Doctors have warned that severe shortages of an “essential” drug used to protect alcoholics from degenerative brain diseases could disproportionately affect “some of the most vulnerable” in society.
Pabrinex, a multivitamin injection, is used to protect drinkers against conditions such as Wernicke’s encephalopathy and Korsakoff’s syndrome, which can have dementia-like symptoms. Doctors are concerned that the incidence of these debilitating diseases may increase due to the shortage.
The Department of Health and Social Care (DHSC) warned in April that intravenous Pabrinex injections were likely to be in short supply until August 2025 at the earliest, and intramuscular injections were being phased out.
Dr Marcus Bicknell, a GP specializing in addiction, described the situation as an “absolute disaster”. “It’s a cheap, very effective drug that we’ve used for more than 50 years, but next year it won’t be available to us at all.” If this was a cancer drug, there would be no way that withdrawal would be accepted.”
Bicknell said his center had already begun dosing the drug and reducing doses of the “essential” drug given to patients, which he called a “scandal.”
A spokesman for Japanese company Kyowa Kirin, the licensee of Pabrinex, said the supply of the drug had been affected by the closure of manufacturing facilities that had to be upgraded to comply with changes in EU regulations.
The spokesperson said: “We have identified a new manufacturing partner for Pabrinex IV and are actively working to facilitate the transfer of manufacturing to this new partner. The transfer is being accelerated, but it is a complicated process.”
Bicknell said he thinks manufacturers are taking the drug off the market because it’s not cost-effective enough. “Addictive illnesses should not be treated as second-class citizens – it’s disgraceful,” he added.
The UK has experienced a dramatic increase in the number of unavailable medicines recently, with supply problems doubling from 648 in 2020 to 1,634 last year. A report by the Nuffield Trust in April found that while global manufacturing problems linked to Covid, inflation and the war in Ukraine had contributed to shortages, the situation in the UK had been made worse by Brexit.
Alcoholism impairs the body’s ability to absorb vitamins, which can increase the risk of degenerative brain disease. Pabrinex contains five vitamins, including thiamine, and is described as the “gold standard” treatment for protecting heavy drinkers from irreversible brain damage, and there are limited benefits.
The drug, which costs £2 per treatment, is out of stock in some areas. Thiamine injection is another treatment but there is currently no licensed product in the UK.
Dr David Bremner, medical director for drug and alcohol charity Turning Point, said: “The population is not a vocal health user group or a motivated group to be able to fight against this type of withdrawal service.
“We are currently only giving Pabrinex to 10% of the people we used to give it to.” The problem with prophylactics is that they only work if we give as many people as possible. It starts to get scary when we start dosing because until something catastrophic happens, you don’t really know if you’ve given it to too few people.”
Wernicke-Korsakoff syndrome, a type of brain injury, has two distinct stages and can lead to disorientation, poor balance and a dementia-like state if left untreated.
Sharon Bright, 63, from Nottingham, was treated with Pabrinex. “Pabrinex probably saved my life,” she said. “My parents were told that with a brain injury I would be in a nursing home for the rest of my life, but with the rehabilitation and medication, my nervous system opened up again and now I am working, driving and living independently again.”
A DHSC spokesman said: “We know how frustrating and upsetting problems can be for patients. This government inherited an ongoing global supply problem that continues to affect drug supply and we are working closely with industry, the NHS, manufacturers and other partners in the supply chain to resolve the current issues as quickly as possible.
“We have been working to get imports and support new products to come to the UK market. As a result of these actions, Pabrinex’s expected restock date has been moved forward by almost a year.
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