Amid a nationwide shortage of children's pain and fever medications, Health Canada was due to speak with manufacturers on Thursday to discuss ways to boost supply.
Parents across the country have noted empty shelves where they had hoped to find pediatric acetaminophen or ibuprofen products, like liquid Tylenol and Advil, or chewable tablets.
Conflicting advice from health organizations in recent days has led to confusion about how to buy the products and prompted concerns about potential panic-buying.
Pharmacists and other health organizations are urging the public not to hoard the medicines, as there are backup options available and pharmacists can offer individualized advice for treating kids.
Do you have questions or an experience to share about the children's medication shortage? Send an email to email@example.com
Do I need a prescription?
No, you do not need a prescription for children's acetaminophen or ibuprofen products. They are over-the-counter medicines, but the current shortage means they might not be on some store shelves.
If a parent is unable to find the medications, they should speak with a pharmacist, who can help by:
Dispensing a small quantity from a larger stock bottle.
Compounding a customized dose from base ingredients.
Advising how to administer the right dose for their child from an adult product.
Pharmacists are experts in customizing medications for patients, and can easily do so if requested, said Bertrand Bolduc, president of the Quebec Order of Pharmacists.
"We have access to the active ingredients, we have recipes, we know how to mask the taste of that drug, so if push comes to shove, we'll make it ourselves," he told CBC Radio's Daybreak Montreal.
It would be up to an individual pharmacy to decide whether to charge a dispensing fee for medication from a stock bottle or for compounding medicine, several pharmacists told CBC News.
WATCH | Don't stockpile children's medicine, parents urged:
Why are people talking about prescriptions if they're not needed?
On Monday, Toronto's SickKids hospital advised parents and caregivers of its patients that they would now need a prescription for children's acetaminophen or ibuprofen products for take-home use, due to the nationwide shortage.
However, on Tuesday, the hospital clarified that advice, saying it "recommended" a prescription "to help ensure access" to a pharmacy's larger stock bottles, adding that its original message was not meant for the general public.
According to the Ontario Pharmacists Association, a prescription can be helpful because it tells the pharmacist the right amount of medication to dispense to the individual child, and what dosage to put on the label, based on their age and weight. That said, a prescription is not mandatory.
Can my child take adult acetaminophen or ibuprofen?
Possibly, but parents should seek advice from a pharmacist about the right dosage for their child, said Jamie Wigston, a pharmacist at West End Medicine Centre in New Westminster, B.C., and president of the B.C. Pharmacy Association.
Older kids might be able to swallow part of an adult tablet, while for younger children, a tablet may need to be crushed and mixed into a food, like applesauce, or a pharmacist can compound a custom liquid for them.
"There's certainly a lot of options, even if the certain products most parents are used to aren't available," Wigston said.
Is it OK to give my child pediatric medication that has expired?
Speak with a pharmacist before going this route, said Barry Power, editor-in-chief of the Canadian Pharmacists Association.
"There are a lot of factors that come into play when you're making a decision about using out-of-date medications," he said.
Why is there a shortage now?
Pharmacists in parts of Canada have reported running low on over-the-counter medications used to treat fever, cold and flu — both for children and adults — in recent months as pandemic measures lifted and Canadians got back to everyday activities, leading to more viruses spreading.
"There's an increased demand for [medications] for flu and for colds, generally, and that demand has been quite significant over the past several months. The demand outstrips supply by a wide margin," said Michael Fougere, CEO of the Pharmacy Association of Saskatchewan.
Manufacturers have also faced supply-chain issues throughout the pandemic.
Advil manufacturer Haleon, a division of drug giant GSK Canada, said it was dealing with shortages of raw materials, packaging and labour.
"We are working tirelessly with our suppliers, manufacturing partners and the government to address these issues and return to inventory levels that are aligned to current demand," the company told CBC News in a statement.
What's being done to resolve the shortage?
Most of Canada's acetaminophen and ibuprofen products are produced domestically, and manufacturers have given assurances that their facilities are "working at maximum capacity," Power said.
Neither Haleon, nor Tylenol and Motrin manufacturer Johnson & Johnson, responded to questions about whether they were able to further increase their domestic production, or redirect products to Canada from abroad.
Power told CBC News his organization would take part in a meeting about supply with Health Canada and manufacturers on Thursday afternoon.
A Health Canada spokesperson said Thursday that talks were ongoing about the extent of the shortage and ways to mitigate it. A day earlier, the agency said "regulatory measures to accelerate resupply" were possible, but did not give further details.
One potential solution, Power said, is to have Health Canada allow the sale of identical medicines from other countries until the shortage is resolved, as it did with inhalers labelled in Spanish during a 2020 shortage.
Will there be a shortage of adult medications?
There are no signs that adult acetaminophen and ibuprofen products are in short supply, Power said.
Those products are manufactured by a larger number of companies, which means there are more brands available, including generic products.
Everyone says don't panic-buy, but should I stock up anyway?
Absolutely not, say pharmacists, urging against a repeat of a scenario like the toilet-paper hoarding of early 2020.
"What is available at any given day may be changed from day to day, or week to week, but there are products that are still out there," said Tim Smith, a Winnipeg pharmacist and pharmacy practice adviser for Pharmacists Manitoba.
"Pharmacists are experts in helping navigate drug shortage issues [and] will help you find the appropriate medication for your child."
Some pharmacies have pre-emptively moved their remaining stock of pediatric pain and fever products behind their counters to discourage panic-buying, noted Power, and customers who encounter empty shelves should speak with a pharmacist to see if the medicine is still available, and what the alternatives are.
When will the shortage end?
Haleon and Johnson & Johnson did not respond to questions about when their products would be more readily available across Canada.
Some pharmacists told CBC News they were unable to order any more children's acetaminophen or ibuprofen products from the companies' warehouses, and there was no expected return date for the products.
Power warned that there could be a further spike in illnesses when kids head back to school next month, which could put further pressure on the already-limited supply.
He urged parents to ensure their kids' vaccinations against childhood illnesses are up to date, to keep them as healthy as possible.