Excedrin Return Still Months Away

Novartis hopes to gradually restart production at its Lincoln, Nebraska manufacturing plant as early as May, and resume shipping some products at mid-year. But a return to full production will probably not happen until 2013.

Production will restart on a line-by-line basis, according to David Epstein, Division Head of Novartis Pharmaceuticals, who offered a status update during the Novartis 1st Quarter 2012 Earnings Conference Call earlier today (April 24th)

“[W]e are in the middle of quality remediation activities at Lincoln,” Epstein said, “and we are making good progress. We had a meeting with the FDA recently, and shared with them our startup plan for the plant. We will begin production in May and we will resume shipments mid year.”

Epstein indicated that the “ramp up” would be slower than expected. “We’ll have a relatively limited portfolio in the back half of the year. So we have signed up some third-party manufacturers for some key products,” he explained. Neither Epstein nor any other participant in the conference call specified the order in which Excedrin and other products manufactured at that plant would reappear. Nor was there any indication as to which products would be farmed out to third-party manufacturers.

Novartis suspended production at its Lincoln facility on January 8, 2012 and recalled more than 125 million bottles of Excedrin and other OTC medications after a FDA inspection revealed flagrant and long-standing deficiencies in the company’s quality assurance and consumer complaint procedures. The shutdown of the Lincoln plant also has affected availability of a number of veterinary products, including Interceptor, a popular medication for preventing heartworm in dogs and cats.

I asked FDA for a description of the steps usually undertaken in a situation such as this one. After making the usual disclaimer that “FDA does not comment on an ongoing investigation,” Shelly Burgess of FDA’s Office of Public Affairs offered the following explanation:

“FDA investigators conduct routine inspections at drug manufacturing facilities to determine, among other things, compliance with the current good manufacturing practice regulations. When the investigator finds significant deviations from those minimum standards, he or she lists the deviations on a document called a form FDA 483, or the “483,” and issues that to the manufacturer at the conclusion of the inspection. By providing this notice, the Agency gives a manufacturer the opportunity to take voluntary and prompt corrective action. The manufacturer may submit a written response to the Agency explaining how it has corrected the violations or plans to do so, or explain why it disagrees with any of the listed observations. In most cases, manufacturers comply voluntarily but in some instances FDA sends the manufacturer a warning letter or an untitled letter. In addition, where appropriate, FDA may pursue enforcement action such as seizure and injunction.”

“The timeline can vary considerably depending on the extent of the corrective actions that are required for the firm to achieve compliance and demonstrate sufficient controls over manufacturing to produce acceptable quality drugs. Some deficiencies can be corrected within hours or days of notification such as when re-training an employee or fixing a piece of equipment. Other corrective actions may take days or months, such as qualifying a complicated manufacturing operation or validating a new test method.”

It’s not surprising that the restart in Lincoln will be slower than Novartis had originally hoped, or that the company is being vague regarding which products will receive priority when production at the facility resumes. No one wants a repeat of the problems that led to the recalls and shutdown.

Nevertheless, the delay will result in additional headaches for consumers, pharmacists, doctors, and veterinarians as the product shortages continue.

FDA Identifies Source of Salmonella Bareilly Outbreak

Frozen, scraped, raw yellowfin tuna backmeat, known as Nakaochi Scrape AA or AAA has been fingered as the source of an outbreak of Salmonella Bareilly illnesses that sickened at least 116 people in 20 states and the District of Columbia.

Here is what FDA reported late this afternoon:

Moon Marine USA Corporation (also known as MMI) of Cupertino, Calif. is voluntarily recalling 58,828 lbs of a frozen raw yellowfin tuna product, labeled as Nakaochi Scrape AA or AAA. Nakaochi Scrape is tuna backmeat, which is specifically scraped off from the bones, and looks like a ground product.

The Nakaochi Scrape is associated with an outbreak of 116 cases of Salmonella Bareilly in multiple states: Alabama (2), Arkansas (1), Connecticut (5), District of Columbia (2), Florida (1), Georgia (5), Illinois (10), Louisiana (2), Maryland (11), Massachusetts (8), Mississippi (1), Missouri (2), New Jersey (7), New York (24), North Carolina (2), Pennsylvania (5), Rhode Island (5), South Carolina (3), Texas (3), Virginia (5), and Wisconsin (12).

The raw yellowfin tuna product may have passed through several distributors before reaching the restaurant and grocery market, and may not be marked with lot information. Distributors and end users should consult their suppliers to determine the origin of any Nakaochi Scrape AA or AAA in their possession.

