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Finding Gluten-Free Nutrition, Dietary Supplements, and Medications

Non-celiac gluten intolerance and celiac disease are becoming more common. Celiac disease is a chronic autoimmune disorder caused by a genetic intolerance to gluten. Non-celiac gluten intolerance is diagnosed in people who do not have celiac disease, but have intestinal or extra-intestinal symptoms related to ingestion of gluten-containing grains.

Both conditions are treated by avoiding gluten containing foods. Finding ‘gluten free’ nutrition is becoming easier to do, but eliminating gluten from one’s diet can be a complex and time-consuming process.

Gluten is the protein component of wheat (e.g., including spelt, kamut, semolina, and triticale), barley (e.g., including malt), and rye. When a person with celiac disease or non-celiac intolerance ingests gluten, specifically the antigenic gluten constituent called gliadin, it can cause intestinal inflammation, diarrhea, abdominal pain, bloating, weight loss, fatigue, and iron deficiency anemia. Food malabsorption and nutritional deficiencies result.

Over time, these conditions can cause liver disease, defective gallbladder emptying, and osteoporosis. Celiac disease may be a reversible cause of osteoporosis. Adherence to a gluten-free diet is one way to help suffers minimize overall symptoms and to maintain maximal bone mineral density.

For perspective, oats are considered a type of gluten grain, but do not have the antigen that other gluten grains above do. Thus, oats do not induce an immune reaction in the small intestine of people with celiac disease. However, many commercial oat products are contaminated with wheat, barley, or rye and it’s important to carefully read their labels. Look for products that are certified to contain less than 20 ppm of gluten (FDA’s ‘gluten free’ definition).

Consumption of as little as 10 mg-50 mg gluten daily can lead to a clinical relapse in people with these conditions. Celiac disease may increase the risk of developing some types of cancer (e.g., T cell lymphoma and intestinal adenocarcinoma) if gluten restrictions are not maintained or gluten intake is only partly restricted.

It is important to find out where gluten resides in foods. This means not only reading food labels on products you purchase for home but also on foods you consume from fast food establishments and restaurant dining. Soups, sausages, and ice cream may contain hidden amounts of gluten as fillers. Talk with your grocer and restaurant owners before you consume questionable food items.

Watch out for the gluten content in herbs, other dietary supplements, and medications.

Gluten-Free Foods
Consuming foods certified to be ‘gluten free’ will help keep the daily gluten total to under 50 mg and not cause symptoms for most people with celiac disease. Gluten-free grains include rice, millet, corn, quinoa, sorghum, and buckwheat. For more information, visit

Gluten-Free Herbs and Other Dietary Supplements
It would be impossible to find information about the gluten content in over 60,000 products on the worldwide market. One can contact dietary supplement manufacturers directly for more information on gluten content before taking any of these products, including vitamins.

Gluten-Free Medications
Over-the-counter and prescription medications may contain gluten in the list of inactive ingredients. For example, sweeteners used in medications may be hidden sources of gluten. Some manufacturers cannot guarantee their medications are gluten-free because the suppliers of raw materials can not do so, making it even more difficult for consumers to figure out what is safe to take and what is not.

A great resource for determining the overall ingredient content in medications, including whether or not gluten is present, can be found online at .

Another online medication reference comes from the National Institutes of Health at Go to the site, type in the generic name of the medication you want to review, then scroll down to the name of the manufacturer of that particular product, then click on ‘description.’ Scroll down to the inactive ingredients and look for gluten.

A third way to find more information about your medication’s gluten content is to call the medication manufacturer directly. Be sure to have the medication’s lot number available when you call.

Finally, click on for “Gluten content of the top 200 medications: follow up to the influence of gluten on a patient’s medication choices” by AR King in Hosp Pharm 2013:48:736-43.

By Cathy Rosenbaum PharmD MBA RPh CHC

OTC Diagnostic Tests – Hair Analysis & Antioxidant Testing – What Can They Tell Us?

There’s been an explosion of “alternative” diagnostic methods claiming to identify nutrient deficiencies, detect environmental toxins, predict serious diseases before they emerge, and help guide health conscious individuals in their diet and supplement choices.

Look through any consumer-oriented health magazine and you’ll likely see lots of ads and articles referencing iridology, bio-impedance testing, hair analysis, applied kinesiology, meridian analysis, oxidative stress measurement and a host of other diagnostics.

