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Posted (edited)

I've just been informed earlier today by pharmacists at both Fascino and Boots that there is no availability of Metoprolol Tartrate tablets in any dosage at all.

 

I asked about both the STADA and SefLoc or any other brands which might be available and they just say that it's not available right now.

 

This is a widely used beta blocker and it's prescribed for various reasons including the treatment of Angina and reducing elevated blood pressure.

 

How can this be suddenly not be available? It's one of the drugs that you're not supposed to suddenly stop taking. Stopping this suddenly could cause major problems for people including stroke.

 

I'm remembering another German pharmaceutical company, Bayer when I think about this.

 

Does anyone know what's up here - something seems to have happened.

 

The pharmacist at Boots told me she's been trying restock for many weeks with zero success.

 

Someone appears to have off the supply. They just shrugged their shoulders and don't appear to care.

 

Edited by ukrules
Posted (edited)

There are several substitutes for metoprolol, and it would be possible to switch until a time when metoprolol comes back in, but I'm not going to post medical advice on here for obvious reasons. I am certain that Thai pharmacists will not be willing to suggest you try something else. There have been shortages in the UK on both strength tablets.

 

Anyone who has ever worked in a pharmacy will tell you that dozens of medications will be unavailable at any one time, the pharmacists call it "MCS" - manufacturer cannot supply.

Edited by pr9spk
  • Like 1
Posted

 

I just called the pharmacy around the corner,  they have metoprolol on stock,  one strip 15 baht.

I suggest you inquire at a real pharmacy (a shop selling medicine to Thai people, not cosmetics - they usually have a big green shop sign saying ยา).  Boots is not a real pharmacy, their selling medicine is just a sideline business.  Fascino is a real pharmacy but sometimes i cannot figure out why they don't have certain things. If Boots and Fascino don't have it that doesn't mean anything.    

Posted

Fascino are a national company and it's not just that these two large chains are out of stock - they can't get any new stock because there isn't any left.

 

I will go to a few other pharmacies and will probably find some which has been sitting on the shelf for the last couple of months and I will buy it all.

Posted

There are 6-7 brands of this with different manufacturers. They will not all be out of stock. Boots usually has just one brand of things (if they have it at all).

Fascino also may carry just 1 or 2 brands especially at their satellite branches.

Go to large Thai drug store (ran kai ya). Ask specifically about:

Melol
Meloc
Metoblock
Cardeloc

Which are all local brands

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

  • Like 1
Posted
2 hours ago, Sheryl said:

Melol
Meloc
Metoblock
Cardeloc

Thanks for these names, I hadn't heard of them before.  When I'm looking around Hua Hin I will look for them and I'm sure I will find them somewhere.

 

Posted (edited)

I was looking for Metoprolol on Saturday in Rayong but the pharmacy there only had it in 100mg tablets; which was unfortunate for me because I only take half a .25mg tablet in the morning and the other half at at night. So it would have required a Swiss Watch maker to cut each 100mg tablet into eighths for me had I purchased them.

Edited by oslooskar
Posted (edited)
18 minutes ago, oslooskar said:

I was looking for Metoprolol on Saturday in Rayong but the pharmacy there only had it in 100mg tablets; which was unfortunate for me because I only take half a .25mg tablet in the morning and the other half at at night. So it would have required a Swiss Watch maker to cut each 100mg tablet into eighths for me had I purchased them.

Removed

Edited by dddave
Posted
58 minutes ago, oslooskar said:

I was looking for Metoprolol on Saturday in Rayong but the pharmacy there only had it in 100mg tablets; which was unfortunate for me because I only take half a .25mg tablet in the morning and the other half at at night. So it would have required a Swiss Watch maker to cut each 100mg tablet into eighths for me had I purchased them.

 

AFAIK it only comes in 100mg strength in Thailand. But there is at least one brand that is scored in foiurths.

 

Also note you can buy pill cutters at a pharmacy or online from lazada that take the guesswork out of splitting tablets and do pretty good job.

Posted
33 minutes ago, ukrules said:

Buy it while you can because there's none left at the distributors.

 

I very much doubt that is true of all distributors for all brands. Especially local brands.

Posted
11 minutes ago, Sheryl said:

 

AFAIK it only comes in 100mg strength in Thailand. But there is at least one brand that is scored in foiurths.

 

Also note you can buy pill cutters at a pharmacy or online from lazada that take the guesswork out of splitting tablets and do pretty good job.

