Shortage of key heart medication — nitroglycerin spray — sparks worry in Alberta

A tight supply of a fast-acting heart medication is causing concern for Alberta patients and health-care providers as a shortage looms across the country.

Nitroglycerin spray is used under the tongue to treat pain, known as angina, and improve blood flow to the heart in people with coronary artery disease.

Health Canada issued a public advisory on Friday, saying it expects supply of the drug will be limited in hospitals and community pharmacies during the spring.

The shortage is classified as Tier 3, meaning it has the most potential to impact the country's drug supply and health system.

"Alberta has a limited supply at the manufacturer and wholesale level," Alberta Health spokesperson Charity Wallace said in a statement emailed to CBC News.

"It is anticipated that supply will be constrained for the next few weeks, possibly months, with some improvement expected in the summer."

According to the Health Canada advisory, three manufacturers — Mylan, Sandoz and Sanofi — are reporting shortages due to increased demand or supply issues with the raw materials. 

Patient worries

"I'm very concerned," said Dr. Anmol Kapoor, a cardiologist in Calgary. He's already hearing from patients who are having trouble refilling their nitroglycerin prescriptions.

"It's not as easy as it was before, so that is contributing to a lot of anxiety and a lot of caution."

Kapoor is now telling patients that if they don't have a bottle of nitro spray and they have chest pain, they should call 911 right away.

"It's certainly something that could be a major issue," said Dr. Steve Tilley, a Red Deer cardiologist, who is watching the situation closely but has yet to hear from affected patients.

"I think at this stage we need to advocate. There may be some lead time until it impacts patients. [Are] there things that could be done in the meantime to mitigate this problem? I hope that's being worked on behind the scenes."

In its public advisory, Health Canada said it's working to conserve existing stock, speed up shipments to hospitals and pharmacies and access alternatives.

It's also extended the expiry dates for some nitroglycerin sprays.

"Nitroglycerin spray is an important and widely used product. Health Canada recognizes that this shortage is concerning for people who use it to treat pain from angina," the statement said.

"Health Canada is also evaluating the available supply of tablets, which may be a potential alternative for some people."

Advice for patients

The Heart and Stroke Foundation of Canada is urging patients to meet with their health-care provider and come up with a plan and to continue taking all of their medications regularly.

"The most important thing you can do is, first of all, check your supply, check the expiry dates, contact your physician and/or your pharmacist to verify whether you can extend your expiry," said Patrice Lindsay, the organization's director of health systems.

"It's really important that they understand what the options are for them and that they really have the right supply without trying to overly stockpile. So that everybody who needs it has an opportunity to get some."

Another key message, according to Lindsay, is that patients shouldn't avoid using their nitroglycerin spray over fears they'll run out of it.

"Our strong guidance is use it when you need it because you don't want to put yourself in a situation where that chest pain then becomes worse. And you can have a bigger event happen."

She's also advising people to continue to be vigilant and watch for heart attack symptoms.

A spokesperson for Alberta Health Services told CBC News the health authority is not impacted by the shortage.

The Canadian Pharmacists Association is advising its members to limit dispensing nitroglycerin spray as much as possible in an effort to conserve supply.

The three impacted manufacturers are reporting their shortages are expected to resolve between the end of April and the end of July.

Meanwhile, Kapoor said there have been a number of key drug shortages over the past few years that have affected heart patients.

"Last year, it was a radio isotope. Before that, it was a blood pressure medication. Today, it's nitroglycerin. Tomorrow, it could be something else," he said.

Kapoor added he'd like to see a federal strategy in place to ensure adequate drug supplies.

"It's embarrassing.… We are making our heart patients suffer."