The popularity of these alternative self-diagnosis methods is part of the broader movement toward patient self-empowerment, self-care and personal responsibility. Many people know they’re not eating balanced diets rich in vitamins, minerals, and antioxidants. Their concerns for health are warranted, and in many cases nutritional supplementation is reasonable.

But are these testing methods valid? Can they really provide the sort of guidance consumers eek?

Hair Analysis

Techniques for measuring minerals, metals and other substances in hair have been around for decades. Advocates say they can indicate chronic mineral and nutrient deficiencies thus identifying which nutrients should be supplemented. Others use hair analysis to detect toxic heavy metals like mercury or lead, to guide detoxification protocols.

The American Medical Association and other mainstream medical societies have been categorically dismissive of hair analysis. In 1994, AMA issued a statement indicating that it “opposes chemical analysis of the hair as a determinant of the need for medical therapy and supports informing the American public and appropriate governmental agencies of this unproven practice.”

While it is unlikely that hair analysis can accurately detect vitamin/mineral deficiencies or imbalances, it can screen for exposure to heavy metals like mercury, lead, and aluminum.

Normal hair levels for minerals or heavy metals have not been well established. The truth is that over time, heavy metals like mercury, found in the earth’s crust and in our environment, do find their way into our hair, blood, and body. Here’s one scenario. Hair analysis may serve as an initial screen for mercury exposure. Then based on the type of mercury suspected (e.g., organic or inorganic), blood and/or urine levels may more accurately represent potentially toxic amounts in the body. Researchers would use additional tests to confirm these levels (i.e., cold vapor atomic absorption spectrophotometry). Surprisingly, it’s rare to find a person with no mercury in her/his body. Many people without amalgam dental fillings can have a blood mercury level of 5 mcg/L based on exposure from the environment.

Mineral and vitamin imbalances in the body (i.e., calcium, zinc, iron, copper, manganese) may be due to multiple factors such as improper diet, medication usage, stress, and genetics. Common medications like birth control pills may deplete zinc and some B vitamins; corticosteroids deplete calcium, selenium, and zinc. Histamine-2 receptor antagonists for ulcers may deplete iron, zinc, and vitamin B12. If the results of a hair analysis indicate a low level of minerals, it is prudent to screen for and address the root cause of the problem before recommending dietary supplements to replace them. An initial next step would be a blood test.

Next, since hair has no blood supply and grows slowly, mineral levels in hair do not correlate with the amount of minerals in other body tissues. Contrary to what consumers may believe, a hair analysis will not reflect a person’s most recent diet or health status. Further, many people color their hair, expose it to sun, chemicals in pool water, and hair dryer heat, all of which can affect the function of the hair follicle as well as alter the analysis of a given hair sample. Traces of substances we eat, drink or breathe may end up in our hair, but so will many other things, making it difficult to glean meaningful information about nutritional needs from hair studies alone (Seidel S. JAMA 2001;285;67-72).

There is also the big question of reference standards. Regardless of the specific analytic techniques used by commercial laboratories, hair analytic techniques must be validated against a standard reference. Not all clinical labs use a reference. Examples of reliable analytical methods used to measure and verify substances in the hair include the following: cold vapor atomic absorption (used for methyl mercury); inductively coupled argon plasma mass spectrometry (methyl mercury); inductively coupled argon plasma optical emission spectrometry (trace elements); neutron activation analysis (trace elements); X-ray fluorescence (mercury); and proton induced X-ray emission spectrometry (good for discerning external hair contamination from internal hair follicle contamination). Only a trained scientist can understand the differences among these tests and it’s important to note which is used when interpreting hair analysis.

A better approach to diagnosing mineral deficiencies involves measuring blood levels of iron, calcium, zinc, plasma copper, and manganese to assist in nutritional recommendations addressing clinically significant deficiencies. Multi-elemental hair analysis may hold a clue or two regarding a person’s heavy metal exposure or nutritional status, but it should not take the place of a thorough health history, medication & dietary supplement history, and physical exam.

Oxidative Stress and Antioxidant Testing

The concept of oxidative stress has gotten a lot of media attention, as researchers learn more about how free radicals contribute to the aging process and chronic diseases. Likewise, the public has shown tremendous interest in antioxidants and their role in preventing free radical oxidative damage. These concerns have spawned wide consumer interest in tests to assess oxidative stress levels and antioxidant capacities.

