STOCKOUT: THE IMPACT OF NATIONAL HALOPERIDOL TABLET SHORTAGE TO PHYSICIAN PRESCRIPTION PATTERN AND PATIENT OUTCOMES

Abstract

Introduction Drug shortages are common in the United States, and in 2019 alone there are 11 psychiatric medications out of a total of 270 drugs that are current listed as in shortage by the FDA. One of these medications is haloperidol, which has been in shortage since October 2018 for its low dosage tablet forms, only one out of two pharmaceutical companies recently restocked these forms as of September 2019. Consequently, patients are impacted due to compromised efficacy, possible medication or dosage errors, of which these lead to higher cost for substitute drug and increased risk of rehospitalization. In Canada, for example, those impacted by haloperidol decanoate shortage had higher rehospitalization rate after switching to a different long acting injectable (LAI) medication. As such, it is important for physicians to be aware of current drug shortages and be ready to address the concerns of patients and their caregivers. Methods We conducted a retrospective chart-review mirror study of the nine months before and after the shortage occurred in October 2018 in 37 patients who are on haloperidol followed in geriatric psychiatry outpatient clinic in Brooklyn, New York. Results The preponderance of subjects in this study were diagnosed with either primary psychotic disorders or dementia with behavioral disturbances. Twelve out of 37 (32%) patients who are prescribed haloperidol had to be switched to a higher dose or liquid form. All twelve patients were previously prescribed less than five milligrams of haloperidol daily. None of the patients had a psychiatric emergency visit or hospitalization in the last year prior to haloperidol shortage, but two of the 12 patients had poor medication adherence following the mandatory medication switch. For these two patients, one agreed to a switch to LAI form and the other decompensated and required a visit to the Comprehensive Psychiatric Emergency Program (CPEP). None of the 25 patients who were unaffected by the shortage had a change or decompensation. Conclusions Low dose haloperidol tablet shortage resulted in subsequent change in medication form in our cohort. Medication adherence became an issue following the switch with resultant emergency visit. These findings reflect the underreported impact of psychiatric drug shortages and specific measures should be taken to better coordinate drug supply chain to minimize negative impact to otherwise chronically stable patients. This research was funded by: This study is funded by the Department of Psychiatry, SUNY Downstate Medical Center