A Popular Drug Disappeared In Belarus

It's about an antidepressant.

"White Coats" became aware of a new outage of psychiatric drugs in Belarus. It's the third for the last six months.

Lithium, which is necessary for people with bipolar disorder, disappeared from the sale in December last year and buprenorphine, important for addicts, disappeared at the end of February. This time problems are observed with the supply of fluoxetine.

This is one of the most famous antidepressants from the group of selective serotonin reuptake inhibitors. According to Tabletka.by, only one variant of the drug is now on sale - fluoxetine 20 mg #20 by Russian manufacturer Ozon.

The list of pharmacies shows single points in Brest region: Kobrin, Bereza, Brest, Zhabinka. Until recently, it was available in most pharmacies in Belarus.

Fluoxetine is a relatively old drug, but it has not gone into the medical archives. The WHO includes it in the model list of essential medicines.

FDA lists fluoxetine among drugs for the treatment of depression, obsessive-compulsive disorder, bulimia and panic disorder; separately, the instructions prescribe the combination of fluoxetine with olanzapine for depressive episodes in bipolar disorder type I and for resistant depression. It turns out that its disappearance hits several groups of patients at once.

The drug has several properties that keep doctors actively prescribing it. It can be used for bulimia nervosa, and for this group of patients the choices are often very narrow.

It has pediatric indications: the FDA guidelines list fluoxetine for the treatment of depression in children as young as 8 and OCD in children as young as 7. It has a long elimination period: the active ingredient and metabolite remain in the body longer than many other antidepressants For patients who sometimes forget to take a pill, this reduces the risk of acute deterioration due to a single skip.

It is also important that fluoxetine is very cheap. According to Apteka.103.by, a pack of Russian fluoxetine 20 mg #20 cost about 2.78-2.79 rubles. This is a standard dose, it can be three times higher, but even in this case, the cost of treatment for a month is less than 9 rubles. That is, it is a drug available to people with any level of income.

According to the information received by "White Coats", the first reports about problems with buying Fluoxetine began to appear a few weeks ago.

On Tabletka.by in the questions section as early as May 11, a user asked why the drug was missing and why it was available only in Brest and the region. There are a lot of such questions, and the last one, published on June 1, was answered with the following: the problem is that the Ministry of Health has not received permission to import the drug. It's unknown when the situation will change.

We remind that Ukrainian fluoxetine was supplied to Belarus until 2022. After the outbreak of a full-scale war of Russia against Ukraine, these supplies were stopped. Then the Russian drug remained on the market. Patients complained that the replacement was less effective, but there were almost no alternatives. Now this option is also disappearing.

The consequences of the disappearance of fluoxetine depend on the diagnosis and treatment regimen. A part of patients can switch to another antidepressant. For some, such a transition is undesirable: fluoxetine may have been prescribed after unsuccessful attempts to treat with other drugs. In bipolar disorder, switching is more difficult, because you have to change not just one pill, but the whole regimen. With bulimia, the room for maneuver is even narrower.

A separate risk is waiting on one's own. If a person runs out of fluoxetine and just waits for the drug to appear in pharmacies, the condition can worsen. In depressive disorders, deterioration is associated with the risk of suicidal behavior.

Reminder that according to WHO, the suicide mortality rate in Belarus remains one of the highest in the world - 17.52 per 100 thousand people. It is especially sensitive when the disruptions affect psychiatric patients, who are already rarely spoken about publicly.

What should patients do? If there is at least a month's supply of fluoxetine, there may be no need to make any sudden moves: perhaps a supply will show up sooner. If the drug is low or has already run out, it is important not to hesitate, contact your doctor and discuss a replacement.

It is a bad idea to change the dosage on your own, divide the scheme "as it turns out" or discontinue treatment without counseling. For the future, patients who take fluoxetine continuously should keep a supply of about a month's worth. This is unpalatable advice because patients should not be insuring system failures. But as long as this is the way the system works, the White Coat community sees no other options.

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