How is Mexico Solving the Supply of Drugs During the Pandemic?

The attention to the health crisis in Mexico has developed into a critical situation, both because of the massive number of people infected by the SARS-COV 2 virus who are in an ICU and require intubation, and the shortage of the drugs required to perform intubations. It is necessary to use drugs that are considered high-risk medicaments, such as Propofol, a powerful anesthetic that induces and maintains the general anesthesia in patients who are mechanically ventilated, and Midazolam, a hypnotic-sedative that produces long-term sedation. Without them, it is virtually impossible to intubate patients.

Both drugs have and can be manufactured in Mexico; however, by not having authorization to import the active ingredients and the raw components, which is normally the responsibility of COFEPRIS, it has been necessary to import these drugs from different parts of the world. For this reason, hospitals, such as those within IMSS and ISSSTE, have received these drugs on an emergency basis but with one massive problem: They are arriving in boxes with all texts, legends, labels and instructions in the language of the country where they were manufactured. Hospital pharmacies are receiving high-risk drugs in Dutch, Russian and Arabic, which no one can read.

From a regulatory point of view, several norms and regulations established in the country are being broken; some products have no sanitary registration or fail to meet the requisite that every medication that enters Mexico must have all labels in Spanish. The urgency of the situation might justify their importation but the most critical factor is the massive increase in the risk to the lives of patients due to the potentially incorrect use of these drugs. The personnel in hospitals now face a new challenge for which they are not prepared: reading and, most of all, interpreting the right administration, dosage and preparation of these drugs that are completely unknown in Mexico.

As many of us know, this type of drug preparation is performed in the denominated “Central de Mezclas” (central mixing lab). That is where the pharmacists in charge prepare the medications that the medical specialists order for every patient. It is important to mention that every treatment is individualized, since every critical patient comes with different conditions and comorbidities. Some are overweight, others anemic, or diabetic or have asthma; therefore, every treatment is designed by the doctors with help from the pharmacists for each individual patient. That is how these “cocktails” are made using known solutions or intravenous serums.

One wrong decision in the preparation or the dosage unequivocally will put patients’ lives at risk. Neither doctors nor pharmacists, and for that matter the nursing staff, want to take this massive risk, which is why it is a necessity to have all the information about these foreign drugs translated before they are used.

Our approach as specialized pharmacists is most definitely to guide the prescribers of these drugs and completely mitigate the risks involved in the administration of a drug. Otherwise, in one single stroke we are removing the possibility of an effective pharmacovigilance of these drugs being brought over in the midst of this emergency. To perform the necessary and proper pharmacovigilance of these drugs, adverse effects must be known and properly identified and reported in the VIGIFLOW program.

Nevertheless, the emergency is here now and we have to act with clarity. It is for this reason that the National College of Chemical Pharmaceutical - Biologists Mexico A.C. is putting itself at the disposal of the director of the National Pharmacovigilance Program and the Health Development Commissioner of COFEPRIS and placing at their disposal translators of all languages to translate foreign medication labels and legends BEFORE they are used. Today, we are waiting to receive the first package of materials to be translated. With this action we can avoid the risks that are being generated in the treatment of all critical patients.

There are other reasons that increase the risk of acquiring and using foreign medications that don’t have a sanitary registration and are unknown in the country, but this is a discussion for another time.