AFAIK?? Is that a generic for Metoprolol? Regarding pill cutters; I have two of them but I can't imagine them being able to cut a pill into eighths.

Posted
1 minute ago, oslooskar said:

AFAIK?? Is that a generic for Metoprolol? Regarding pill cutters; I have two of them but I can't imagine them being able to cut a pill into eighths.

 

AFAIK = As Far As I Know

 

I have checked listing of drugs registered in Thailand and do not find any brand coming in less than 100mg dose.

 

I regularly cut pills into eighths for my cat, cat doses often being about 1/8 the lowest human strength available.  It is not ideal but can be done. Main issue is that you lose little bits of it in the cutting process.

 

As I believe i mentioned in another thread if you can get it accurately into 4ths (preferrably via a pre-scored tablet) it is nit a big deal if the split you then make is not 100% even as you'll be taking both pieces the same day.

 

Many patients take their entire daily dosage just once a day.

Posted (edited)
21 minutes ago, Sheryl said:

 

AFAIK = As Far As I Know

 

I have checked listing of drugs registered in Thailand and do not find any brand coming in less than 100mg dose.

 

I regularly cut pills into eighths for my cat, cat doses often being about 1/8 the lowest human strength available.  It is not ideal but can be done. Main issue is that you lose little bits of it in the cutting process.

 

As I believe i mentioned in another thread if you can get it accurately into 4ths (preferrably via a pre-scored tablet) it is nit a big deal if the split you then make is not 100% even as you'll be taking both pieces the same day.

 

Many patients take their entire daily dosage just once a day.

The pharmacist had a generic for Atenolol in .25mg which he claimed was the exact same thing as Metoprolol. However, I looked online and there seem to be some differences so I'll toss the Atenolol and try splitting the 100mg tablet of Metoprolol as you suggest. Thanks for the info, it is appreciated.

Edited by oslooskar
Posted
The pharmacist had a generic for Atenolol in .25mg which he claimed was the exact same thing as Metoprolol. However, I looked online and there seem to be some differences so I'll toss the Atenolol and try splitting the 100mg tablet of Metoprolol as you suggest. Thanks for the info, it is appreciated.
Atenolol and metoprolol are the same class of drug but are not the same thing.

You could ask your doctor if possible to change or not. Atenolol has longer half life so if you can change could probably take just once a day.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

Posted

I managed to find a pharmacy (small one who knows I buy many months worth at a time of whatever I need) who had metoprolol in stock.

 

I would guess she had no idea there's a shortage, she had 200 x 100mg tablets in stock (2 full boxes) so I bought them all. She's going to be in for a shock when she tries to order the replacements.

 

I will be buying additional stocks when I'm out of town. I'm going to Bangkok for a couple of days in a few weeks time.

Posted
13 hours ago, ukrules said:

I managed to find a pharmacy (small one who knows I buy many months worth at a time of whatever I need) who had metoprolol in stock.

 

I would guess she had no idea there's a shortage, she had 200 x 100mg tablets in stock (2 full boxes) so I bought them all. She's going to be in for a shock when she tries to order the replacements.

 

I will be buying additional stocks when I'm out of town. I'm going to Bangkok for a couple of days in a few weeks time.

Just curious, how much did you pay for it? I pay about 500 B/box normally at Fascino.  

Posted
31 minutes ago, Jack Mountain said:

Just curious, how much did you pay for it? I pay about 500 B/box normally at Fascino.  

Yes, I think it was about 500 per box for the SefLoc brand.

  • Thanks 1
  • 3 weeks later...
Posted
On 4/1/2019 at 7:10 AM, Sheryl said:

 

AFAIK it only comes in 100mg strength in Thailand. But there is at least one brand that is scored in foiurths.

 

Also note you can buy pill cutters at a pharmacy or online from lazada that take the guesswork out of splitting tablets and do pretty good job.

Hi Sheryl, thanks again for your advice! I did find the brand that was scored in fourths and quickly discovered that I could easily break each pill into four pieces using just my fingers. And, to my great relief, I also soon discovered that all I need do was push one of the pie-shaped .25mg fourths into my best pill cutter and it could easily be cut in half. So problem solved. ????(Note: each 100mg pill of metoprolol cost me 35 baht so the cost of such medication comes to just under 9 baht a day for me.)

Posted

Great!

 

Can I ask what brand of pill cutter you have? Because I am looking for one to do pretty much the same thing, I have a cat with chronic kidney disease and have to cut up human drugs into cat sized dosages.

Posted
7 hours ago, Sheryl said:

Great!