In principle, there’s nothing unreasonable about this. The body does produce several measurable markers of oxidative stress, including 8-isoprostane, a prostaglandin-like compound; oxysterols (i.e., 7-ketocholesterol, 7B-hydroxycholeserol); allantoin, the product of uric acid oxidation by purine catabolism; Total hydroxyoctadecadienoic acid (tHODE), a measure of hydrogen donor capacity; and thiobarbituric acid reactive substances (TBARS), measured with an assay utilizing malondialdehyde (MDA).

Natural antioxidants found in our bodies, thought to counteract reactive oxygen species, include erythrocyte superoxide dismutase, glutathione peroxidase, lipid hydroperoxide, and selected protein carbonyl groups. Common dietary antioxidants found in foods as well as supplements include vitamin C, vitamin E, vitamin A, beta carotene, and many others, all of which can be measured to some degree of accuracy.

But what can measuring these constituents tell us, and can measurements really be used to guide supplementation regimens?

Blood Antioxidant Measurements: Many consumers are asking about their ‘antioxidant health’ in an effort to stave off free radical cellular damage from high levels of oxidative stress. Clinical testing labs offer a wide range of tests for the various natural antioxidants listed above, as well as exogenous antioxidants from dietary supplements like co-enzyme Q 10, vitamin A, vitamin E, selenium, and beta carotene. Legitimate testing methods may be used to guide a physician, naturopath, or pharmacist to make nutritional or dietary supplement recommendations.

Each of the antioxidant tests could cost you over $100. It’s wise to check with your insurance carrier to find out if tests are covered before your physician prescribes them.

FRAP Test: The total antioxidant “power” of blood plasma can be defined by way of an assay called the FRAP test, measuring ferric reducing/anti-oxidant power in µmol/L. There are several published clinical studies of FRAP testing. One small study indicates the need to differentiate test results by gender (Chung W. Atherosclerosis 1998;136:78). Another demonstrates how the FRAP test may be used to evaluate the antioxidant effectiveness of wine (Katalini V. Food Chemistry 2004;86:593-600). Results of the FRAP test may have more application to food analysis than clinical practice, and may not correlate well with antioxidant deficiencies in the body.

Skin Carotenoid Test: This test has been widely popularized in recent years by Pharmanex, a multi-level, network-marketing supplement company that has made biophotonic scanning of carotenoids in the skin a cornerstone of its sales strategy.

The test, called “Bioscan,” makes use of the fact that carotenoids in human skin resonate with a certain wavelength of blue laser light, releasing a light signal of altered wavelength that can be easily measured.

Pharmanex representatives use the Bioscan as a way of detecting antioxidant deficiencies in their prospective clients. The client receives a piece of paper, a Bioscan Certificate, with his/her “Skin Carotenoid Score.” The score is mapped on a color bar ranging from low to high, then given a numerical value. Generally, if the value is low, the individual’s intake of carotenoid-containing food and/or supplements is low, and the representative encourages the prospective client to increase their intake, preferably with Pharmanex products. The Bioscan is a legitimate test for skin carotenoid levels but cannot predict total body stores or nutritional deficiencies.

Leaving aside the ethical question of using a test like this to sell supplements, there is the clinical question of whether the level of skin carotenoids, a single class of antioxidant compounds in our diets, accurately represents an individual’s overall dietary intake of foods containing potentially thousands of different flavonoid-like constituents found in nature? Further, can carotenoid levels alone be used to guide nutrition-based strategies? The carotenoid test is a snapshot of one nutritional day not a trend over months or years and may have little clinical bearing beyond an initial screening tool regarding your nutritional status.

A well-balanced diet including vitamins and minerals, while imperative for optimal health seems to be difficult for most Americans to maintain. Dietary supplements do offer an alternative, and research tells us that antioxidant-rich dietary supplements or foods have promise in the area of cancer prevention, cardiovascular health, and memory health. However, we do not know the optimal dose for each nutrient/ingredient for prevention of these conditions according to a National Institutes of Health-funded study (Huang H. Ann Intern Med 2006;145:372-385.).

There are legitimate reasons to question some of the testing methods that have captured consumers’ interest. But it is also important to recognize that in seeking out these tests, consumers are revealing their health concerns and demonstrating a wish to make changes.