The recalled product was not distributed for retail sale to consumers, but may have been used to make sushi, sashimi, ceviche and similar dishes available in restaurants and grocery stores. While the company name and “Nakaochi Scrape AA or AAA were printed on boxes of product supplied to distributors, the tuna may not be readily identifiable by consumers as being from implicated lots.

News of the Salmonella Bareilly outbreak first broke on April 3rd. As of the CDC’s last update (April 13th), twelve people are known to have been hospitalized out of the 116 confirmed case patients. Reported onset dates for illnesses range from January 28th to March 31st. The youngest outbreak victim is 4 years of age; the oldest is 78 years old. Half of the confirmed case patients are female.

FDA has this advice for consumers:

  • Because raw seafood is not fully cooked to assure that pathogens are destroyed, it is not considered as “safe” as cooked seafood. The handling of raw seafood can also affect the safety of the product. Because the tuna may have been broken into unmarked sublots and may not be readily identifiable, consumers should take precautions in choosing to eat raw Nakaochi Scrape and be sure that it is not from the implicated lots.
  • If you purchase “spicy tuna” or other sushi, sashimi, ceviche, or similar dishes that might contain Nakaochi Scrape from a restaurant or grocery store, check with the establishment to make sure that it does not contain raw recalled product from Moon Marine USA Corporation, also known as MMI. When in doubt, don’t eat it.
  • Consumers who think they might have become ill from eating possibly contaminated raw Nakaochi Scrape should consult their health care providers.

Guardian Drug Company Recalls PediaCare, Other OTC Products

On March 7, 2012, Guardian Drug Company issued the following notice to its customers:

Guardian Drug Company Issues Voluntary Nationwide Recall of 71 lots of Over- the- Counter Simethicone Containing Products Due to possible microbial contamination with Burkholderia cepacia

March 07, 2012: Guardian Drug Company, (Guardian) Dayton, NJ is voluntarily recalling the product lots listed in the link below to the retail level.

Guardian is initiating this voluntary recall because the raw material simethicone emulsion lots, which were used in manufacturing of the product lots listed below, were voluntarily recalled by the supplier for possible microbial contamination with Burkholderia cepacia.

B. cepacia does not usually cause infections in the healthy population, however can cause infections in at risk populations including cystic fibrosis patients, immunocompromised patients, and children and infants with immature immune systems. Guardian has not received any reports of adverse events related to this recall.

Guardian has tested the raw material lots which were recalled later and the finished product lots manufactured with the same recalled raw material. None have shown presence of B. cepacia. However, Guardian is initiating this recall as suggested by the raw material supplier and for precautionary measure.

Guardian is notifying all customers who may have received lots listed in the link below and arranging for the return of products. Distributors and retailers that have product which is being recalled should immediately stop distribution and sales of the listed products.

Customers with questions regarding this recall can contact Guardian by calling 609-860- 2600 extension 109 on Monday to Friday 9.00 am to 4.00 pm or e-mail: recall@guardiandrug.com. Consumers should contact their physician or healthcare provider if they have experienced any problems that may be related to taking or using this drug product.

Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA’s MedWatch Adverse Event Reporting program either online, by regular mail or by fax.

• Online:www.fda.gov/medwatch/report.htm1 • Regular Mail: use postage-paid, pre-addressed Form FDA 3500 available at: http://www.fda.gov/MedWatch/getforms.htm2. Mail to address on the pre-addressed form. • Fax: 1-800-FDA-0178

This recall is being conducted with the knowledge of the U.S. Food and Drug Administration.

Guardian is a manufacturer of Over-The-Counter (OTC) Pharmaceutical products, specializing in store-brand products.

This retail-level recall may have been conducted with the knowledge of FDA, the consuming public was never made aware of the potential bacterial contamination – until today (March 23rd), that is, when Food City posted a notice that several PediaCare OTC products had been recalled.

The Guardian recall affects four different products – Maximum Strength Alumox Cherry Liquid (Product Code 508), Extra Strength Megacid Original Liquid (Product code 516), Non-Staining Infants Gas Relief Drops (Product Code 520) and Infants Gas Relief Drops (Product Code 521) – sold under various different store brand names.

