Leaving the party - withdrawal of South African essential medicines

Abstract

In August 2004 pharmacies and drug depots were advised that the sole supplier of parenteral phenobarbitone in South Africa, essential for the management of status epilepticus in children, was stopping production at the end of the same year. Alternative protocols for the management of status epilepticus resulted in more children requiring intensive care intervention (N = 9) at the Red Cross Children’s Hospital, over a 2-month period, than had occurred in any 12-month period since 2000 (2000 N = 3, 2001 N = 1, 2002 N = 1, 2003 N = 2, 2004 N = 7). Other agents that have suffered or are at risk of the same fate are sodium nitroprusside, labetalol and esmolol. Sodium nitroprusside is used extensively in the peri-operative period in cardiac patients requiring after-load reduction. There are no other nitrates with equivalent efficacy. Supply was stopped in 2005 and only reinstated after the pharmaceutical company was contacted directly. Supply of labetalol and esmolol was stopped without warning. Without access to these products it is necessary to resort to agents that are not appropriate for paediatric use. Acetylcysteine (Parvolex), used in the management of acetaminophen overdose, also became unavailable and the supply was re-established only after direct communication with the pharmaceutical company.