More long-term research is needed to confirm endogenous (internal) as well as exogenous (from our diet) baseline antioxidant status, as well as confirm the magic combination of antioxidants, doses, and duration of therapy necessary to help prevent certain diseases. A lot of the tests consumers are seeking are probably not able to provide them the guidance they need.

Rather, seek out well-trained clinical pharmacists and naturopathic physicians, as well as clinical laboratories with high integrity and solid analytical testing methodologies to help better serve you in your health journey. Of course, start with good nutrition including colorful fruits and vegetables high in antioxidant value.

Contributing Author: Cathy Rosenbaum PharmD MBA RPh CHC -> Upcoming Events

For a complete list of Dr. Rosenbaum’s upcoming events related to natural healing, integrative health practices, dietary supplement usage, medicinal herbal teas, and much more, please visit and click ‘like’. Visit for information on personalized wellness consultations.

Grapefruit Interactions with Medication

Certain prescription and/or OTC medications and dietary supplements may negatively interact with grapefruit juice, grapefruit, Seville oranges, pomelos, and tangelos due to chemicals in the fruits.

Fruit chemicals are thought to block enzymes in the body that metabolize medication in the small intestine, thereby causing the medication to hang around longer than expected. Interestingly, these fruits may also interfere with transporters in the body, causing medication to be less well absorbed into the bloodstream, and may reduce medication or supplement effects. Sound confusing? It’s complicated.

Product classes involved in unwanted interactions include, but are not limited to:

-Antihistamines (e.g., Allegra)
-Cholesterol-lowering ‘statins’
-Corticosteroids for Crohn’s disease and ulcerative colitis
Dietary supplements

Only some of the medications and supplements in each of the categories can be affected by the fruit/juices. Every person may react differently based on the amount of fruit they consume, the medication or supplement type/dose taken, and the individual’s natural ‘enzyme levels.’

Don’t worry, but do get educated about how and when to properly take your medications and supplements to be safe. Enjoy healthy nutrition. Talk with your pharmacist about what’s best for you!

Beyond Use Dates on Prescription/OTC Medications & Dietary Supplements

Expiration dates on OTC & prescription medications and dietary supplements typically fall between 12 – 60 months after product production. Pharmaceutical manufacturers are required by law to establish these dates but do not have to study product stability and potency beyond those dates.

A recent study published in JAMA Internal Medicine using eight medications containing 15 active ingredients demonstrated product potency for decades beyond the original expiration dates. Another study in the military concluded the same results for 100 medications after 15 years.

The U. S. government has a Shelf Life Extension Program to extend dates on federal stockpiles for the military. But this is the exception to the rule in a special population to save the government money in repurchasing.

The bottom line for consumers is this – > follow the product manufacturer’s established expiration date stamped on the OTC bottle or prescription vial. Follow these same guidelines for your dietary supplements as well.

Keep all of these products in a cool, dry, dark place in your home.

Frogsicles – Dr. Cathy’s Children’s Book Now Available

On June 29, 2017, Frogsicles about the Parks’ family adventure to Alaska finally arrived!

Please cut and paste the link below into your internet browser for more details and share with others.

Menopausal Hot Flashes & Soy-Based Dietary Supplements?

Studies examining the efficacy of soy-based dietary supplements for menopausal hot flashes and night sweats have shown mixed results (e.g., modest to no benefit). Here’s an interesting fact that might explain why! Some women convert the soy-based constituent, daidzein (an isoflavone), to equol (a metabolite with estrogen-like activity). Typically women of Asian or Hispanic background make the conversion and are more likely to experience positive results from a soy-based supplement for their flashes. However, many women do not make this conversion. For the latter group, it would not matter what soy-based dietary supplement they consumed as none would be expected to work.

If you are peri-menopausal and experiencing hot flashes, instead of taking a soy-based dietary supplement, consider adding a 1-2 servings each day of tofu, soy milk, edamame, or a soy-based protein powder for a few months to see if any of these foods/products make a difference.

If you have a history of hormone-dependent cancer (especially estrogen receptor-positive breast cancer) please refrain from consuming soy-based foods, products, or dietary supplements for any reason unless your physician has first given you permission to do so. If you are in the cancer risk category and are suffering from hot flashes that impair your lifestyle, please talk with your physician about the appropriateness of one of several other prescription options including venlafaxine, paroxetine, of clonidine. Explore other natural healing practices to help with this challenging time of life. Hang in there and keep a positive attitude as best you can. This too shall pass – typically within 6 months to 2 years for most women!