 

Can I ask what brand of pill cutter you have? Because I am looking for one to do pretty much the same thing, I have a cat with chronic kidney disease and have to cut up human drugs into cat sized dosages.

This is the one I use; however, bear in mind that it was given to me at the Kaiser Permanente Pharmacy in Redwood City, California. So let me know if you have a problem getting your hands on one and I will see what I can do. https://www.iherb.com/pr/Apex-Ultra-Pill-Splitter/27055

  • 1 month later...
Posted (edited)

Below is an exerpt from an article in the 24 May Boston Globe which reports on the frequency of the failure of generic drugs to perform in the same manner of the branded equivalents and the weakness of the FDA's inspection and certification system in catching substandard generics.

The quoted section refers specifically to METOPROLOL and may help explain the current shortage of this drug in Thailand which gets a majority of it's generics from India.  "Lever" refers to the Doctor doing the investigation: Dr. Harry Lever.  

 

 

"LEVER GREW INCREASINGLY concerned about the FDA’s ability to oversee drug manufacturing abroad. In December 2012, he sent a detailed letter to Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, specifically flagging the metoprolol succinate formulation made by the Indian generic-drug company, Wockhardt. In his letter, he noted that he could not properly control his patients’ chest pain, heart rate, or blood pressure when they took Wockhardt’s drug, but their symptoms abated if he switched them back to the brand-name version.

 

While I have no data to back up my concerns, I have a significant amount of experience with this disease and see a large number of patients,” he wrote. “It is absolutely clear to me that there are differences that are clinically significant.”

Within two days, Lever received a detailed response from the FDA’s Office of Pharmaceutical Quality, pledging to conduct a comparative study of the brand and generic metoprolol products.

Seven months later, three FDA inspectors arrived at the Wockhardt plant in the Chikalthana area of Aurangabad, in western India. They searched through the plant’s computer systems and discovered that its technicians had been conducting unofficial pretests of its drugs to evaluate the results, then deleting evidence of those tests from the plant’s hard drives and retesting the drugs in the official computer system.

The evidence suggested the plant was manipulating its quality tests to ensure that its drugs — even those that didn’t meet specifications — got passing results.

Shockingly, eight months after the Wockhardt inspection, a senior FDA official contacted Lever at the Cleveland Clinic to explain that an “extensive multidisciplinary investigation” had determined that Wockhardt’s metoprolol succinate was bioequivalent to the brand. The FDA had reached this conclusion, in part, by reviewing the company’s own initial data, which the FDA inspectors had flagged as suspicious.

In the end, it was Wockhardt itself, followed by Dr. Reddy’s, that recalled their metoprolol succinate from the market, with the admission that the drugs were not bioequivalent. Lever had been correct all along."

 

Wockhardt and Dr. Reddy's are the two largest manufacturers of generic metoprolol outside of China

 

This is the article in full: 

https://www.bostonglobe.com/ideas/2019/05/24/ideas-katherine-eban-these-pills-could-kill-you/d4gYXkoMR24n1uoLUkbnqJ/story.html?p1=Article_Feed_ContentQuery

Edited by dddave
Posted

Same problem in Europe.  Most generics are physically manufactured in China or India, often by an Israeli company (Teva is the biggest), and sold under some venerable European brand name.

Regulatory oversight is very poor.

In the case of carcinogenic Valsartan, it took the authorities 6 years until they issued the first warnings to the public. According to a parliamentary inquest, in Germany alone, about a million people have been taking carcinogenic valsartan, often for years.

Posted
6 hours ago, dddave said:

 

The quoted section refers specifically to METOPROLOL and may help explain the current shortage of this drug in Thailand which gets a majority of it's generics from India.  "Lever" refers to the Doctor doing the investigation: Dr. Harry Lever.

image.png.baf0a51e32ccbcce96c6392a1cccb8db.png

 

Manufactured in Thailand apparently, by these guys :

 

image.png.91a2b53bb66aad4df53756309eac71ab.png

 

What is a 'generic' when the drug has been around for so long? I have no doubt that there's a lot of counterfeit drugs on the market everywhere in the world.

 

 

  • 4 months later...
Posted

Metoprolol Succinate Er (extended release)  or metoprolol tartrate still have availability problems in Thailand? I am going back to Thailand soon for extended stay.

Thanks in advance for any useful responses

Posted (edited)

I just picked up metoprolol  at my pharmacy here in Chiang Mai, had a huge stack of em available.  

Edited by Ajvat37

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