Wyeth has agreed to reconsider its decision to discontinue lorazepam injection
(Ativan) following pressure from health care professionals.
It announced recently that the product was to be discontinued at the end of
October (see p501). A spokesman
for Wyeth told The Journal on September 27 that the company had not been aware
of the impact that withdrawing the product would have.
The reasons for the decision to withdraw the product were a combination of low
demand and supply chain difficulties associated with the need to store the product
at low temperature.
The spokesman said that Wyeth was “taking steps to review the decision”
with a view to reversing it; however, there were “an awful lot of logistics
required to make this happen”. He added that further details could not
be given at this stage (the decision was made as The Journal was going to press)
but that the company would be contacting the medical community to enlist its
help on how to manage the situation.
Wyeth’s decision had been questioned by a number of medicines information
pharmacists. Ms Morag Martin (principal pharmacist, Greater Glasgow Primary
Care NHS Trust and member of the United Kingdom Psychiatric Pharmacy Group committee)
told The Journal on September 26 that the decision had major consequences for
psychiatry. She was particularly concerned that there had been no consultation
over the discontinuation. “Much work has been done in developing protocols
and procedures throughout the country, emphasising the benefits of intramuscular
(IM) lorazepam in managing acutely disturbed behaviour and also in controlling
agitation in elderly demented patients. Benzodiazepines are safer than antipsychotics,
but the problem of accumulation can be problematic, hence the use of a short-acting
preparation,” she said.
Mr Simon Wills (head of medicines information, Wessex drug and medicines information
centre, Southampton General hospital) told The Journal that lorazepam’s
two major uses were in rapid tranquillisation and status epilepticus. Many hospital
trusts used lorazepam injection and, while there were alternatives, its withdrawal
could be detrimental for patient care because it was considered to be the best
treatment for these two indications. For rapid tranquillisation, Mr Wills said
that, assuming that an antipsychotic (such as haloperidol, droperidol or chlorpromazine)
was not acceptable to control behaviour, the alternatives that might be considered
included lorazepam injection (Temesta) which could be imported through IDIS,
although it was unlicensed in the UK. Other alternatives were IM promethazine
which was licensed for “sedation” in adults, midazolam which was licensed
for IM use but not for emergency tranquillisation, or clonazepam which was not
licensed for either the indication or IM use. Published data on such use of
midazolam and clonazepam was limited, he said.
Ms Martin raised concerns over importing the product saying that the use of
an unlicensed product was “fraught with difficulties concerning consent”