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Huge Price Hike Force Hospitals To End Use of Nitroprusside and Isoproterenol

Fewer patients have access to the lifesaving heart drugs

Many hospitals have reacted to the huge price increases in the heart medications nitroprusside and isoproterenol by discontinuing their use, according to research letter in the New England Journal of Medicine. Utilization of the two lifesaving drugs has decreased dramatically at 47 hospitals since the price increases.


Isoproterenol helps monitor and treat heart rhythm problems during surgery. Its use decreased 35% as the price jumped from $27.46 in 2012 to $880.88 in 2015 per milligram. During that same period, the number of patients getting nitroprusside decreased 53%. The price for 50 mg of the drug jumped from $24.46 to $880.88.

The reductions in use occurred despite the proven efficacy of the two drugs, which have been around for decades. The FDA approved nitroprusside for the treatment of hypertension in 1974. Isoproterenol was first approved for use in the U.S. in 1947.

Umesh Khot, MD, a cardiologist at the Cleveland Clinic and the lead author of the NEJM letter, told Kaiser Health News (KHN): “This isn’t like a cholesterol medicine, these are really, very specialized drugs.”

Valeant Pharmaceuticals International bought the drugs in early 2015 from Marathon Pharmaceuticals. Valeant launched a rebate program for the drugs, and the company says that it wants to limit drug price increases. Valeant spokeswoman Lainie Keller said in a statement: “The current management team is committed to ensuring that past decisions with respect to product pricing are not repeated.”

Talking about the NEJM letter, Erin Fox, a drug expert at the University of Utah Health Care, told KHN that the situation reveals “exactly what a lot of pharmacists have been talking about. When prices are unsustainable, you have to stop using the drug whenever you can. You just can’t afford it.”

Hospitals have used a variety of tactics to limit use of medications when prices unexpectedly skyrocket. In September 2016, for instance, P&T published a letter on efforts at Morristown Medical Center in New Jersey to reduce spending on isoproterenol by removing it from many cardiac resuscitation medication trays, allocating it sparingly to critical-care areas, and instituting changes that reduced waste. And in October 2016, P&T printed a study on therapeutic interchange of clevidipine for sodium nitroprusside in cardiac surgery at another New Jersey institution, Englewood Hospital and Medical Center.

Sources: NEJM; August 10, 2017; Kaiser Health News; August 9, 2017; P&T; September 2016; P&T; October 2016.

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