Canada-wide shortage of liquid Children's Tylenol now also impacting chewables

Pharmacist explains kids' pain meds shortage Dr. Nardine Nakhla explains the state of Canada's children's pain medicine shortage and what parents can do to treat their sick child.

Laboratoire Riva, manufacturer of generic and store-brand drugs, reported a shortage of acetaminophen chewable tablets for children on Tuesday.

The Quebec-based company is citing increased demand, according to DrugShortagesCanada.ca, a Health Canada website for drug sellers to report when they are unable to meet demand.

A months-long, nationwide shortage of liquid Children's Tylenol due to a combination of supply chain issues and unseasonably high demand prompted Toronto's Hospital for Sick Children to inform caregivers and patients on Monday of potential challenges in accessing liquid acetaminophen and ibuprofen, along with a recommendation to obtain a prescription from their SickKids care provider to help ensure access.

Ottawa's CHEO (Children's Hospital of Eastern Ontario) has also said it is taking steps to ensure there are no supply issues for its patients.

The Canadian Pharmacists Association also clarified in a statement on Wednesday that a prescription is not needed to purchase liquid Tylenol or Advil and that it was a “recommendation” by SickKids to the caregivers of its patients. The organization also urged everyone “to not purchase larger quantities than what they need, so that all caregivers can access what they need, when they need it.”

Tylenol is the brand name for acetaminophen, while ibuprofen is also known under the brand names Advil and Motrin.

One Ontario-based pharmacist working for a nationwide chain told CTVNews.ca that the over-the-counter Tylenol suspension version has been on backorder since around May or June.

The pharmacist said even the generic store brand for liquid acetaminophen has been out of stock for months, adding that the large, 500 ml bottles of acetaminophen stored behind the counter and used for prescriptions are typically not regularly stocked in most stores and is also currently on backorder.

The letter from SickKids also suggested using alternative forms of the medications including chewable tablets, but stressed the importance of speaking with a pharmacist or healthcare provider to make sure the correct product and dosages are safely administered.

The Drug Shortages Canada reports issued on Tuesday were for the 80mg, 24-tablet and the 160mg, 20-tablet packages of acetaminophen chewables manufactured by Riva. The company did not immediately respond to queries via phone or email.

Separately, Paladin Labs Inc. also reported a shortage of its 80mg Tempra Infant Drops of acetaminophen in 15ml- and 24 ml-sized bottles on Wednesday due to "disruption of the manufacture of the drug," according to the drug shortage reporting website. The drugmaker had previously reported a shortage of its 100ml acetaminophen Tempra Children’s Syrup on July 27.

"We know that there are challenges within the global supply chain with drug manufacturers who are doing everything they can to catch up," Justin Bates, the CEO of the Ontario Pharmacists Association, told CTV News Channel on Wednesday. "But the raw materials, sourcing, and putting all this together has caused challenges with respect to keeping and maintaining the supply of these products."

"And on top of that, we have unprecedented demand due to both cold and flu as well as fever and pain that we haven't normally seen at this time of year."

Some of Canada’s largest pharmacy chains did not immediately respond to queries regarding the shortages and the outlook. Loblaws, which owns Shoppers Drug Mart, directed queries back to Bates.

"The manufacturers are not indicating yet when this will be replenished," said Bates.

"We're monitoring the situation closely. They're working very hard to make sure that the shelves are stocked and our hope is by the fall when we see the cold and flu season spike, we'll have more supply on the shelves."

FAMILIES 'STRESSED'

Some parents, concerned about the fall, are stocking up.

"A lot of families are very stressed about this. We're heading into what we are worried might be a really crazy viral season," Toronto-based pediatrician Dr. Dina Kulik told CTV News Channel on Wednesday.

The shortages started in early spring, said Kulik, and have been ongoing in some parts of the country.

"Viruses have remained very high throughout the whole year. We don't typically see so many viruses this time of year, but heading into … [the] viral season, a lot of us are worried that the kids won't have access to pain and fever medications that they need to make them feel better when they're sick."

SickKids said that while some retail pharmacies may have adequate supply of the over-the-counter versions, other pharmacies may only have them in large quantities that must be dispensed by a pharmacist.

"For this reason, the medication may require a prescription. As a result, SickKids is reminding patients and families who visited the hospital and need a liquid form of pain or fever medication for at-home use to obtain a prescription from their SickKids care provider to help ensure access," SickKids spokesperson Sarah Warr said in an emailed statement to CTVNews.ca. She added that the letter was not intended as a recommendation for the general public.

OPA's Bates says it is not mandatory, however, and that caregivers can still speak to their pharmacist who may be able to dispense from the large bottles into smaller volume containers with the appropriate labeling and dosing.

Historically, physicians have not had to write prescriptions for these types of over-the-counter medications, Kulik noted.

"If there are real shortages, we may have to all be writing prescriptions," she said, adding that doctors will generally provide prescriptions over the phone for certain illnesses.

"I expect most doctors would feel comfortable giving acetaminophen or ibuprofen via phone, via virtual visit."

While it is unclear how long the shortages will last, health care professionals recommend against hoarding.

"I know there's a lot of anxiety out there. We want to avoid any hoarding and so that's why we're rationing this with respect to having a prescription which will allow for coverage of private drug plans as well as public drug plans, and as well, make sure that everybody who needs it gets it," said Bates.