Albuterol shortage is about to worsen in USA: What are the alternatives?

Albuterol, a drug used to treat patients with breathing problems, is currently in short supply in the United States, sparking concern that doctors may have to limit its use.

The American Society of Health-System Pharmacists confirmed that liquid albuterol has been in short supply since the summer of 2022 and the drug has been on the FDA’s shortages list since October.

The situation has worsened after a major supplier was shut down in the US, likely exacerbating the shortage. Akorn Operating Company filed for bankruptcy in 2020 but had continued to manufacture albuterol until last fall. It was the only US company which produced albuterol products for continuous nebulizer treatment, which is common in children’s hospitals.

Dr Juanita Mora of the American Lung Association warned: “This is definitely concerning, especially as we are coming out of the respiratory season where we had a big demand with RSV, Covid-19 and flu, and are now heading into spring allergy season when a lot of kids and adults experience asthma symptoms.”

What are the alternatives to albuterol?

With supply unlikely to improve in the near future, medical professionals are turning to other pharmaceuticals to provide relief for sufferers of asthma and other respiratory issues.

The Mayo Clinic, a non-profit academic medical center with a focus on research, has suggested the drug levalbuterol (Xopenex HFA) as a possible alternative.

Albuterol is a short-acting beta agonist (SABA), meaning that it is predominantly used as a quick-relief medication to ease symptoms of asthma. Sometimes referred to as ‘rescue medications’, they begin working within minutes of application and the effects can last for up to six hours.

Levalbuterol is inhaled through the mouth to open up the bronchial tubes and ease breathing in the patient. The Mayo Clinic states that the drug can “relieve cough, wheezing, shortness of breath, and troubled breathing.” Levalbuterol is only available with a prescription from your doctor.

Hospitals struggle to source albuterol for patients

Since Akorn ceased manufacturing the pharmaceutical, hospitals have been left with just one major domestic producer of liquid albuterol, Nephron Pharmaceuticals. However the company will need to increase its production rapidly if hospitals are to avoid a shortage in the drug in the coming months.

This issue is one of a number of supply chain-related concerns that have beset hospitals in recent years, and institutions have sought to keep a higher stock of cheaper pharmaceuticals like albuterol. But T. J. Grimm, director of retail and ambulatory services at University Hospitals Cleveland Medical Center, warned that the industry is in danger of burning through the stockpiles and could be left dangerously short in future.

“When you have supply chains that are just-in-time, it can create some issues with when something goes off,” Grimm said. “There’s the short-term crisis we all have to get through and then there’s a longer term. We need to think about these things a little more strategically, especially with our kids.”