Shortage of Sodium Bicarbonate, Important for Chemotherapy, Could Impact Mesothelioma Patients

Mesothelioma patients may be affected by a sodium bicarbonate shortage that is impacting care at hospitals and clinics across the United States. The injectable mixture that is vital for everything from giving stitches to chemotherapy to open-heart surgery, has hospital staff scrambling to manage the supply.

Although sodium bicarbonate, the key ingredient in baking soda found in most households, is a simple drug to manufacture, manufacturers have fallen behind. There are only two suppliers of the drug in the U.S.: Pfizer and Amphastar. The reasons cited for the shortage are increase in demand and slow down in production from manufacturers.

According to a May 21 article in the New York Times, pharmacists have been scouring their hospitals to gather up and manage the supply  to ensure the solution is available for the highest priority cases. Doctors and pharmacists are holding meetings to determine whether procedures need to be postponed and just how to distribute the injectable mixture that is in high demand throughout every hospital.

In some cases, hospitals have postponed operations or put off chemotherapy treatments, according to the Times. Patients currently undergoing chemotherapy treatment for their mesothelioma, an aggressive cancer caused by past asbestos exposure, may need to contact their oncologist to ensure they are not impacted.

The drug is critically important for managing pH level in patients’ blood. Oncologists use sodium bicarbonate to neutralize the acidic properties in chemotherapy drugs. Some oncologists believe the solution changes the pH of tumors, increasing the effectiveness of the mesothelioma treatments and helping to prevent the spread of cancer cells.

Gino Agnelly, the head pharmacist at Providence Hospital in Mobile, Ala. said they were down to just 175 vials of the solution when one heart patient needed 35 vials. The hospital had to postpone seven open-heart operations scheduled one week and transfer a critically ill patient to another hospital.

“Does the immediate need of a patient outweigh the expected need of a patient?” said Agnelly. “It’s a medical and ethical question that goes beyond anything I’ve had to experience before.”

“It is unbelievably frustrating,” said Erin Fox, a drug shortage expert at the University of Utah. “It makes me so mad that we are out of these really basic lifesaving medications.”

The U.S. Food and Drug Administration initiated a process under former-president Barack Obama to broaden reporting of potential shortages of certain drugs, expedite review of applications to alter production of these drugs and provide the Justice Department more information about potential collusion on price fixing or price gouging.  Information about drug shortages can be found on the FDA agency’s website.

Hospira (https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Sodium%20Bicarbonate%20Injection,%20USP&st=c&tab=tabs-1) (owned by Pfizer), reports it could be into the third quarter before they recover from the shortage. In a letter to customers, posted on the FDA’s website (https://www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM559332.pdf), the company reports that the supply of sodium bicarbonate injection is depleted now with the next delivery expected in June. The letter lists the following key steps Pfizer is taking to rectify the situation:

• Dedicated team focused on addressing these delays by prioritizing the manufacture and delivery of medically necessary drugs;
• Increasing production at the company’s key injectable manufacturing plants;
• Adding resources to address distribution delay.

For the nearly 3,000 patients diagnosed with mesothelioma each year, their cancer is primarily managed through chemotherapy, making sodium bicarbonate important to their care. To find out more about the drug shortage, talk to your physician and visit the FDA’s website.

“As I talk to colleagues around the country, this is really a problem we’re all struggling with right now,” said Mark Sullivan, the head of pharmacy operations at Vanderbilt University Hospital and Clinics in Nashville, according to the New York Times.