The Union of Medical Workers of the Salvadoran Social Security Institute (SIMETRISSS) denounced that for more than a month there has been a shortage of intravenous methotrexate, a drug that is used especially in the treatment of some types of cancer.
SIMETRISSS explained that the shortage occurred in parallel to an alert issued by the National Directorate of Medicines (DNM) on December 3 on the use of the drug. The DNM warned of side effects, specifically the “onset or worsening of neurological symptoms, such as general muscle weakness, vision disturbances, changes in thinking, memory, and orientation leading to confusion and personality changes.” However, Dr. Rafael Aguirre, Secretary General of SIMETRISSS, said that these adverse effects are those already known to patients and health personnel.
“You already know that these kinds of side effects, especially when used at high doses, which is how it deals with cancer patients,” he said.
Since the alert does not refer to new side effects, the doctor questioned its intention, since that same week the drug began to be in short supply. “More or less from that date on, we stopped perceiving methotrexate at the oncology level,” he said.
Methotrexate is a drug that is administered orally and intravenously. It is used in the area of rheumatology to treat rheumatoid arthritis, psoriasis, systemic lupus erythematosus and osteoarthritis. In the hematology area, it is prescribed for acute lymphoblastic leukemia and non-Hodgkin lymphoma of the central nervous system.
But Aguirre stressed that its use is especially essential in oncology. He explained that the oral dose is used for the area of rheumatology and occasionally intravenous, but for hematology it is only prescribed intravenously. Precisely from “that there has not been for more than a month,” he said.
LA PRENSA GRÁFICA asked the Social Security call center about this drug. The operator assured that the entity has methotrexate orally, but clarified that he could not confirm the existence of intravenously administered methotrexate. “We cannot know the existence of this drug, since it would have to go directly to the care center or where it is going to be applied,” he said.
The problem with this shortage, said Aguirre, is that for hematologists, methotrexate is essential in the treatment of many diseases, especially for certain types of cancer. If a patient doesn’t get it, they may face relapses.
“In certain pathologies it can be replaced, but not in all, which makes the absence of the drug dangerous,” added the SIMETRISSS spokesperson. “The patients are not really aware of this situation. They know that there is no methotrexate, but they have not been told and they have not told us when it will be available,” said the doctor.
ISSS SIN RESPONDER
Aguirre revealed that on December 14, 2021, he contacted the deputy director of the ISSS, Wendy López, to warn her of the shortage and learn the reasons why methotrexate was not available in the pharmacies of the Hospital de Especialidades y de Oncología.
The doctor said that at first the deputy director of Social Security explained that the lack of the drug responded to the DNM alert. However, said the doctor, when questioned that the statement warns about side effects that are already known and also does not mention the need to remove it from circulation, the official changed the version. According to Aguirre, López maintained that “the supplier had made a mistake with certain stationery that he had to present at the DNM and, therefore, the medicine had not been purchased,” said the union secretary.
Until December 14, the doctors prescribed the drug they had in reserve, “from other cases that had not been used – said Aguirre – but there is definitely nowhere to be found.”
This newspaper was aware of the shortage from that date and sought the ISSS to explain the situation, but until the closing of this article it did not receive a positive response.
Aguirre also pointed out that the deputy director of Social Security has been warned on several occasions of the shortage, but the official justified the shortage by arguing that the drug had not entered the country because the inserts, where the side effects are detailed, do not coincide with what described in the DNM alert.
“The deputy director practically did not correspond to us and on the same date, she has not said what happened with that and what the measure that will be taken is going to be,” said the SIMETRISSS secretary.
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