Vitamins, Are They Safe?

A recent review of multiple studies indicates that mega-dosing of fat soluble vitamins (A, E, D) and some water soluble vitamins (C, folic acid) may not help prevent disease and can potentially cause harm. Please talk with your doctor or pharmacist about the right combination and dosage of multiple vitamins and other dietary supplements for your health needs. Everyone is unique and different!

– Hamishehkar, Ranjdoost, et al. Vitamins, Are They Safe? Adv Pharm Bull 2016:6(4):467-477.

Turmeric (Curcuma Longa) & Osteoarthritis Pain

This yellow spice/dietary supplement from the ginger family has become popular in recent months. Its active ingredient is curcumin, one of the spices found in curry powder frequently used in Indian cuisine, and in yellow mustard. Curcumin is a potent anti-inflammatory and antioxidant.

Research studies have been conducted with turmeric for osteoarthritis pain management. Turmeric side effects include heartburn, as it is truly ‘spicy.’ So, if you already experience GERD (acid reflux disease) you will not be a candidate for this product.

A typical turmeric extract dose is 1 gram/day or less. One gram is ~ equal to 3 – 15 teaspoonsful of the ground spice, so there is wide variability between products and food. Some of the turmeric dietary supplement manufacturers add black pepper to their formulations to increase turmeric’s absorption and inhibit turmeric’s metabolism. I’m not sure that has been scientifically proven to work.

If you suffer from osteoarthritis pain and have been taking NSAIDs for years (e.g., Naproxen, Motrin, Celebrex, Feldene, Diclofenac), you may wish to consider talking with your physician about the appropriateness of taking the supplement turmeric in place of them to avoid significant long-term NSAID side effects on the stomach, heart, kidneys, and liver.

Please do not start taking turmeric without the advice and consent of your physician. Schedule an appointment for a prescription medication/dietary supplement/integrative health consultation with Dr. Cathy Rosenbaum today!

Happy New Year….Be healthy….Be Wise….Stay Safe

The Long and Short About Drug Shortages

Managing prescription drug shortages has become quite complex and requires a multidisciplinary team of creative healthcare professionals to keep up with the changing supply chain. Shortages include, but are not limited to, generic sterile injectables, anti-cancer drugs, anesthetics, pain medications, and nutritionals, creating an estimated annual impact on U.S. hospitals of $216 million from purchase of therapeutic substitutions.

Pharmacists are frequently asked, “Why does this happen?” There are multiple contributing factors in the supply chain that affect drug shortages.

• Raw Material Shortages. Nearly 80% of pharmaceutical grade raw materials are sourced outside of the USA. Drug availability is impacted when political instability interrupts U.S. trade in foreign countries, animal diseases contaminate tissue from which raw materials are harvested, or environmental issues affect plant growth from which raw materials are sourced. Remember the heparin recall a few years ago due to adulteration with oversulfated chondroitin in China?

• Quality Issues. Nearly 42% of sterile injectable drug shortages in 2010 were caused by product quality issues (e.g., particulates, microbial contamination, stability changes). Recently, Bedford Labs recalled injectable medroxyprogestrone due to silicone particles found in the product. A few years ago, Benvenue announced it was closing a plant that produced injectable methotrexate and Doxil, two chemotherapeutic agents, due to quality control issues. Only three other companies in the USA manufacture either methotrexate or Doxil, causing a supply issue for children with leukemia, as well as women with ovarian cancer, respectively.

• Manufacturing Difficulties or Production Decisions. Business decisions regarding branded drugs are made every day based on availability of generic drugs, the product’s market size, patent expirations, drug approval status, and anticipated clinical demand for the product. Manufacturers are not required to report product discontinuations to the FDA unless they are the sole source of a life supporting medication or a medication used to prevent a debilitating disease. Mature brand enthusiasm decays over time and there is a diminishing financial return to the manufacturer followed by a decision to sunset the brand. J&J stopped manufacturing branded IV Levaquin when it went generic.

• Change in Product Formulation. In 2006 there was a transition from albuterol and other metered dose inhalers with chlorofluorocarbons to metered dose inhalers containing hydrofluoroalkanes. Line extensions and formulation changes can evolve for marketing reasons or safety reasons or both.

• Regulatory Issues. FDA enforces standards like current Good Manufacturing Practice (cGMP). Yet, the FDA will help manufacturers out of cGMP compliance return to compliance when a significant corrective action involves a medically necessary product. FDA does not have the authority to require a manufacturer to produce any drug, even if the drug is a medical necessity. Bedford Labs’ oncology line was shut down by the FDA within the past year (i.e., carboplatin, cisplatin, leukovorin, Taxol). Bedford was told by the Feds that Bedford can not ship out any oncology product on hold in their warehouse until further FDA notice.

• Industry Consolidation and Company Mergers. Mergers frequently involve closing a manufacturing facility and result in a narrowed drug product portfolio for the post merger corporation. Baxter recently sold their entire generic injectable line to Westward resulting in a shortage of lidocaine, fentanyl, ketorolac, and midazolam. There are fewer generic drug manufacturers today than in the past even though there is a long line of applicants for new generic drug manufacturing processes at the FDA.

• Restricted Drug Distribution and Allocation. A drug manufacturer can place restrictions on limited drug supplies by requiring its drug is sourced through a specialty distributor. Clozapine and Tikosyn can only be supplied to a pharmacy registered in the manufacturers’ programs. Other prescription drugs are only supplied specific to each patient at the time the physician prescribes them.

• Just in Time Inventory (JIT). JIT is a strategy to minimize costs at various points along the supply chain. Some drug shortages may be wholesaler dependent, as drug shortages can occur when contracts with suppliers are delayed. Drug wholesalers oftentimes charge the drug manufacturers for stocking their drugs, and the drug manufacturers restrict the wholesalers from overstocking.

Wholesaler purchase differs from direct manufacturer purchase, or purchasing from med/surg suppliers.

• Changes in Product Demand and Shifts in Clinical Practice. When a new indication for a marketed drug is FDA approved, when new hospital programs start, or when a drug representative promotes new products and unanticipated demand increases for those products, it may be more difficult for the hospital or physician office based practice to keep up with supply. Direct-to-consumer advertising on television and in print ads also contributes to fluctuating product demand.

• Gray Market. The number of licensed non-traditional distributors who buy direct from the drug manufacturers to stockpile scarce drugs and resell at much higher prices are increasing as drug shortages go on. Purchasing from the gray market does not ensure drug pedigree, especially if sourced outside of the USA. Drug pedigree is a law in Florida and other states where most of the gray market wholesalers are located, but not law in Ohio. Gray market Epogen was available several years ago.

• Natural Disasters. About seven months ago a fire at a Hospira manufacturing plant in New York reduced inventory for emergency syringes (e.g., dextrose, sodium bicarbonate, epinephrine). This forced the manufacturer to decrease production of another medication in another facility to continue making the drug for a life threatening indication.

Managing Drug Shortages.

Government Interventions.
Participants of the Drug Shortage Summit on November 5, 2010, including the American Society of Health Systems Pharmacists, the Institute for Safe Medication Practices, the American Society of Anesthesiologists, and the American Society of Clinical Oncology, agreed that:

Congress should
• expand FDA authority to require manufacturers to notify FDA of supply interruptions/product discontinuations;
• allow FDA to require manufacturers to develop continuity of supply plans;
• require development of expedited approval pathways for pre-1938 drugs.

FDA should
• encourage confidential notification to FDA when there is a single source active pharmaceutical ingredient.
• explore incentives that encourage manufacturers to enter the market or stay in the market to minimize potential for shortages.
• collaborate with the DEA to alter quotas for controlled substances in short supply.

Senator Amy Klobuchar’s Bill 296 (H.R. 2245) requires drug manufacturers to notify the FDA at least six months in advance when experiencing a planned interruption in the production of a drug potentially resulting in a shortage situation or as soon as possible if an unexpected interruption or adjustment in supply transpires. The bill supports development of contingency plans for drugs vulnerable to shortage.

On October 31, 2011, President Obama issued an executive order directing the FDA to expand its reporting of prescription drugs and speed up regulatory reviews to respond to shortages.

Healthcare professionals around the country are actively working together in multidisciplinary teams to come up with alternate therapeutic options for these drug shortages which are not going away any time soon.

For more information, please visit the ASHP drug shortages web resource center @