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Health Canada is warning people with severe allergies that EpiPens are in short supply across the country after the company that makes the auto-injectors reported shortages of both the regular and junior versions of the emergency medication.

Pfizer Canada flagged shortages of EpiPens four times last year and again in January of this year, but in each of those cases the manufacturer was only running low on auto-injectors for older children and adults.

This time, a shortage has been declared for both the regular EpiPen and the EpiPen Junior for children who weigh between 15 and 30 kilograms.

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Pfizer is the lone supplier of EpiPens in Canada.

Supriya Sharma, chief medical adviser for Health Canada, said the shortage does not mean the EpiPen cupboard is bare at every pharmacy, only that the supply is being carefully managed to ensure that patients and parents who genuinely need a new EpiPen get one. Pfizer does not know when the shortage will be resolved.

“The major issue is not to panic,” Dr. Sharma said. “The concern is that when people know something is in shortage, they go out and try to make sure they have supply.”

EpiPens allow patients or bystanders to more easily inject a single dose of adrenaline, also known as epinephrine, to counter the effects of life-threatening reactions to food, insect stings or other allergens.

EpiPens have a shelf-life of 12 to 18 months. Most people who require an EpiPen keep more than one on hand.

In the case of an emergency, an expired EpiPen can still be used, Dr. Sharma said.

“It’s not that you can’t use it beyond that date, it’s that we don’t have reliable data to talk about the quality of that medication beyond that [expiry] date,” she said.

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Medication shortages have become a persistent problem in Canada and around the world, largely because of the tightening of the global drug supply chain. As pharmaceutical companies have consolidated and come to rely on fewer factories – many of them in China and India – to make key ingredients, patients have become more vulnerable to shortfalls.

Ottawa made the reporting of drug shortages mandatory in March, 2017. Since then, pharmaceutical companies have flagged about 4,400 actual and anticipated shortages to the federal government, Dr. Sharma said.

The entire global supply of EpiPens is manufactured in a single, Pfizer-owned factory in St. Louis, Mo.

This most recent shortage was caused by a manufacturing delay at the Missouri plant that stemmed from a limited supply of one component of the auto-injector made by a third party, Pfizer said in a news release Thursday.

“As much as we manage our inventory very carefully, it’s not unusual for EpiPen auto-injectors to be on back order for limited periods of time,” Christina Antoniou, a spokeswoman for Pfizer, added in an interview.

Phil Emberley, an Ottawa pharmacist and the director of practice advancement and research for the Canadian Pharmacists Association, said he has heard from his colleagues across the country that the availability of EpiPens has “been really up and down.”

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“In Saskatchewan, the pharmacy association there is actually instructing pharmacists to show patients how to manually draw up a syringe and administer epinephrine that way,” as a backup option, he said.

Mr. Emberley’s pharmacy tried to place an order for EpiPens on Sunday and was told there were none left in the warehouse.

However, Jennifer Gerdts, the executive director of the non-profit group Food Allergy Canada, said the previous EpiPen shortages appeared to have been well managed.

“Fortunately, we haven’t been hearing from too many people. Those that we’ve heard from have been able to go to other pharmacies to get renewals or new EpiPens.”

Editor’s note: An earlier version of this story incorrectly said the shortage for two EpiPen products would be resolved by the end of May. In fact, the federal government’s drug shortages website was updated late in the day yesterday to indicate the end date is not known.
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