Medicine Shortages: How to Stay Safe When Your Drug Runs Out

Why medicine shortages happen and who they affect

Medicine shortages in Syria, Yemen, Sudan, and Lebanon are not occasional inconveniences. They are a structural reality driven by conflict, sanctions, import restrictions, collapsing currency, and disrupted supply chains. A 2025 study published in Frontiers in Public Health examining hypertension care among Syrian refugees in Lebanon found that access to antihypertensive medication was seriously impaired, with many patients unable to maintain consistent treatment. This pattern repeats across chronic disease categories including diabetes, epilepsy, and mental health conditions.

The same shortage dynamic affects countries without active conflict when currency collapses make imported medicines unaffordable, as happened in Lebanon from 2019 onward, and when national regulatory systems cannot process import approvals quickly enough during crises. A 2025 study in BMJ Global Health found that awareness of substandard and falsified medicines in Jordan was high among healthcare professionals, reflecting the pressures that shortages place on supply chains and the substitutions people make when first-line products disappear.

The people most harmed by shortages are those managing chronic conditions that require daily medication: diabetes, hypertension, epilepsy, heart failure, thyroid disease, psychiatric conditions, and HIV. These are not conditions where missing a few days of tablets is manageable. Some are conditions where stopping medication abruptly is medically dangerous.

Which medicines are dangerous to stop suddenly?

This is the most important thing to understand in a shortage. The danger of abrupt stopping varies enormously by drug class, and for some drugs it is not a hypothetical risk but a documented cause of serious medical events. The following drug classes should never be stopped without a plan, and if you are running short, that plan needs to be made before you run out.

Beta-blockers, which include metoprolol, atenolol, carvedilol, bisoprolol, and propranolol, were among the first drugs where abrupt withdrawal was documented as causing rebound cardiovascular events. A landmark study published in Circulation in 1980 measured a surge in adrenergic responsiveness after abrupt propranolol withdrawal in patients with angina, consistent with reports of worsening chest pain and acute coronary events in those who stopped suddenly. Tapering rather than stopping abruptly is the standard approach.

Corticosteroids, including prednisone, prednisolone, and dexamethasone taken for more than a few weeks, suppress the adrenal glands. When the tablet is stopped suddenly, the adrenal glands cannot immediately resume their own production of cortisol, which can cause adrenal insufficiency: severe fatigue, low blood pressure, vomiting, and in serious cases collapse. A 2023 protocol paper in PLoS One described this risk formally in the context of designing steroid tapering trials.

How to find the equivalent of a medicine you cannot get

Every medicine has two names. The brand name is what the manufacturer calls it, for example Glucophage or Concor. The active ingredient name, also called the generic name or the international nonproprietary name (INN), is the actual chemical compound, for example metformin or bisoprolol. The brand name changes by country and manufacturer. The INN is the same everywhere in the world.

When a specific brand is unavailable, the first step is to find the INN on your packaging. It is usually printed in smaller text below the brand name, or on the box in a section called composition or active ingredient. Once you have the INN, you can ask a pharmacist for any product containing that same molecule at the same or similar dose. The pharmacist can confirm whether what they have is bioequivalent, which means the body absorbs and uses it in the same way.

Some drug classes tolerate substitution between members more than others. Within the beta-blocker class, for example, atenolol can generally be substituted with metoprolol or bisoprolol at an equivalent dose, because they act on the same receptor with similar effect. Within anticonvulsants, substitution is much more complex because different drugs in the class work through different mechanisms and have different therapeutic windows. For epilepsy in particular, any substitution should ideally involve a doctor.

What to do when only partial supply is available

Sometimes a medicine is partially available: you can get enough for two weeks but need treatment for a month. Rationing a medicine by taking less than the prescribed dose is sometimes the only option, and it is better than nothing for most conditions. However, the implications depend entirely on which medicine is being rationed.

For antihypertensives, taking half the dose is almost always better than taking nothing. Blood pressure control will be incomplete but some control is better than none, and the risk of rebound hypertension from stopping entirely is real. For antiepileptics, any dose reduction risks reducing the level below the therapeutic threshold and precipitating a seizure, which makes this a high-risk strategy. For insulin, dose reduction is genuinely dangerous and the threshold of harm is unpredictable.

If you are facing a partial supply situation, tell the pharmacist the quantity you have and ask them how to spread it over the longest safe period for your specific drug. A pharmacist who knows the pharmacokinetics of the drug can give practical guidance. For high-risk drugs, prioritising getting any contact with a doctor, whether in person, by phone, or through a telemedicine service, before rationing is important.

Specific situations: insulin and diabetes medicines

Insulin shortages are among the most immediately dangerous shortage situations. Insulin-dependent people, whether type 1 or those with type 2 diabetes who have been on insulin for years, cannot simply stop. Without insulin, glucose rises rapidly, leading to diabetic ketoacidosis in type 1 diabetes, which is life-threatening within hours to days if untreated. The first step when insulin supplies are threatened is to contact every pharmacy in accessible range and to contact any diabetes clinic or hospital with an endocrinology service.

Different types of insulin are not equivalent and substituting between types requires guidance. A short-acting insulin is not interchangeable with a long-acting one without a careful dose recalculation. If the specific formulation has run out but another type is available, a doctor or diabetes nurse who knows your regimen can help convert the doses. Regional WHO and diabetes association guidance for shortage situations sometimes specifies priority allocation of insulin to insulin-dependent patients over those whose diabetes might be managed for a period on oral medication.

For people with type 2 diabetes on oral medications such as metformin, sitagliptin, or gliclazide, a shortage creates significant but less immediately life-threatening risk. Tightening dietary control, reducing carbohydrate intake, and increasing physical activity can partially compensate for a period. Regular blood glucose monitoring, where a glucometer and strips are available, becomes even more important to track whether the situation is manageable.

Specific situations: blood pressure and heart medicines

Uncontrolled hypertension during a medicine shortage significantly increases the risk of stroke and heart attack, particularly in people who already have cardiovascular disease. When a specific antihypertensive is unavailable, pharmacists can often suggest an alternative from the same class or a different class that achieves similar blood pressure lowering. Many antihypertensive classes are available as generics and are relatively inexpensive when imported versions are not available.

Among blood pressure medicines, clonidine requires particular caution. It has a specific rebound hypertension on abrupt discontinuation that can produce a dangerous blood pressure spike within 24 to 48 hours. If clonidine is your blood pressure medicine and you cannot get it, seek medical advice quickly about how to taper rather than stop. For common blood pressure medicines such as amlodipine or lisinopril, abrupt stopping carries less rebound risk but blood pressure will rise and needs to be monitored.

For heart failure medicines including ACE inhibitors, diuretics, and digoxin, any gap in therapy can destabilise a condition that was balanced on a specific combination. Weight monitoring at home, watching for ankle swelling, and reducing salt intake aggressively can help buy time. A phone call to any available doctor or nurse is valuable in a heart failure patient facing a medication gap.

Specific situations: psychiatric and neurological medicines

The evidence on antidepressant discontinuation syndrome is now comprehensive. A 2023 review in European Neuropsychopharmacology documented that discontinuation syndrome occurs in a significant proportion of people stopping antidepressants, particularly paroxetine and venlafaxine, and can include dizziness, electric shock-like sensations in the head and limbs known as brain zaps, severe anxiety, nausea, and insomnia. These symptoms begin within days of stopping and can last weeks. Tapering slowly is the standard approach, but when medicines run out abruptly in a shortage, the syndrome can be severe.

For people on antipsychotic medication who face a shortage, the risk of psychiatric relapse is real and can develop quickly. Families supporting someone on antipsychotic treatment should understand that behavioural change, paranoia, or agitation emerging after a medication gap may reflect relapse rather than a new problem. Contact with a psychiatrist or psychiatric nurse should be sought urgently.

Epilepsy presents the highest acute risk among neurological conditions in a shortage. The antiepileptic drugs most commonly available in resource-limited settings are phenobarbital, carbamazepine, and valproate. Phenobarbital is on the WHO essential medicines list and is usually the most widely available. If your specific drug is unavailable, the closest available equivalent should be discussed with a neurologist, and the transition should be gradual wherever possible.

Practical preparation before a shortage strikes

Maintaining a personal medicine record is the single most practical preparation. The record should contain: the brand name of each medicine you take, the active ingredient name (INN), the dose in milligrams, the frequency, and the condition it treats. This record should be on paper as well as in a phone, because phones lose charge and networks fail. It should be with you when you travel and copied to a family member.

Asking your doctor to prescribe a slightly larger quantity when supplies are available, if this is permitted in your country, builds a short buffer. In countries where prescription quantities are limited, knowing which medicines can be obtained in larger amounts from a hospital pharmacy versus a community pharmacy is worth finding out in advance.

Building a relationship with a local pharmacist who knows your medicine list is valuable beyond a shortage. Pharmacists in the region often have advance knowledge of upcoming supply problems and can alert regular customers. They can also contact distributors to source specific medicines that are not in their own stock, which is often faster than a patient searching between multiple pharmacies independently.

Where to find help and information during a shortage

Pharmacists are usually the first and most accessible source of help in a shortage. They know what is in their stock, what is available from their distributors, and what the generic alternatives are. In cities with multiple pharmacies, calling ahead rather than visiting each one saves time. Some pharmacies in Beirut, Damascus, and Amman participate in informal networks that share stock information.

Hospital outpatient pharmacies and emergency departments often have access to supplies that community pharmacies do not, particularly for essential medicines such as insulin, antiepileptics, and cardiovascular drugs. Presenting to a hospital pharmacy and explaining a shortage situation can access medicines not available elsewhere.

NGO and humanitarian organisations active in Syria, Yemen, Sudan, and among displaced populations often maintain medicine access programmes. The International Committee of the Red Cross, Medecins Sans Frontieres, and UNHCR all operate medicine supply lines in crisis areas. Being registered with a humanitarian health programme can give access to basic essential medicines even when commercial supply has completely broken down.

Sources

• Lindenfeld J, Crawford MH, O'Rourke RA et al: Adrenergic responsiveness after abrupt propranolol withdrawal in normal subjects and in patients with angina pectoris, Circulation, 1980
• Fornaro M, Cattaneo CI, De Berardis D et al: Antidepressant discontinuation syndrome: A state-of-the-art clinical review, European neuropsychopharmacology, 2023
• Komminoth M, Donath MY, Hepprich M et al: Glucocorticoid withdrawal and glucocorticoid-induced adrenal insufficiency: Study protocol of the randomized controlled TOASST multicenter trial, PloS one, 2023
• Al-Rousan T, Naja W, Wejse CM et al: Hypertension in Syrian refugees: prevalence, awareness, and access to care in Denmark and Lebanon, Frontiers in public health, 2025
• Falah MM, Daar E, Zahra D et al: Prevalence, experience and awareness of substandard and falsified medicines among the public and healthcare professionals in Jordan, BMJ global health, 2025
• World Health Organization: Ensuring uninterrupted supply of essential medicines during conflict and emergencies