Doctors have warned that a severe shortage of a “vital” medicine used to help protect alcoholics from degenerative brain conditions could have a disproportionate impact on “some of the most vulnerable” in society.
Pabrinex, a multivitamin injection, is used to protect heavy drinkers from conditions such as Wernicke’s encephalopathy and Korsakoff syndrome, which can have similar symptoms dementia. Doctors are concerned that the incidence of these debilitating conditions may increase as a result of the shortages.
The Department of Health and Social Care warned in April that Pabrinex intravenous injections were likely to be in short supply until August 2025 at the earliest and intramuscular injections were discontinued.
Dr Marcus Bicknell, a GP specializing in addiction, described the situation as “an absolute disaster”. “It is a cheap, highly effective drug that we have been using for more than 50 years, but next year it will not be available to us at all. If it was a cancer drug, there is no way that strike would be accepted.”
Bicknell said his center had already begun rationing the drug and reducing the doses of the “essential” medicine given to patients, which he called “outrageous.”
A spokesman for Kyowa Kirin, the licensee of Pabrinex, said supply of the drug had been affected by the closure of manufacturing facilities that would have required upgrading to meet changes in EU regulations.
The spokesperson said: “We have identified a new manufacturing partner for Pabrinex® IV and are actively working to facilitate a manufacturing transfer to this new partner. The transfer is being expedited, but it is a complex process.”
Bicknell said he thinks manufacturers are withdrawing the drug from the market because it is not profitable enough. “Addiction patients should not be treated as second-class citizens – this is outrageous,” he said.
The United Kingdom has seen a dramatic recent rise in the number unavailable drugswith 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 with Covid, inflation and the war in Ukraine contributed to shortages, the situation in the UK was exacerbated by Brexit.
Alcoholism impairs the body’s ability to absorb vitamins which can increase the chance of developing the degenerative brain condition. Pabrinex contains five vitamins, including thiamine, and is described as a “gold standard” treatment to protect heavy drinkers from irreversible brain damage, and there are limited alternatives.
The drug, which costs £2 per treatment, has run out in some areas. An injection of thiamine is an alternative treatment, but no product with a market authorization currently exists in the UK.
Dr David Bremner, medical director for drug and alcohol charity Turning Point, said: “The population of people is not a vocal group of healthcare users or a self-motivated group to be able to combat these types of withdrawal services.
“We are currently only giving Pabrinex to 10% of those we used to give it to. The problem with a preventive medicine is that it only works if we give it to as many people as possible. It starts to get worrisome when we start rationing medicine, 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 result in 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 my brain injury I would be in a care home for the rest of my life, but with the rehabilitation and the medication, my neurological pathways opened up again and now I work, drive a car and live independently again.”
A department of Health and Social Care spokesperson said: “We know how frustrating and distressing medicine supply issues can be for patients. This Government has inherited ongoing global supply problems that continue to affect the availability of medicines, and we are working closely with industry, the NHS, manufacturers and other partners in the supply chain to resolve current issues as quickly as possible.
“We have been working to source imports and support new products to enter the UK market. As a result of these actions, the expected resupply date of Pabrinex has been brought forward by almost a year.”
