Over-the-counter medications, distilled water drying up at pharmacies

Once plentiful on shelves in stories, Tylenol is becoming hard... — Once plentiful on shelves in stories, Tylenol is becoming hard to find, pharmacists say. Credit: iStock Photo

By Carol PolskyCarol.Polsky@newsday.comMarch 23, 2020

Customers anxious about COVID-19 are sweeping widely used over-the-counter medicines and supplies off the shelves, with little assurance they will reappear soon, pharmacists said.

Hand sanitizer, gloves, masks and alcohol were the first to go. Now, fever and pain reliever Tylenol is sometimes hard to find, as are the popular antibiotic Zithromax Z-Paks, and hydroxychloroquine, a drug used to treat malaria and autoimmune diseases. Hydroxychloroquine has been touted as a possible COVID-19 treatment by President Donald Trump and Gov. Andrew M. Cuomo.

One pharmacist said rescue inhalers soon could become scarce. And even water is drying up. Over the last week, distilled water used to humidify apnea patients’ CPAP machines, a device that forces air into a sleeping person who otherwise would periodically stop breathing, has become almost impossible to find.

“There is no distilled water,” said Michael Nastro, owner and pharmacist at Fairview Pharmacy in Port Jefferson Station. And, “I get 15 to 20 calls a day minimum asking for it. Pharmacists are going on eBay, I hear.”

Besides CPAP machine humidifiers, distilled water is used for things such as cleansing contact lenses and irrigating wounds and catheters. Experts in sleep disorders said CPAP users could forgo using the humidifier, and to contact the manufacturer for guidance on whether tap water could be used without damaging the machine.

“You can use tap water, but empty out the chamber every morning and hang the CPAP hose over the shower rod to dry out,“ advised Dr. Avram R. Gold, medical director of Stony Brook University Hospital Sleep Disorders Center, warning about the potential for microorganisms and precipitates in tap water.

Dr. Michael Weinstein, chief of sleep medicine at NYU Winthrop Hospital, said he wouldn’t recommend using tap water, although boiling it might help kill potential microorganisms, and urged users to contact manufacturers. “We haven’t really encountered this situation where people would have to use tap water on an ongoing basis … if you do use it, keep everything as clean as possible,” he said.

Tylenol disappeared after French medical authorities cautioned against use of products with ibuprofen, noting that several COVID-19 patients worsened after receiving it. Any link between ibuprofen and the patients’ deterioration has not been scientifically established, but that didn’t stop the stampede to buy an alternative, Tylenol.

“Everyone came in and bought Tylenol,” said Denis Lipovac, owner and pharmacistat Village Pharmacy and Surgical in Babylon. “Right now, we have zero Tylenol on the shelf, and our suppliers have no more to ship to us. They estimate they’ll get more by the beginning of April.”

President Trump last week labeled hydroxychloroquine as a potential “game changer” in the search for COVID-19 treatment. The drug treats autoimmune diseases such as lupus and also is used to prevent and treat malaria. Cuomo said the state will begin testing antiviral medicines Tuesday, noting New York has secured thousands of samples of hydroxychloroquine, Zithromax and chloroquine for testing.

While an informal report from France about a limited number of patients suggested hydroxychloroquine could help in treating COVID-19, it is still being evaluated in clinical studies and there is no definitive proof it is effective or safe for COVID-19 patients. Nigeria recently warned against self-medicating with chloroquine, a more toxic cousin of the drug which President Trump also cited, after two people there were hospitalized with overdoses. Yet, fearful customers here have rushed to get prescriptions, making hydroxychloroquine difficult to find for those who need it for their chronic diseases.

“That’s valued higher than gold right now,” said Max Yunat, pharmacist and owner of Family RX Pharmacy in East Meadow, who said he's on a waiting list with wholesalers to obtain more.

“We have prescriptions on file waiting to be filled before we even get a shipment,” he said, adding he only dispenses the drug to customers age 70 and older, and to his regular autoimmune patients who he’d made sure had a three-month supply early on in the COVID-19 crisis.

But many other patients are not as fortunate, according to rheumatologists who treat lupus patients.

“Many patients are already reporting difficulties in obtaining the drug — this is true on a local, as well as a national, level,” said Drs. Cynthia Aranow and Meggan Mackay, co-directors of the Feinstein Lupus Center of Excellence, of the Northwell Health System in Manhasset. “It's a real concern as this drug helps to control and stabilize the disease in many patients.” They reassured patients that several weeks without the medication was “certainly not ideal, but not harmful” and that several companies were ramping up production.

Elizabeth Spencer, a nurse from Garden City, called or made trips to a half-dozen pharmacies last week before finding enough pills to last her 3 1/2 months. Spencer, 58, said her joint pain would be so great within a day or two of stopping the medication that she would be unable to work. When the pharmacists told her they were filling a surge of prescriptions for people without autoimmune disease or active COVID-19, “I was very upset,” she said. “I can understand if someone had the coronavirus, but just to have it around just in case is just wrong.”

Z-packs of an antibiotic called azithromycin commonly used for upper respiratory ailments are also disappearing, pharmacists said, because they are used in conjunction with hydroxychloroquine.

Nastro said he had a small quantity of hydroxychloroquine, but would no longer dispense a 90-day supply even to regular patients who use it to treat rheumatoid arthritis. “We have gotten a lot of calls asking do you have it in stock,” he said. “If I wanted to buy more, I couldn’t get it.” The little he has, he said, would be reserved for people diagnosed with COVID-19 and autoimmune patients.

Pharmacists said most medications were not difficult to stock, and that insurers were cooperating with them in helping customers bring them home.

Robert Raduazzo manager of Greenvale Pharmacy and Home Care, said the pharmacy had not encountered problems with insurance companies when customers requested early refills or three-month supplies of medications, other than controlled substances, which are generally prescribed for only a month at a time.

Raduazzo added that if a drug isn’t in stock, he can usually get it from a wholesaler within a day or two. He said wholesalers were allotting supplies where shortages were appearing for items like cough syrup and Tylenol, which, he said, is sometimes available. When items like thermometers or drugs like hydroxychloroquine are out of stock, “We limit the item to one per customer.”

Pharmacists help each other out and help fill in gaps if they can, Raduazzo said.

Lipovac warned of possible future shortages, noting that the rescue inhalers that asthmatics depend on in an emergency were “starting to become short” as supplies were shifted to hospitals. "We have to shop around a lot and a lot of wholesalers are out of stock,” he said.

Yunat said he soon expects to get “a decent supply” of Tylenol and hand sanitizer. He intends to repay his loyal customers with the hard-to-find sanitizer, he said.

“We’re going to dispense it free of charge to several local senior citizen complexes. It’s the least we can do,” Yunat said.