Q&A on supply challenges affecting children's pain and fever medications

Canada has been experiencing supply issues impacting pediatric formulations of both acetaminophen and ibuprofen products due to a significant increase in demand that started during Summer 2022. While some community pharmacies may still have challenges with lower supply, the situation continues to improve. We’ve put together this brief Q&A to help keep you updated on the situation.

What is driving these supply issues?
What are manufacturers doing to increase supply?
What is the federal government doing to address the situation?
What do I need to know about the imported products?
Is this a nation-wide issue?
What is CPhA doing to represent pharmacists?
When will the situation be resolved?
How can I help mediate supply and demand?
Is a prescription required for over-the-counter acetaminophen and ibuprofen?
Is a prescription required when compounding children’s and infant’s acetaminophen and ibuprofen?
What resources are available to me to help educate parents and caregivers?
How can I stay up to date on the situation?
Related links

What is driving these supply issues?

The supply challenges are the result of an unprecedented increase in demand that started in Summer 2022. As of March 2023, Health Canada noted that there are indications demand is beginning to normalize.

What are manufacturers doing to increase supply?

When it comes to domestic supply, manufacturers have ramped up production to help meet soaring demand. Domestic production remains at record levels and is expected to remaining high throughout March and April.

What is the federal government doing to address the situation?

Health Canada has been working with a broad range of stakeholders to address the situation, including manufacturers, distributers, and others. Mitigation options include work to boost production of Canadian-approved drugs and import foreign authorized drugs. As of April 4, nearly 3.5 million units of children’s pain and fever medications have been imported into Canada. (List of products eligible for importation).

What do I need to know about the imported products?

Health Canada has posted details related to imported products on their website, including important labelling information.

Is this a nation-wide issue?

While the situation might vary from community to community, the supply issues affecting these products are present across the country. High demand and supply challenges related to these products have been reported in other countries and are not unique to Canada.

What is CPhA doing to represent pharmacists?

CPhA continues to participate in regular stakeholder meetings convened by Health Canada to discuss the evolving supply situation, collaborate on messaging and represent the front-line pharmacist perspective. Other activities include:

In October 2022, we met with federal health minister Jean-Yves Duclos directly to discuss the issue and the impact that this has had on pharmacy teams. The Minister expressed gratitude for everything the profession has done to address the situation and was interested in how the government could support the pharmacy community and our communications efforts. We raised concerns about the amount of time and resources these types of shortages require.
We also participated in a roundtable meeting with the federal health minister in November 2022 alongside representatives from stakeholders across the supply chain, including manufacturers, distributors, pharmacies and pediatric groups. At the meeting, CPhA shared how pharmacy teams are supporting caregivers and the impact this shortage is having on pharmacists’ workload during an already extremely busy time.
CPhA also worked with Health Canada and other stakeholders to support the importation of foreign products to help address the situation and ensure important product information is available in both English and French.
We have conducted regular rapid surveys of pharmacy professionals across the country to better understand and communicate supply challenges and patient demand at the pharmacy level.
CPhA has participated in dozens of national media interviews to help clarify a number of issues, communicate the role of pharmacy professionals and stress the importance of not stockpiling/panic buying.

When will the situation be resolved?

While some community pharmacies may have challenges with lower supply, the situation continues to improve since last fall with the importation of millions of units, increased domestic production and what appears to be a decreasing demand.

How can I help mediate supply and demand?

We understand this is a challenging situation for pharmacy professionals that is putting further pressures on your already demanding workload. Here are some things that you can do to help manage supply:

Place temporary limits on purchases of these products (e.g., one product per customer) where appropriate
Keep product behind the pharmacy counter
Use appropriate signage on any empty shelves
Educate parents/caregivers

We encourage pharmacists to use their expertise and professional judgement to educate patients about the situation and how to manage fever and pain. As a trusted health-care provider and a source of credible health information, pharmacists can play an important role in putting parents/caregivers at ease and offering suitable alternatives as appropriate.

Is a prescription required for over-the-counter acetaminophen and ibuprofen?

No, a prescription is not required for these over-the-counter products. Pharmacists should avoid referring parents/caregivers to other healthcare professionals to receive a prescription for these products.

Is a prescription required when compounding children’s and infant’s acetaminophen and ibuprofen?

Given the significant impact the shortage is having on Canada’s health system, Health Canada has clarified that it does not object to allowing compounding of these products without a prescription but within a patient-healthcare professional relationship, until this shortage resolves.

Health Canada recommends that, at the pharmacy level, appropriate documentation is maintained to demonstrate a patient-healthcare professional relationship. In practical terms, CPhA suggests that when dispensing a compounded medication, that pharmacists create a patient record to keep track of the patient’s name, contact information, the product and dosage and date dispensed. It’s recommended that pharmacists keep these records in accordance with the compounding standards of practice and other requirements set out by the regulatory authority of their province/territory .

Pharmacists should follow any provincial/territorial regulations set forth and seek further guidance from their provincial/territorial regulatory authority if necessary.

What resources are available to me to help educate parents and caregivers?

CPhA collaborated with a number of pediatric experts in Canada to develop a resource for parents and caregivers to help them navigate these supply challenges, which includes information about managing a child’s fever, some helpful do’s and don’ts, and guidance on when to seek the advice of a health-care professional. This webpage and handout can be utilized to help facilitate and support your conversations with patients. We’ve also included some helpful links below. CPhA has also developed a dosing resource for health-care professionals to assist with the administration of acetaminophen during the shortage of children’s products.

How can I stay up to date on the situation?

CPhA will continue to keep pharmacy professionals updated and share any new developments, via email or social media. We will also continue to update our webpage for pharmacy professionals on the issue.