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Parkinson Society British Columbia is the voice of British Columbians living with Parkinson's.  Our purpose is to ease the burden and find a cure for Parkinson's disease through advocacy, education, research and support services.

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Media / Sinemet UPDATE
Overview of the Situation with Medication in BC (Updated - May 30, 2011)
Jennifer Foster, Director, Education and Support Programs, PSBC

As you are aware, there have been significant changes recently with respect to the most
commonly used Parkinson's medications: Sinemet (brand name), and the generic form
Levocarb.

Overview of Sinemet and Levocarb
It is important to know that both Sinemet and Levocarb come in two types: immediate
release (IR) and controlled release (CR). The difference between IR and CR pills is
that the CR pills have a special coating on them that causes the pill to break down in
your system more slowly than the IR ones, thereby allowing a more prolonged release
of medication into the body. In addition, both Sinemet and Levocarb come in a variety
of strengths. The most common strengths are 200/50 and 100/25. Your doctor will
prescribe either IR or CR based on what they think will best manage your symptoms.
Some people take both IR and CR pills. As you read this, please pay close attention
to the type that is described.

There are two issues that have changed over the past 18 months: supply of Sinemet
and Levocarb, and changes to Sinemet pills.

Supply of Sinemet and Levocarb
In December 2009, we received information that Apotex, a distributor of the generic
Levocarb, was permanently discontinuing the very commonly used strength of their
controlled release medication - Levocarb CR 200/50. There was also a back order of
Levocarb CR 100/25 for several months, at which time no generic form of the CR tablet
was available. While there are other manufacturers of Levocarb in Canada, there is
currently no Levocarb CR available in BC
(note that this may not be the case in all
provinces). Levocarb IR is available in various doses.

Since 2010, with the discontinuation of the Levocarb CR product, there have been
intermittent shortages of other forms of the drug (both Sinemet CR and Levocarb IR) as
the market adjusted to lack of supply of Levocarb CR. Currently there is a shortage of
Levocarb IR 250/25 which is expected to end in July, 2011.

The issues with supply are complex, so I will not go into them here, except to say that
Merck Frost, the company that owns and distributes Sinemet, has been monitoring and
adjusting supply to meet the need. However, timing has been an issue, so some regions
of the province (and Canada) experienced interim shortages.

Changes in Sinemet
In November 2010, Merck announced that they were changing the image of Sinemet
CR 100/25 and 200/50 tablets. In March 2011, they announced they were changing the
image of Sinemet IR 100/10 and 250/25. This is part of a worldwide effort to have one
universal image for Sinemet. (Please note, at this time the image of Sinemet IR 100/
25 has not been changed, however currently this strength is not available and this
shortage may last until the fall of 2011).

The changes to the image of Sinemet include new colours, shapes, markings, non-
medicinal ingredients and storage conditions. The changes also affect how people take
the drug and how physicians prescribe it.

The following changes are important to note:
  1. The name "Sinemet" no longer appears on the new tablets, so be careful that you
    are taking the correct medication.
  2. The new pills are no longer scored for splitting. People who were accustomed
    to splitting a pill can no longer do so and have had to or will have to obtain a
    prescription for a supply of the half-strength pills. This has resulted in higher
    costs as there are cost efficiencies in splitting pills.
  3. There has been a change to the non-medicinal ingredients of the new tablets.
    As a consequence, some people are experiencing adverse reactions. Please
    note that everyone's reaction to new medication is different. However, if you
    experience an adverse effect, it is important that you contact your neurologist.
    We would also appreciate knowing about this, as the more information we have,
    the better our advocacy efforts can be.
  4. Lastly, Health Canada has a process for reporting adverse reactions to drugs.
    You will find that information at the end of this letter. You may also contact the
    Merck Customer Information Centre at 1 800 567 2594 if you have questions or
    concerns related to the new Sinemet CR.
What you can do
Before you leave the pharmacy, check your order. If you have the "new product", make
sure you receive accurate, updated information on how to take it.
 
Some pharmacists are not aware that there is a change in Sinemet products, despite
Merck's efforts in advising neurologists, pharmacists and retail/wholesale chains.
If you find that pharmacists are not aware of this, click the links below to download
a copy of two letters by Merck, as well as a copy of a document which shows new images
of Sinemet (make sure you make colored copies). Both documents can be given to your
Pharmacist.
 
 
Current Supply Situation
We continue to hear that some of you are still having difficulty accessing Sinemet. We
are not sure exactly why this is happening, but markets across the country are in the
transition phase from the old to the new products and adjusting to previous shortages.
While the purpose of Merck's changes is that supply will be constant, we are not yet
there. It appears that some pharmacies have limited or no supply of Sinemet CR while
other pharmacies do have a supply.

This means that until supply is stabilized, you may need to shop around for your
medication. We understand that many people develop relationships with their pharmacist
and that moving pharmacies temporarily is not ideal. We would appreciate being kept
informed if you continue to have trouble accessing your medication(s).

As recently as May 24th, 2011, we learned that Apo-Levocarb CR 100/25, a
generic controlled release product, will be available mid-August 2011 through
a drug company called AAPharma (for more information about the drug visit
AA pharma inc.). We anticipate that once this product is available supply of CR
medications will be improved.
 
Drug Coverage Affected
There are two forms of Insurance for drug coverage in BC: public (Fair PharmaCare)
and private (e.g. SunLife, Blue Cross, etc). The medication supply issues have caused
temporary changes to drug coverage. In a market when there is supply of both brand
(Sinemet) and generic (Levocarb) medication, Fair PharmaCare and private insurers
reimburse only a portion of the cost of Sinemet. The amount that is reimbursed is equal
to the price of the generic.
 
However, given that there is currently no Levocarb CR available in BC, everyone who
had a prescription for Levocarb CR has been switched to Sinemet CR. As long as there
is no Levocarb CR on the market (which will be the case until at least the middle of
August), Insurers (both public and private) will reimburse for most of the cost of Sinemet.
Please note that if you are not receiving reimbursement for Sinemet CR you should
contact your Insurer.

Conclusion
I wish to conclude this summary by acknowledging the complexity and distressing nature
of the situation with Parkinson's medications in BC right now and to suggest that if you
have any questions about this information, or about your personal situation with respect
to medication supply or coverage, please do not hesitate to call us. We will do our best
to help.

Helpful Resources
A useful tool to find out what medications are available and covered by PharmaCare,
as well as how much of the cost will be reimbursed, is the BC PharmaCare
formulary search at Health Canada's website.
 
Consumers and health care professionals can report adverse reactions of
medications to Health Canada. Visit the Health Canada website for forms and
contact information for regional offices. There are several ways to submit a report:
  • Fax: download and print Canada Vigilance Reporting Form and fax to regional
    office at 1 866 678 6789.
  • Mail: download form, complete and mail to Health Canada regional office
  • Phone: toll free 1 866 234 2345
 
Parkinson Society of British Columbia