Multiple Factors Behind the Verapamil Shortage
The supply of verapamil is not impacted by a single event, but rather by a series of cumulative and intermittent issues affecting different manufacturers and formulations over time. These issues, common in the generic drug market, include manufacturing problems, quality control failures leading to recalls, and companies deciding to cease production of certain products.
Recent Recalls and Quality Control Problems
One of the most immediate causes of localized or batch-specific shortages is recalls initiated by manufacturers or enforced by regulatory bodies like the FDA. These recalls often stem from out-of-specification results during product testing. For instance, in September 2025, Glenmark issued a recall for specific lots of its Verapamil Extended-Release tablets due to quality control concerns. A similar incident occurred in early 2023 when Amerisource Health Services (AHP) recalled verapamil tablets after tests showed out-of-specification dissolution results.
- September 2025: Glenmark Extended-Release tablets recalled for out-of-specification dissolution.
- Early 2023: AHP recalled Extended-Release tablets due to out-of-specification dissolution.
- August 2023: Glenmark recalled a combination product (trandolapril and verapamil) for subpotency.
Manufacturing and Production Disruptions
Manufacturing issues form a bedrock of many drug shortages. Supply chain fragility can cause disruptions at any point, from sourcing active ingredients to final packaging. For verapamil, this has been a consistent problem. Reports from organizations like the American Society of Health-System Pharmacists (ASHP) and Drug Shortages Canada highlight manufacturing difficulties.
- Mylan: The company reported disruptions to manufacturing in 2023 for its sustained-release tablets.
- Sandoz: Experienced a manufacturing disruption for its verapamil hydrochloride injection in late 2023.
- Hospira: Historically, as the sole supplier of verapamil injection, Hospira faced immense pressure when demand increased, leading to shortages.
Manufacturer Exits and Market Discontinuation
Another significant factor impacting verapamil availability is the decision by pharmaceutical companies to discontinue certain products. As generic drugs age, some manufacturers may find production less profitable, leading to market exit. This happened with Mylan, which discontinued its verapamil extended-release tablets in June 2021. More recently, in January 2025, Teva Pharmaceuticals decided to discontinue its extended-release capsule, Verelan. When a market loses a supplier, the remaining companies face higher demand, potentially causing shortages.
Increased Demand for Verapamil Injections
While recalls and discontinuations affect specific versions, a surge in demand can strain even a healthy supply chain. Hospira, for example, reported a shortage of verapamil injection due to increased demand, a situation exacerbated by its position as the sole supplier at the time. Unexpected increases in hospitalizations or shifts in treatment protocols can quickly deplete stock, a common scenario in drug shortages.
Verapamil vs. Alternatives: A Comparison
In the face of shortages, healthcare providers may need to consider therapeutic alternatives. Verapamil is a calcium channel blocker, and other drugs in this class or other anti-hypertensives may be suitable depending on the patient's condition. The following table provides a high-level comparison.
| Feature | Verapamil | Diltiazem | Amlodipine | Metoprolol | Lisinopril |
|---|---|---|---|---|---|
| Drug Class | Non-dihydropyridine Calcium Channel Blocker | Non-dihydropyridine Calcium Channel Blocker | Dihydropyridine Calcium Channel Blocker | Beta-Blocker | ACE Inhibitor |
| Primary Uses | Hypertension, angina, arrhythmia (rate control) | Hypertension, angina, arrhythmia (rate control) | Hypertension, angina, coronary artery disease | Hypertension, angina, heart failure, arrhythmia | Hypertension, heart failure |
| Primary Action | Slows heart rate and relaxes blood vessels | Slows heart rate and relaxes blood vessels | Relaxes blood vessels | Decreases heart rate and blood pressure | Blocks enzyme that produces angiotensin II, relaxing blood vessels |
| Onset | Varies by formulation; fast for IV, slower for SR | Varies by formulation; fast for IV, slower for SR | Gradual onset | Gradual onset | Gradual onset |
| Side Effects | Constipation, headache, dizziness, bradycardia | Headache, dizziness, swelling in extremities | Swelling in extremities, headache, fatigue | Fatigue, dizziness, bradycardia, hypotension | Dry cough, dizziness, fatigue, renal issues |
| Considerations | Can interact with grapefruit juice; check SR alternatives | Check interactions; different indications than amlodipine | Preferred in some cases due to less impact on heart rate | Preferred in specific cardiac conditions | Common alternative for hypertension |
What the Verapamil Shortage Means for Patients
The ripple effects of a drug shortage can significantly impact patient care. Beyond the immediate inconvenience of not finding a prescription, patients face more serious risks.
- Treatment Delays: Unavailability can lead to delays in starting or continuing treatment, potentially worsening a condition.
- Risk of Medication Errors: Switching to an unfamiliar alternative can increase the likelihood of dosage or drug-related errors.
- Adverse Drug Reactions: Patients may respond differently to alternative medications, leading to unexpected side effects or adverse reactions.
- Increased Anxiety and Stress: The uncertainty of accessing essential medication can cause significant stress for patients managing chronic conditions.
- Financial Burden: Some alternatives or mail-order options may be more expensive, increasing out-of-pocket costs.
How Healthcare Providers and Patients Can Respond
Managing a drug shortage requires proactive measures from both patients and their healthcare teams. As recommended by health organizations, clear communication and a willingness to explore alternatives are crucial.
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For Patients:
- Contact Your Care Team: Inform your doctor or pharmacist immediately if you cannot fill your prescription. They can recommend appropriate alternatives or dosage adjustments.
- Explore Other Pharmacies: Check with different pharmacy chains, independent pharmacies, or a mail-order service. Some may have stock when others are depleted.
- Request Partial Fills: If a full prescription is unavailable, ask your pharmacist for a partial fill to cover you while a full supply is located.
- Consider Alternative Formulations or Strengths: Discuss with your doctor whether a different formulation (e.g., immediate-release instead of extended-release) or multiple tablets of a different strength could be a temporary solution.
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For Healthcare Providers:
- Review Therapeutic Alternatives: Evaluate the clinical situation to determine the most appropriate alternative medication. For example, during a diltiazem shortage, the Ohio State University Wexner Medical Center adopted verapamil as an alternative for rate control.
- Communicate with Patients: Clearly explain the reasons for the change and what patients can expect with the new medication, including potential differences in side effects.
- Use Hospital Drug Shortage Protocols: Many institutions have formal processes for managing and communicating drug shortages, helping ensure consistent patient care.
Conclusion
The ongoing issue of why is there a shortage of verapamil is a microcosm of the wider complexities within the pharmaceutical supply chain. It highlights vulnerabilities stemming from manufacturing issues, market consolidations, and a dependence on a few key producers. For patients reliant on this crucial medication, the intermittent shortages underscore the importance of maintaining open communication with healthcare providers, exploring viable alternatives, and remaining flexible in treatment plans. Regulatory bodies and manufacturers must continue to work together to mitigate future disruptions, while patients and providers can navigate current challenges through a combination of information and proactive strategies.
Navigating Drug Shortages: How Patients Can Take Control
- Immediate Action: If your pharmacy is out of verapamil, contact your doctor right away to discuss alternatives or dosage changes.
- Alternative Pharmacies: Check different pharmacy chains, independent stores, or mail-order services, as their stock levels can vary significantly.
- Dosage Adjustments: Your doctor may suggest taking multiple lower-dose tablets to achieve the same total dose if certain strengths are unavailable.
- Information Gathering: Don't hesitate to call the drug manufacturer's customer service for specific updates on the shortage status.
- Proactive Planning: Don't wait until you run out of medication. Start the refill process early to allow time to find stock or secure an alternative prescription.
The Cumulative Impact of Recalls and Discontinuations
- Complex Causes: The verapamil shortage isn't due to a single issue but a combination of manufacturing problems, quality control recalls, and market exits by manufacturers over several years.
- Supplier Dependence: Over-reliance on a small number of suppliers for a generic drug, like Hospira for verapamil injection, can lead to shortages when issues arise.
- Quality Control Failures: Product recalls due to failing dissolution tests or subpotency frequently contribute to intermittent supply problems.
- Market Pressure: The departure of manufacturers, such as Mylan and Teva, reduces overall supply and puts a greater burden on remaining producers, creating broader shortages.
- Patient Safety Risks: Forced changes in medication due to shortages can increase the risk of medication errors, adverse reactions, and treatment delays for patients.
How Healthcare Teams Manage Medication Shortages
- Regular Meetings: Hospital pharmacy committees meet regularly to develop operational and therapeutic strategies for managing drug shortages.
- Inventory Management: Hospitals may prioritize limited stock for the most critical needs, especially for injectable forms of verapamil.
- Therapeutic Substitutions: Clinical pharmacists suggest patient-specific drug regimen alternatives and help medical teams safely implement therapeutic substitutions.
- Communication: Providers must clearly communicate the reasons for shortages and any changes to the patient's treatment plan.
- Formulary Adjustments: Hospital drug committees may make temporary adjustments to formularies to reflect the available supply of alternative drugs.
