Thrombolytic drug shortage is expected to last until 2024. The manufacturing company is limiting supply to all countries worldwide. Currently, the impact on future drug delivery is still unclear. However, for the month October, drug delivery will be further restricted.
Additionally, the production of Actosolv, mainly used for IV cathether obstruction, has not yet been resumed and will likely become unavailable from January 2023.
With the help of Belgian experts, FAGG/AFMPS has released guidance for hospital pharmacists and medical doctors concerning the shortage of thrombolytic drugs. The guideline serves the purpose of making other medical specialities aware of the shortage and restricting the use of thrombolytics for non-urgent indications. Centralisation of hospital stock and monitoring of local usage is highly recommended. With regards to treatment of ischemic stroke, increased use of MRI or CT perfusion imaging is recommended to avoid treating stroke mimics as much as possible, avoiding off-label alteplase use and optimalisation of alteplase dosing using complete vials of 20 and 50mg, taking into account local availability of both dosages, is advised to avoid wastage.
Some guidelines for rational use of tPA:
Avoiding tPA wastage by limiting the use of 2x 50mg vials and rounding to full vial dosages. As a rule of thumb we suggest:
- 60 kg: 1 x 50 mg
- 70 kg: 3 x 20 mg
- 80 kg: 1 x 20 mg + 1 x 50 mg
- 90 kg: 4 x 20 mg
- from 100 kg: 2 x 20 mg + 1 x 50 mg
Read also the FAGG recommendation here
See also additional guidance by the European Stroke Organization and the Advisory board Thrombolytics – Boehringer Ingelheim: