title: Successful importation of cytarabine into the United States during a critical national drug shortage.
abstract: OBJECTIVE
  The importation of cytarabine into the United States during a critical national drug shortage is described.
  
  
  CONCLUSIONS
  In March 2011, the hospital pharmacy team at an acute care hospital was struggling to supply cytarabine for four specific patients, all of whom needed critical maintenance therapy after induction. Cytarabine was not available from any source in the United States, and the team had no realistic projected release dates for back orders. Idis UK, a pharmaceutical distributor, was asked to identify available drug and eventually found an unrestricted source of cytarabine in Switzerland. Once available drug was identified, a price quote for the supply amount was written for our consideration. This was inspected carefully to ensure that the drug, strength, dosage form, and any other ingredients listed were indeed what were expected. The pharmacy department worked with the hospital's department of finance and accounting to submit the necessary financial paperwork. Payment was electronically sent to the distributor before the drug was shipped. Before the order for cytarabine was placed, the associated risks and benefits were assessed. The patients provided consent to treatment with the unapproved product. Acceptance of the price quote and instructions to order the drug were e-mailed to the distributor. The necessary documentation was completed and included with the shipment. The importation process, from initial inquiries to delivery, took 21 days.
  
  
  CONCLUSIONS
  The importation of cytarabine amid a drug shortage required a complex process that involved the efforts of an overseas distributor, the cooperation of multiple health professionals, and meticulous attention to detail.
authors.affiliation: Park Nicollet Methodist Hospital, 6500 Excelsior Boulevard, St. Louis Park, MN 55426, USA. wendy.hunnisett_dritz@parknicollet.com
authors.forename: Dee
authors.initials: D
authors.lastname: Hunnisett-Dritz
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D003561:Cytarabine / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use; D017277:Drug Approval / Q000331:legislation & jurisprudence*; D016527:Drug Costs; D004345:Drug Industry / Q000191:economics / Q000592:standards*; D006801:Humans; D007258:Informed Consent; D007391:International Cooperation; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008910:Minnesota; D019982:Organizational Case Studies; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000379:methods / Q000458:organization & administration*; D018570:Risk Assessment; D013557:Switzerland; D014481:United States; D014486:United States Food and Drug Administration / Q000331:legislation & jurisprudence
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine