Yeah, yeah. How's it going today? Very well. Thank you. Great. Yeah. Thanks for taking the time to speak with me on this. I'm sure you're quite busy. Yeah, no problem. Um, yeah. So a general question is on the shortage of nitroglycerin sprays and tablets in Canada and I was wondering what you can tell me about what this means for Canadians cardiovascular health and the treatment of heart disease and other heart ailments.
So, so, the shortage is with nitroglycerin pills. So the short acting pills and the short acting spray so, you know, in general folks with angina we'll use those skills or sprays I'll just use the word nitro which are changeably. But in general, most will use those to combat episodes of angina. So discomfort with exertion for example, everybody's joining us just a little bit. A common example of it would be getting chest discomfort with exertion. So say climbing a couple of stairs or something like that. Patients will use short activators to combat those episodes. And of course, tracking other situations it's used to the emergency department invasion investigations going on Gnostic casting and that sort of thing, but in my particular sort of thinking, Mr. Smith, who has cardiac disease, who sort of the approach want me to take sure we go, okay. So so the, the Nitro has a has a has a role in treating cardiac disease when patients have symptoms of angina, but really, the foundation the foundation of treating cardiac disease is good medical therapy. So good medical therapy includes like prevention, things like aspirin, cholesterol lowering drug, and in terms of set for symptom relief and for prevention. There's other drugs that are long acting, that helps prevent that from happening in the first place. Right. So you know, we all have lots of patients who are on medical therapy and because they have good medical therapy, so or very rarely, because they have good therapy or on top of medical therapy they've had, they've had stent put in or they've had bypass surgery. They've had they have a foundation of good medical therapy. They have additional therapies like statins for bypass surgery. as needed. And many of them have very good quality of life and have very few symptoms. On the occasions that folks have symptoms, that's when they sort of use that short acting. So the shortage, certainly caused by some concern, but it's also an opportunity to read it as an opportunity to revisit how we're treating our patients. Making sure that folks who are having have a lot of need for nitro are getting have that good foundation in place like is there room to move on some of their long acting drugs? Can we increase doses of other drugs to help prevent the emphasis on so that didn't get used as much as the other authors also, there's also options in the manual, because there are long and military preparations that are not short. So things like natural patches and there's prolonged backing pills that we can also use to help mitigate the challenges that are that you could potentially foresee with a shortage. Right.
I have a question about increased demand for these drugs. That was what the Health Canada press release said. Could you confirm it? There's been an increase in demand over the past three years for these sorts of drugs, whether that's because there's a increases in angina or heart disease or things of that nature.
But there's been an increase in Canada fingers that an increase in demand for sure. Yes. So I mean, I have the data to confirm that. But, you know, it wouldn't surprise me because we have an aging population. And we've had, you know, we've been through a global pandemic where people have been at various points, actually. narrowed contacts, because if it's, you know, worried about catching colds, either physicians credit problems, right. So, there's been a lot of perhaps unrecognized risk factors, but people can also see family. Blood pressure categorized in your cholesterol check cannot be screened for diabetes. So you know, things are kind of go on. Because of stress, a lot of people are smoking and all that sort of thing. Right. So the decreased overall health system over the last few years, has perhaps led risk factors that would otherwise be attended to early and well managed, are now being attended to happen to have a couple years to do things to people. So people that are farther along in disease trajectory, when they're coming to attention, so does it surprise me that they're coming to like, multiple options to be quite honest with you? No, but I have not seen so I cannot confirm that that is true.
Could you also talk about a shortage of the key ingredients in nitroglycerin? Like do you have any knowledge or data that you've seen on that aspect of this
essential, essential threat so I don't have I don't have my understanding. So how can there be no more than this but my understanding is that it is the it is the raw ingredients is in short supply. So it's not like you have a bunch of pills that are made that are trapped in a supply chain or something like that, right. It is a longer candidate. Other than, perhaps other suppliers, that sort of thing. Again, that's something that you have to discuss society was approached by Health Canada to assist with us in terms of messaging and making sure that the right people knew what was going on and what to do about it. And that this is a collaboration with the Canadian Pharmacists Association that's responsible to help message there's been a nice infographic that is actually specifically for pharmacists, because that's often where the patients will touch one of their health care providers right when they're getting refills under prescriptions. So there's been an infographic infographic that we've seen that have been attributed to pharmacists and family conditions. Alternate health care provider, most likely will be beneficial in the pharmacies because they are such a common point of contact with the healthcare system. So there's like these decision trees that we go through today. Your patient is having days there for a refill the first question is,
when's the last time they had use available stock sensibly? Right? Somebody hasn't had an invite in three years, they probably don't need to fill the position today. Right.
So he's still targeting the available stock which is very important. It's an opportunity for the pharmacist to touch base with the patient and
physician says, hey, you know, are there other strategies that you can put in place where we've already discussed that? You can increase doses of medications introduce nitrates you can optimize, optimize therapy. So that you know the other thing is, is that my understanding is that the spray is more in shortage than the pills are, although it was anticipated it's not surprising the pills are shorter, but using the right preparation for the right person, so you know, an elderly patient with medical experience issues, hormonal issues is is better off getting right and a patient who has no issues with that dexterity. So right now, it's being sensible and wise about which drugs we get in which patients and why and so Canada is working on it. Getting getting perhaps an alternative source. Getting more information for us about how long will this shortage last and what future steps strategies we have to look at. Right.
Okay, thank you for that. I think that should be all I need for the story, but that's very helpful. And again, I really appreciate you taking the time to speak with me on this
week. I definitely don't want there to be sort of a sense of panic about this, right? I mean, if you want to compare stories, the Tylenol story caused a lot of angst in a lot of people, right. We don't want to be the Tylenol story. I think that you know, the right people. I would prefer that you write this as yes no shortage but it's okay people there's a shortage of people have strategies
in a way that people should be hysterical and be
Tylenol, Tylenol was not. There were lots of things that were handled poorly about that but lots of people can't. And I think we have a pretty good muscular group of practitioners. We're not panicking because we've got lots of shortage gets worse. It's going to be absolutely frustrating. And it's going to be we're gonna have to really think smart but I don't want my patients to panic because emotional stress and content. Right, so emotional stress can trigger things for patients. So we don't want I just don't want the messaging to be this independent. I want the messaging to be yes, we know there's a shortage, and it's okay. We have sensible strategies in place to mitigate this until until the shortage is over. If you're having symptoms, please talk to your
doctor. Okay, yeah, sounds good. I'll definitely be carbon neutral in the way I frame this.
Yeah, cuz like I really don't want to panic because literally, it is one of the one of the triggers for anginal events and we don't want to be your emergency department. So people having chest pain because they're worried to check and make sure you're starting over.
Okay, well, good luck with that. Thank you for your time.
