Managing Medications in a Crisis

May 15, 2020

Keep calm and keep track of your medication needs

People across Canada are worried about drug shortages during this time of increased stress and uncertainty. Both the provincial and federal governments are working hard with pharmaceutical companies to ensure Canadians have access to their medication(s).

The Canadian League Against Epilepsy and the Canadian Epilepsy Alliance https://www.canadianepilepsyalliance.org/ are monitoring for indicators of drug shortages, and drug manufacturers have assured these organizations that the drug supply will not be interrupted.

Currently, there are no known shortages of anti-seizure medication due to COVID-19. A lot of the drug shortages you might be hearing about on the news are related to intravenous drugs for patients in hospital with COVID-19 being treated in the ICU. Hospitals across Canada are doing their best to ration these medications, which are  mostly sedatives, pain killers, and muscle relaxants.

Here are a few things you can do to receive
your medication in a timely manner:
  • Remember, we are all in this together and epilepsy occurs in every 1 in 100 people, which means a lot of people accessing anti-seizure medications. Be kind to each other.
  • Keep track of your medication:
    • Know how much medication you have on-hand at home (i.e. 7 days, two weeks, etc.)
    • Know the number of refills you have on file with your pharmacy
    • Know when you need your prescription renewed by your prescribing health care provider.

Pharmacies are limiting prescription refills to 30-days to ensure there are adequate supplies of medication for all Canadians moving forward.

Develop a Good Relationship With Your Pharmacist

Pharmacies are overwhelmed at this time.  Where in the past your pharmacist may have reached out to you to remind you about your prescription refill, now pharmacies are asking that we try to be as proactive as possible in contacting them for refills.Develop a good rapport with your pharmacists. Ask about their procedure for prescription renewal authorizations and refilling medication. Do they typically have your medication in stock, or does it have to be order from there wholesale distributor? How long does it take for them to receive the medication from the distributor?

Here are some key points to ask your pharmacist when requesting a refill or getting a prescription anti-seizure medication:

  • When you call or visit your pharmacy ask the pharmacist if you can get a 30-day refill or partial refill (meaning smaller than your normal 30-day supply) to carry you over to your next refill date. Most pharmacies can refill medication 10 days prior to the refill date.
  • If you cannot get a 30-day refill, check with the pharmacist and ask if they will be contacting their wholesale distributor to see if they have the medication in stock or if they will be calling around to other pharmacies to see if they can “borrow” stock. Due to how busy pharmacies are right now, you may have to call around yourself to other pharmacies to see if they have your medication in stock.
  • Ask your pharmacist how long it will take them to notify you about the status of your medication. Ask the pharmacy to put a note on your file to call you when your prescription ready.
  • If you can’t get a 30-day refill and it is your refill date, ask if it is a there is a nationwide shortage or if your pharmacy is simply out of stock.
  • If you determine that the shortage is a manufacturing issue, then contact your prescribing health care provider immediately for advice to discuss medication options.
  • On occasion, you may receive a brand name rather than a generic of the same medication. Usually, your pharmacist will check with your prescribing health care provider to verify that the medication they will be giving you is acceptable. Ensure your pharmacy has approval from your prescribing health care provider.
  • Allow ample time for refills of your medication in case there is a slight delay in getting the medication. Usually, a full 7-day period is enough;, however, pharmacists can usually refill a prescription 10 days before the refill date.

Be mindful of certain medications that are controlled substances (i.e. Ativan, Clobazam and other Benzodiazepines), as prescribing health care providers will stipulate a specific number of days between refills. For example, instructions may say you can refill the medication after 28 days for a 30-day supply. Speak to your prescribing heath care provider to ensure you have enough time between refill dates. 

If you are feeling too nervous to go out and refill medication, call your pharmacy team and ask about their options for having medication delivered or mailed to your home.

Generic versus name brand medications

Be aware when changing medications from brand name to generic or from one generic band to a different generic brand. Some people find they are brand sensitive and require the name brand medication. Speak with your prescribing health care provider before switching from a name brand medication to generic or from one generic brand to another so you know what to watch for in case you sensitivities to medication changes like this.

If you are brand sensitive, I suggest working with your insurance company as well as your prescribing health care provider, to advocate for cost coverage of the brand name medication. If you aren’t able to get the coverage through your insurance provider check into possible subsidy programs through the pharmaceutical company or with your pharmacy for programs like InnoviCares https://innovicares.ca/en/ to help with cost coverage.

Whether you are taking brand name or a generic version of medication always check your prescription refill at the pharmacy when you pick it up. Make sure the medication (unless there have been changes) is identical in colour, dosage and shape to your prior refill. If it doesn’t seem identical consult with the pharmacist to find out why and confirm your refill is the right medication (brand name or same generic brand and dosage) as your prior refill.

Again, even changing from one generic brand manufacture to a different generic brand manufacturer can cause issue for someone who has sensitivities. Pharmacies have different wholesale distributors they order medication from, so one generic brand manufacturer could be different from your pharmacy. This is also why one pharmacy might not be able to order in the medication you need, but another pharmacy can.

Drug Shortage Canada Website

Any drug shortages in Canada can be found on the Drug Shortage Database at https://www.drugshortagescanada.ca. This is a helpful tool for monitoring the drug supply. While drugs can appear on the database for many reasons and simply because a drug is listed does not mean it is unavailable. Some database listings are for only a very short period; others can be for a long-time, but only affect one supplier or manufacturer.

In fact, over the last few years, there have been approximately 30 epilepsy drugs listed on the database at any time, but those drugs are still available to patients. We are monitoring the database for signs of more significant shortages, such as when the same drug is listed by multiple producers. If that happens, local community epilepsy agencies will be alerted.

It is Important to Remember:

You cannot stop anti-seizure medications abruptly, it is advised that if you have any questions or concerns about your medication, please contact your attending physician. You may also call the Epilepsy Association of Calgary at 403-230-2467, ext. 104 for assistance.

Remember: Never skip doses, or adjust your dosage without consulting your prescribing health care provider.

If I have symptoms of COVID-19 should I contact my neurologist/ epileptologists?

If you have symptoms of COVID-19 or think you have been exposed to the virus:

  • First stay at home and self-isolate. Next go onto Alberta Health Services website and take the self-assessment at https://albertahealthservices.ca/topics/Page16944.aspx. If you don’t have access to online self-assessment you can call Healthlink at 811 and a nurse will go through questions with you to determine if you might have COVID-19 and require testing.
  • Take the online self-assessment and if it seems like you could have COVID-19 call Healthlink at 811 and a nurse will instruct you on your next steps (i.e. where and when to go for testing).
  • If your seizures are increasing in frequency or changing in character and it is not a medical emergency, then call your neurologist/ epileptologist (like you normally would) to report this and consult on next steps, if any.
  • If you are having COVID-19 symptoms and the online self-assessment suggests you don’t have COVID-19, you can call your regular doctor to follow up for medical care.
  • You can call Healthlink 24/7 with any health-related concerns if you are concerned or have questions regarding your health.

DO NOT avoid going to the hospital or seeking medical
attention when you need it. Even though COVID-19 spread is
a concern, it is no reason to avoid seeking medical attention
when you need it. If you are having trouble breathing, are in
respiratory distress, or are experiencing any other kind of
medical emergency please seek immediate medical attention
either by calling 911 or going to your nearest emergency

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