While the state says it has enough stocks of hydroxychloroquine (HCQ) tablets, the drug has gone off chemists’ shelves and has become unavailable for those who take it for arthritis, lupus, and malaria, with manufacturers started directing their stocks to government hospitals.
Last week, the Maharashtra government had issued a circular allowing the anti-malarial drug as preventive medication against COVID-19 for not just healthcare workers treating the infected but also for high-risk contacts of such patients, including family members, as well as frontline workers in quarantine centres and containment areas.
While 7.14 lakh tablets have been distributed in Mumbai alone, 17 lakh tablets have been distributed across government centres in the state.
In Maharashtra, 64 manufacturers had received a new license to manufacture HCQ in the last one month but have been unable to start production. “They are facing issues of raw material… not every manufacturer is getting supply. There is also shortage of workers in several manufacturing units,” said Vikas Biyani, Joint Commissioner (Drugs), FDA. He added that there are currently only five major manufacturers of HCQ in the state.
Maharashtra FDA commissioner A B Unhale said, “We are monitoring the supply and availability of hydroxychloroquine. There is adequate stock as of now.”
The FDA is also monitoring availability of 55 active pharmaceutical ingredients required in the production of COVID-19 drugs and 97 other essential medicines, based on a notification issued by the Union government.
Data from Maharashtra FDA shows that as on April 29, the government has a stock of 11.38 lakh 200 mg HCQ pills, while private distributors have seven lakh. While the government has a stock of 14,940 pills and private distributors 2 lakh for 300 mg tablets, for 400 mg pills, the state has a stock of 47,000 and distributors 1.10 lakh tablets.
In all, Maharashtra has over 22 lakh HCQ tablets as of now – while 12 lakh are with the government, 10 lakh are with private distributors.
While FDA records show there is adequate stock, private chemists said they cannot supply the pills to regular patients, adding that there is either hoarding or diversion of stock to government centres.
In Andheri East, Kine Medical Store used to stock HCQ until before the lockdown. “After the lockdown, the medicine has stopped coming. The distributor said he does not have any stock,” said manager Jaykishan Yadav.
At Nobel Chemist in Veera Desai, pharmacist Rohit Bind said they could earlier procure as many HCQ strips as they wanted. “Now after repeated calls, we get only five to six strips. In the last one month, at least 12 customers came to buy HCQ. They were all our regular arthritis patients.”
In Andheri west, Mahavir Medical’s manager Amrit Chaudhary said his stock was exhausted a month ago. “Four patients came since then for arthritis, but we had no strips left,” he said.
Dr Siddharth Lalitkumar, general physician, said for arthritis patients, there is no alternative to HCQ to subside swelling and joint pain.
Anil Navandar, secretary of Maharashtra State Chemist and Druggists Association, said manufacturers have been asked to prioritise and supply to the government first. “Local chemists are unable to get supply because the stock is first directed to government hospitals, where it is being used as preventive medication for health workers. The requirement for HCQ was never huge, but arthritis patients majorly depend on it,” he added.
HCQ, an anti-malarial drug, is commonly used to treat rheumatoid arthritis, lupus and malaria. It decreases pain and swelling in arthritis patients. The drug has shot to popularity globally with COVID-19 with research underway to investigate its possible use in treating the infected and its use as a prophylactic medicine. India had banned its export briefly, but later lifted its supply for the US. On April 1, the Centre made it mandatory for chemists to sell the medicine with doctor’s prescription only.
In Varsha Medical Shop, owner Rakesh Tiwari said there are regular FDA checks to ensure they sell the medicine with prescription. “If a patient of malaria or arthritis does not have prescription, I can’t sell them the medicine. We had few such patients, I asked them to get doctor’s prescription,” he added. Patients are finding it hard to consult doctors with most private nursing homes and clinics either shut or operating for emergency cases.
Dara Patel from Indian Drug Manufacturers Association said India scaled up its production capacity to beyond 20 crore HCQ tablets since March end. “Suddenly, its demand has shot up. There is also panic buying, and chemists have been advised to not sell more than a month’s requirement to a patient,” he said.
Maintaining that there are several hurdles in manufacturing and distribution of the drug, Patel said: “Not all manufacturers are able to get raw material. Transportation of medicines to chemists is also not easy. In Bhiwandi, there are several godowns but we have no loaders or workers to transport the stock.”
He added that Mumbai-based Ipca Laboratories produces 50 per cent of India’s stock for HCQ. Next comes Zydus Cadilla. “Both companies have scaled up their manufacturing. Excess is allowed to be exported.”
While Suryakant Pai, handling distribution for Ipca Laboratories refused to comment, K C Mathews from Gujarat-based Torrent Pharma said, “We are not supplying to the market, we are directly supplying to the government now.”
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