Saturday, 17 March 2018

Shortage of EpiPens

The yearly hunt for new EpiPens begins one month before the ones I have expire. This year is no exception.

Imagine my horror when I was told that there hasn't been any new EpiPen stock in Malaysia for the past few months! My usual pharmacist at the hospital nearby told me that she had a patient who was on the waiting list for the past 5 months and had recently given up waiting!

There is only one company which imports the EpiPens into Malaysia and apparently they don't keep any stock of the pens. If there is demand, then only will they bring it in. And bringing EpiPens into Malaysia now requires TWO permits. Miss Pharmacist told me that she would contact the supplier to inquire and keep me updated.

She returned my call and told me that the situation was still the same. Currently there was no stock of EpiPens in Malaysia. I would be placed on the waiting list and no one knows what the time frame of the waiting list would be. She did not know anything beyond that.

I could not accept this kind of answer as it is ridiculous beyond words. The EpiPen is a life-saving drug.

I called the other hospitals to find out what was happening.

Hospital A came back with the same answer. They have not dispensed EpiPens for the past year as there was difficulty getting the pens. The pharmacist at Hospital A told me that they received a memo stating that EpiPens have been discontinued and no longer in production. I told her that this cannot be true. If it is true, what is the equivalent that has replaced the EpiPens? One cannot just leave the patients out there to die.

She said there was none.

I then ask her what do the doctors give patients who have life-threatening allergies when they are discharged from the ERs/wards?

She said there was none.

I almost went ballistic. I know that in UK, every person who has experienced an allergy attack is given an EpiPen when they are discharged. Don't tell me the allergies in Malaysia are different from the ones in UK? Our Malaysian allergies do not kill?! She then asked me whether is it a must for me to have this EpiPen. My blood was boiling at this point. I gave up and hung up.

Hospital B came back with the same answer: no EpiPens in stock or sight.

Hospital C was the same. So was Hospital D.

But all hospitals couldn't tell me why there wasn't any stock.

I then did some research online about this Malaysian pharmaceutical company who is the only licensed supplier to bring in the EpiPens into Malaysia. I called them.

I was transferred from one department to another department. I felt like I was going around on a merry-go-round. Round and round and round with no answer.

I was asked the same questions over and over again with every new person who answered the call that was transferred:

"Siapa ini?" "Who is this?"

"You dari mana?" "Where are you from?"

"Siapa suruh you call kita?" "Who instructed you to call us?"

"Apa pen itu?" "What pen is that?" You must be bloody kidding me to ask me what pen! You're a pharmaceutical company!

"Apa? Saya tak tahu lah." "What? I don't know lah."

And one of them even hung up on me before I could even finish my sentence.

Bloody hell.

I called back and I blew. I told whoever who answered the phone to stop transferring my calls from one end of the company to the other end. I told the person to transfer me to a person who knows what the hell an EpiPen is and that I want answers and I want them today! And I told the person if they were to hang up on me, they will see me in person. (I got the person's name.)

Yes, I was that pissed.

There was silence on the other end at first and then they transferred me to another department. The woman who answered this time told me that I needed to speak to a particular lady who is in charged of importing of medications. Apparently, only this lady would know what is actually going on. She gave me the lady's contact number.

So I contacted Miss-Only-She-Knows-What's-Happening.

She was very helpful and professional. And yes, there has been a shortage of EpiPens for the past few months due to the Mylan episode where the auto-injectors jammed and couldn't discharge the epinephrine. Due to that, Mylan stopped their production of EpiPens for a few weeks. Thus, the shortage of EpiPens is due to a backlog of demand. Too much demand and too little supply.

I have kept myself abreast of what was happening with Mylan and its scandal of increasing its prices and its auto-injector failure. But I did not know about this shortage! Miss-Only-She-Knows-What's-Happening told me that it's a worldwide shortage and even if I were to go to neighbouring countries, I would not be able to find one. She said Mylan has not replied her queries on when this would be over. What she can advice is that for us to hold on to our expired EpiPens. They would still function even though they are expired. BUT, you must head to the ER IMMEDIATELY without wasting any time after injecting yourself with the EpiPen. One does not know how much strength the epinephrine has after expiry. She also said that EpiPens have not been discontinued.

My pharmacist from the nearby hospital gave the same advice: Hang on to our expired EpiPens. Use them in anaphylaxis episodes. Head to ER IMMEDIATELY without wasting any time.

I did some online searching and found these:

Click on EpiPen Shortage in Canada.

According to the website above, two Epi-pens Junior are equivalent to one adult dose. Alternatively, one could carry an ampule (filled with epinephrine) and a syringe.

Click on EpiPen Shortage in Australia.

Click on EpiPen Shortage in UK.

The ER doctor who treated me at the hospital nearby my place told me if ever EpiPens were to be unavailable, there's always this old-fashion option:

You can carry this with a syringe in a pouch (that is you have some knowledge on how to break the vial and which syringes to use to draw the solution and to jab yourself with). And yes, the balls to do so too.
Good luck with your quest for new Epis.

By the way, Mylan now sells EpiPens in twin packs. One pen costs RM485. A twin pack would now cost you RM970.


  1. So what are the rules for mailing epi pens to Malaysia? Can I mail you some? Or will they stop them at the border? I'll try to remember to check with the post office next week and see what they say.

  2. Well, it was naive of me to think I could send you drugs to Malaysia. The post office says once it leaves they have no control over it. And who knows, maybe they would confiscate it then arrest you for drug trafficking. Besides I'd have to get a prescription for it and that might be difficult. I think your only option would be to fly to the USA and get some...

    1. Thank you for trying to help me. I think it would be risky for you to send it over. And yes, you would need a prescription unless you are friends with a doctor who would help you.

      It's ok. I'll wait as I have a backup adrenaline kit.