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COVID-19 and Fear of Scarcity of Medication

Question:  I take several replacement hormones for my hypopituitarism / adrenal insufficiency.  I’m scared that there will be a disruption to global supplies.  I’m tempted to stretch out my doses so I have my medicine for a longer period of time “just in case”.  I know no doctor would recommend doing this, but how worried should I be about long-term disruptions to medically-necessary medications or devices?

Answer 1:  It is unsafe to do this.  Please maintain or go back to your regular schedule and dose.  There is no reason to believe right now that medication shortage is in sight.  (Dr. Constantine Stratakis, NIH)

Answer 2:  Glucocorticoid replacement (and secondarily thyroid hormone replacement) are the most essential medications in patients with hypopituitarism. Thankfully, both hydrocortisone (HC) and prednisone (as well as generic levothyroxine) are quite inexpensive and readily available. Based on available information, it seems unlikely that there will be a shortage in such essential medications. However, keeping a 2-3 month supply of HC or prednisone seems prudent. “Stretching out” doses is certainly not advisable.  (Dr. Nicholas Tritos, Mass General)

Answer 3: At this point, there is no indication that there will be an interruption of global supplies.  However, it is a good idea to have a 3 month supply of medication at home.  It is equally important not to hoard supplies.  (Dr. Lynnette Nieman, NIH)

Note: Doctors and patients are reporting occasional cases of certain dosages of HC not being available.  This can be problematic for pediatric patients, who usually require smaller doses (5mg is a dose that has seen some shortages), so adult patients are being asked, if they can, to try to fill prescriptions with the 10mg and 20mg doses and split as necessary so that patients who require smaller doses are not forced to split and potentially compromise the amount being taken by their patient (the smaller the dose, the larger the impact of an imprecise cut).

Further, Dr. Adriana Ioachimescu, Emory University Hospital, states that using HC tablets of 10 or 20 mg or brand name cortef resolved the issue raised by several patients last week who couldn’t refill their 5 mg generic HC prescription.

Dr. James Findling, Medical College of Wisconsin, shared the American Association of Clinical Endocrinologists’ Position Statement: Coronavirus (COVID-19) and People with Adrenal Insufficiency and Cushing’s Syndrome and stated that the only modification he thought should be made is “the magnitude of dose increase in HC during an illness: doubling the dose recommendation was started in the 60-70’s when patients were typically on 30 mg daily. Now most patients with adrenal insufficiency are on much lower doses 15-20 mg daily and I usually recommend the 3 x 3 Rule (triple the dose for three days or until feeling better). But whatever dose increase is needed, the patient needs to consult with their endocrinologist for the appropriate dose increase for their situation.

Patients are starting to hoard the hydrocortisone in Wisconsin and my nurse said some of my patients cannot get the 5 mg tablets. Patients need to be reassured that there is not a known shortage of HC (toilet paper maybe) and that prescriptions can be filled at the regular intervals. I usually make sure the patient’s Rx includes plenty of extra doses every 3 months.”

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