Many dentists and physicians use lidocaine as a local anesthetic before surgical procedures. There have been frequent shortages of Lidocaine injections with or without epinephrine for various reasons.
Lidocaine is indicated for infiltration anesthesia, intravenous regional anesthesia, nerve block, and surface anesthesia. Many people who are affected by healthcare shortages are curious as to why.
There are various reasons for drug shortages, but for lidocaine, the primary causes include increased demand and decreased availability. Despite numerous efforts to alleviate drug shortages, they have only worsened.
Current lidocaine products on the shortage list
According to information provided by the FDA, the following lidocaine injections are in short supply:
- Lidocaine injection
- Lidocaine with Epinephrine injections
On Drugs.com, find a more specific classification of lidocaine injections that are in shortage.
Shortage of lidocaine
According to estimates, short supply and increased demand for anesthetics account for approximately 41% of shortages of all drugs.
The following are some possible explanations for the scarcity of anesthetics:
Quality control
Drug shortages are nothing new, especially regarding anesthetic medications like lidocaine. FDA ensures quality standards that can sometimes lead to delays in manufacturing.
Delays in supply occur more frequently in anesthetics as compared to other drugs. Every part of the process is strictly regulated to maintain the highest quality standards, from raw materials and stocks to manufacturing procedures.
High-quality standards are upheld while keeping in mind the critical condition of patients requiring anesthesia; any error can be fatal.
When COVID-19 took over, where demand was suddenly higher than usual, the usual delay associated with anesthetic medications exacerbated the situation. This brings us to the second cause of Lidocaine scarcity: increased demand.
Increased demand for anesthetics
There are several possible explanations for the anesthetic shortage, but COVID-19 is the most relevant and rational.
As previously stated, there was an increase in the demand for anesthetics during the pandemic. Many hospitalized intubated patients required anesthesia to avoid the discomfort and pain associated with it.
This increased demand, resulting in a less obvious but anticipated shortage of local anesthetics such as lidocaine.
Meeting demand for COVID-19 vaccines
There was an abrupt push to manufacture COVID-19 vaccines, which led to the shortages of many other drugs, including Lidocaine injections with or without epinephrine. It has caused an overall increase in the shortage of drugs in the U.S.
However, many disagree with the above explanation that lidocaine and many other drugs enlisted by the FDA in March were short long before COVID-19.
Supply chain issues leading to drug shortage
Experts agree that COVID-19 did not cause the issue of shortages; it has only exacerbated it. Shortage of drugs like lidocaine existed long before COVID-19 due to supply chain management issues.
Drug shortages can occur due to market approval requirements and post-marketing surveillance. This may be a less significant reason for the lidocaine shortage for some in the United States, but it still deserves attention.
For instance, Hospira, a Pfizer-owned company, announced on May 04, 2021, to recall one lot of 0.5% Bupivacaine HCL and one lot of 1% Lidocaine HCL because of a labeling mix.
The mislabeling could cause serious adverse effects, and there was no option but to recall the said lot. This also affected the supply of lidocaine to hospitals and clinics, i.e., supply chain disruption.
Another reason for supply chain disruption is that manufacturers are under economic pressure, so they maintain low inventories, disrupting supply chains and resulting in drug shortages.
Supply chains are also affected due to the interruption of raw materials supply and delays in manufacturing due to quality control.
Natural Disasters; Hurricane Maria And Drug Shortages
In 2017, Hurricane Maria halted Pharma manufacturing leading to a shortage of many in-demand drugs. To this date, it continues to impact the supply and demand chain in the U.S.
Only two companies manufacture lidocaine in the U.S.; Pfizer and Fresenius Kabi USA. The 2017 disaster led to a manufacturing bottleneck for these two companies as many other companies left manufacturing lidocaine with epinephrine.
Effects of Lidocaine shortage- What to do?
Drug shortages are a matter of national security, and the devastating impact of these frequent shortages is being widely addressed. It is critical to discuss the implications of the Lidocaine shortage, regardless of the underlying causes.
A shortage means that clinicians may need a drug to perform their daily procedures, but in its absence, they must rely on less effective therapeutic and financial alternatives.
The scarcity of lidocaine impacts dental procedures and other outpatient elective procedures. Often, dentists and physicians have to postpone appointments to perform risk-free operations.
These delays can cause serious patient complications, and sometimes emergency procedures are required; therefore, a thorough understanding of alternative treatments and drugs is required.
Shortages of Lidocaine injections pose a significant barrier to providing high-quality health care to patients. One possible way is to update and inform HCPs about available alternative drugs and treatment methods.
Pharma companies and FDA need better coordination to cope with future shortages to ensure a continued supply of anesthetics. Raising awareness among HCPs about how to deal with such shortages of essential drugs might also help.
Recommended Alternatives
The alternatives to lidocaine might not be effective in some cases, but some of the alternatives may include:
A topical preparation of lidocaine
In the absence of lidocaine injection, a topical preparation of lidocaine, Emla (2.5% lidocaine and 2.5% prilocaine), may help perform simple surgical procedures.
It is indicated for use on normal intact skin as a local anesthetic and on genital mucous membranes for minor and straightforward surgical procedures.
Bupivacaine HCL injection
In more complex procedures, Bupivacaine is a preferable injectable alternative to lidocaine. However, Bupivacaine has a long duration of action as opposed to lidocaine, which has a short period of activity.
For this reason, lidocaine is preferable for dental procedures, but in cases of shortage, Bupivacaine can be used as a local anesthetic.
Articaine
If lidocaine injection is unavailable, articaine HCL and epinephrine injection are recommended. It comes under the brand name Septocaine.
Widely used by dentists for mouth-numbing in both simple and complex dental procedures. It is also recommended for patients who are allergic to lignocaine.
Propofol
Another drug that can be used as an alternative to lidocaine is Propofol, a general anesthetic. Propofol causes dizziness or drowsiness, and driving is prohibited for several hours after the injection.
Fentanyl
Fentanyl is a narcotic analgesic that can be used in place of lidocaine. Lidocaine is a pain reliever that is frequently combined with Propofol to reduce the pain of injection.
In the absence of lidocaine, fentanyl can be used for its analgesic properties. Fentanyl also has anesthetic properties and is used as local anesthesia. It is not recommended for use in people who have never been prescribed opioids.
Although there are alternatives to lidocaine available in many cases, they are either not recommended or are less effective, so lidocaine is not entirely replaceable by any of the aforementioned alternatives.
Lidocaine is in short supply due to increased demand and decreased availability, but Pipeline Medical never disappoints with stock availability. Check out our products page if you want to buy lidocaine without disrupting your clinical procedures.
