Thousands of patients were left without critical medication for almost a year - now the news arrives

The missing medication is returning to the shelves: this week, the HMOs received the British preparation "Half Beta Progran" in a dosage of 80 mg, which contains the same active ingredient found in the drug "Slow-Derlin". The shipment arrived in Israel after almost a year in which the extended-release medication was almost unavailable in pharmacies, a situation that left thousands of patients without a direct and convenient alternative for their regular treatment.

On the packaging of the new medication, it is noted that these are hard capsules with extended release, containing propranolol hydrochloride. Each package includes 28 capsules in a dosage of 80 mg. Although the trade name is different from the one patients in Israel were familiar with, the active ingredient and the extended-release mechanism are intended to provide a stable effect throughout the day.

Last May, "Maariv" exposed the ongoing nationwide shortage of Slow-Derlin, which began months earlier. Patients reported that they were unable to obtain the medication at HMO pharmacies and private pharmacies, and were sometimes forced to contact many branches in an attempt to locate the last remaining packages.

Slow-Derlin is an old medication containing propranolol, from the beta-blocker family. The medication is used, among other things, for preventing migraine attacks, for treating hypertension, for slowing the heart rate in certain situations, and for reducing essential tremor. Propranolol is sometimes also used to treat physical symptoms of anxiety, depending on the doctor's decision and the patient's medical condition.

The uniqueness of the extended-release version is in the gradual release of the active ingredient. The capsule contains tiny granules that break down over time and allow for maintaining a relatively stable level of the medication in the blood. This structure usually allows for less frequent dosing compared to regular-release propranolol tablets, which sometimes need to be taken several times a day.

During the shortage, there was no identical substitute available on a continuous basis for all patients in Israel. Doctors were sometimes forced to switch to short-acting propranolol tablets, change the frequency of dosing, or choose another medication. Such adjustments require medical monitoring, since switching between preparations can affect blood pressure, heart rate, migraine frequency, and side effects.

Patients suffering from chronic migraines reported that the shortage brought back pain attacks after long periods of stabilization. Migraine attacks can last for hours and even days and include nausea, vomiting, sensitivity to light and noise, and significant disruption to work and daily functioning. Preventive treatment is intended to reduce the frequency of attacks and their intensity, but its effect varies from patient to patient.

The medication is also used by people suffering from essential tremor, a neurological disorder manifested by involuntary tremors, mainly in the hands. The tremor can make basic actions difficult, such as writing, holding a glass, using cutlery, or typing. Propranolol reduces the intensity of the tremor in some patients by blocking the effect of stress hormones on the muscles and the nervous system.

Pharmacists explained during the shortage that old and cheap medications might disappear from the local market when their import is not considered economically profitable. Unlike new and expensive medications, profit margins on old preparations may be low, and the number of companies willing to import them is limited. As a result, production cessation or a delay at one supplier can create a prolonged shortage.

In response to the previous publication, the Ministry of Health stated that the preparation is imported to Israel under "Regulation 29", which allows the import of medications that are not registered in the standard way in Israel or are not available on the local market. The ministry then contacted the four HMOs and examined the status of stocks and orders in transit.

Receiving the shipment this week does not necessarily guarantee immediate availability at every pharmacy. Distributing the medications to HMO warehouses and branches may take several days, and in some places, dispensing the preparation may require prior ordering. Patients are advised to check stock availability in the app, at the HMO call center, or with the pharmacy before arriving.

Although the new medication contains propranolol in a dosage of 80 mg and is extended-release, one should not start it or switch to it from another preparation independently. The doctor or pharmacist must ensure that the dosage and release form are suitable for the existing prescription. Also, one must not open, chew, or crush an extended-release capsule without explicit instruction, as such an action could change the rate of drug release.

Propranolol is not suitable for everyone. Caution should be exercised in patients with asthma and obstructive lung diseases, people suffering from a slow pulse, heart conduction disorders, or low blood pressure. Sudden cessation of treatment can cause an increase in pulse and blood pressure, and in some patients, even worsening of cardiac symptoms. Patients who were forced to change treatment during the shortage period should receive organized instructions before returning to the extended-release preparation.