertainty over when new supplies will arrive on the market.
A dozen pharmacies were contacted by The Daily Star to inquire about the availability of Epanutin, a drug used by patients with epilepsy to prevent seizures and whose active ingredient is called Phenytoin. The drug has been in use for decades.
Only one pharmacy in Tripoli said it had received a shipment of the drug recently and would distribute it in the coming days.
The other 11 pharmacies said the drug supply had been “cut off,” for periods as short as two weeks and as long as five months.
A spokesperson for Pfizer, the drug’s manufacturer, said the supply issue would be fixed soon.
“We did have a supply constraint earlier this year triggered by supply constraints of the Active Pharmaceutical Ingredient [Phenytoin],” the spokesperson said. “However we have fixed that situation and expect the constraints to be resolved by the end of this year or in early 2014.”
“It’s a major problem,” said Bassem Yamout, professor of clinical neurology and director of clinical research at the American University of Beirut's Multiple Sclerosis Center.
“It is an anti-epileptic and the patient should not cut it abruptly,” he said. “If they cut it abruptly, they are at a very high risk of an epileptic fit, which can be a danger to their life.”
The pharmacies surveyed were in Beirut, Dbayyeh, Jounieh, Dikwaneh, Jal al-Dib, Tripoli, Zahle, Batroun, Zghorta and Jbeil.
Pharmacy employees said the supplier was no longer providing them with the drug.
The Health Ministry did not respond to a request for comment.
Earlier in the day, Armand Phares, the president of the Lebanese Pharmaceuticals Importers Association, had said the shortage was a result of a problem in production, likely due to an issue with the raw materials used to manufacture the drug.
He said that the Health Ministry and the local agent that distributed the drug were discussing possible alternatives.
Phares said there was another drug that could be prescribed in an emergency to treat epilepsy.
“There is a problem, but it is not drama,” he said.
But Yamout said patients had been calling him for the last 10 days complaining of the unavailability of Epanutin. He said he was unsure of the reason for the shortage, though some pharmacies say an alternative drug may be available in the coming days.
But some patients may not be able to wait that long, he said.
“Some patients do not have enough medication for 10 days,” he said.
One man who has been living in Lebanon for 10 years and whose wife has been using Epanutin for four decades said he was worried they would run out.
“All the pharmacists are telling me the same story, that there’s a national shortage,” said the man, who requested anonymity for privacy reasons. “The problem seems to be the supply side.”
He said the drug usually cost him LL9,000 for 100 tablets and he usually kept a one-month supply of the drug for his wife.
“What really worries me is the fact that there are a lot of people going to the pharmacists, they rely on the stuff to stop them from having seizures, and they can’t get any,” he said. “That’s distressing and worrisome.”
He said that he would consider taking time off from his work and traveling to procure the drug for his wife, saying it was “ridiculous” that a drug with such widespread use that had been available for a long time was suddenly unavailable.
“This is the kind of drug that should be available everywhere in the world, and as far as I know it is,” he said.
Yamout said this was the first time there was a shortage in Epanutin, saying his patients had been looking for it in pharmacies throughout the country.
Yamout said that there were alternative drugs to treat epilepsy, but they might not be as effective with patients and they could have side effects because epilepsy patients cannot easily switch treatment.
In addition, there are few generic alternatives exist to Epanutin due to the delicacy of the formula used to manufacture the drug. Yamout said his patients were also having difficulty finding generics.
“Epilepsy patients are usually quite sensitive to their treatment,” he said. “We should have the medicine as soon as possible.”
The local agent in charge of distributing the drug is Droguerie Fattal SAL, according to the Lebanese national drug registry. A representative of Fattal was not available for comment.