Doctors have warned that a severe shortage of an “essential” medicine used to help protect alcoholics from degenerative brain conditions could disproportionately affect “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 symptoms similar to dementia. Doctors are concerned the incidence of these debilitating conditions may increase as a result of the shortages.
The Department of Health and Social Care (DHSC) warned in April that Pabrinex intravenous injections were likely to be in short supply until September 2025 at the earliest and intramuscular injections were being discontinued.
Dr Marcus Bicknell, a GP who specialises in addiction, described the situation as “an absolute disaster”. “This is an inexpensive, highly effective drug we’ve been using for over 50 years but next year it won’t be available to us at all. If this was a cancer drug there’s no way that discontinuation would be accepted.”
Bicknell said his centre had already begun rationing the drug and reducing the doses of the “essential” medicine that were given to patients, which he called “scandalous”.
A spokesperson for the Japanese company Kyowa Kirin, the licence holder of Pabrinex, said the supply of the drug had been affected by the closure of manufacturing facilities that would have required upgrading to comply with 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 thought manufacturers were withdrawing the drug from the market because it was not profitable enough. “Addiction patients shouldn’t be treated as second-class citizens – it’s outrageous,” he added.
The UK has experienced a dramatic recent rise in the number of unavailable drugs, with 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 linked to Covid, inflation and the war in Ukraine had contributed to shortages, the situation in the UK had been exacerbated by Brexit.
Alcoholism impairs the body’s ability to absorb vitamins which can increase the chance of developing a degenerative brain condition. Pabrinex contains five vitamins, including thiamine, and is described as a “gold standard” treatment to protect excessive drinkers from irreversible brain damage, and there are limited alternatives.
The drug, which costs £2 a treatment, has run out in some areas. An injection of thiamine is an alternative treatment but no product with a market authorisation currently exists in the UK.
Dr David Bremner, the medical director for drug and alcohol charity Turning Point, said: “The population of people are not a vocal group of healthcare users or a group which incentivises themselves into being able to combat this kind of withdrawal services.
“We are currently only giving Pabrinex to 10% of those we used to give it to. The problem with a preventative medicine is it only works if we give it to as many people as possible. It starts to become alarming 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 separate stages and can result in disorientation, poor balance, and a dementia-like condition if not treated.
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 all my life but with the rehabilitation and the medication, my neurological pathways reopened and now I am working, driving a car and living independently again.”
A DHSC spokesperson said: “We know how frustrating and distressing medicine supply issues can be for patients. This government inherited ongoing global supply problems that continue to impact medicine availability, 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 come into the UK market. As a result of these actions, the expected resupply date of Pabrinex has been brought forward by almost a year.”