CVS Fast Relief Maximum Strength Antacid, Cherry Flavor

  • Lot 508-1596; Expiry 06/2012
  • Lot 508-1810; Expiry 08/2012
  • Lot 508-1853; Expiry 09/2012
  • Lot 508-1951; Expiry 09/2012
  • Lot 508-1992; Expiry 10/2012
  • Lot 508-2085; Expiry 11/2012
  • Lot 508-2108; Expiry 11/2012
  • Lot 508-2236; Expiry 12/2012
  • Lot 508-2272; Expiry 12/2012
  • Lot 508-2273; Expiry 12/2012
  • Lot 508-2319; Expiry 01/2013
  • Lot 508-2433; Expiry 02/2013
  • Lot 508-2434; Expiry 02/2013
  • Lot 508-2477; Expiry 02/2013
  • Lot 508-2647; Expiry 03/2013
  • Lot 508-2648; Expiry 03/2013
  • Lot 508-2649; Expiry 03/2013
  • Lot 508-2650; Expiry 03/2013
  • Lot 508-3065; Expiry 05/2013
  • Lot 508-3066; Expiry 05/2013

Wal-Mart (Equate) Maximum Strength Antacid, Cherry Flavor

  • Lot 508-2459; Expiry 02/2013
  • Lot 508-2460; Expiry 02/2013
  • Lot 508-2461; Expiry 02/2013
  • Lot 508-2462; Expiry 02/2013
  • Lot 508-2473; Expiry 02/2013
  • Lot 508-2474; Expiry 02/2013
  • Lot 508-2475; Expiry 02/2013
  • Lot 508-2476; Expiry 02/2013
  • Lot 508-2818; Expiry 04/2013
  • Lot 508-2819; Expiry 04/2013
  • Lot 508-2820; Expiry 04/2013
  • Lot 508-2835; Expiry 04/2013
  • Lot 508-2836; Expiry 04/2013
  • Lot 508-2852; Expiry 04/2013
  • Lot 508-2853; Expiry 04/2013
  • Lot 508-2909; Expiry 04/2013
  • Lot 508-2910; Expiry 05/2013

Discount Drug Mart Extra Strength Antacid, Original Flavor

  • Lot 516-1999; Expiry 10/2012

Discount Drug Mart Infant’s Gas Relief Liquid Drops, Non-Staining

  • Lot 520-1641; Expiry 06/2012
  • Lot 520-2492; Expiry 02/2013

Kmart Corp. (Smart sense) Extra Strength Antacid Antigas, Original Flavor

  • Lot 516-1999; Expiry 10/2012
  • Lot 516-2367; Expiry 01/2013
  • Lot 516-2577; Expiry 02/2013
  • Lot 516-2846; Expiry 04/2013
  • Lot 516-3067; Expiry 06/2013
  • Lot 516-3147; Expiry 06/2013

Kmart Corp. (Smart sense) Infant’s Gas Relief Drops, Non-Staining

  • Lot 520-1641; Expiry 06/2012
  • Lot 520-1900; Expiry 09/2012
  • Lot 520-2492; Expiry 02/2013
  • Lot 520-2516; Expiry 02/2013

Dollar General (DG health) Infant’s Gas Relief Liquid Drops, Non-Staining

  • Lot 520-1597; Expiry 06/2012
  • Lot 520-1641; Expiry 06/2012
  • Lot 520-1807; Expiry 08/2012
  • Lot 520-1900; Expiry 09/2012
  • Lot 520-2056; Expiry 11/2012
  • Lot 520-2172; Expiry 11/2012
  • Lot 520-2492; Expiry 02/2013
  • Lot 520-2516; Expiry 02/2013
  • Lot 520-2711; Expiry 03/2013
  • Lot 520-2773; Expiry 04/2013
  • Lot 520-2958; Expiry 05/2013
  • Lot 520-3104; Expiry 06/2013
  • Lot 520-3155; Expiry 06/2013

Blacksmith Brands (PediaCare) Infant’s Gas Relief Drops, Dye Free

  • Lot 520-1829; Expiry 08/2012
  • Lot 520-2047; Expiry 10/2012
  • Lot 520-2488; Expiry 02/2013
  • Lot 520-2513; Expiry 02/2013
  • Lot 520-2515; Expiry 02/2013
  • Lot 520-2660; Expiry 03/2013

Blacksmith Brands (PediaCare) Infant’s Gas Relief, Simethicone – Antigas

  • Lot 521-1849; Expiry 08/2012
  • Lot 521-2048; Expiry 10/2012
  • Lot 521-2512; Expiry 02/2013
  • Lot 521-2517; Expiry 04/2013

Quality Choice (QC) Infant’s Gas Relief Drops, Non-Staining

  • Lot 520-1597; Expiry 06/2012
  • Lot 520-1900; Expiry 09/2012
  • Lot 520-2056; Expiry 11/2012
  • Lot 520-2958; Expiry 05/2013

Select Brand Infant’s Gas Relief Drops, Non-Staining

  • Lot 520-1597; Expiry 06/2012
  • Lot 520-1900; Expiry 09/2012
  • Lot 520-2056; Expiry 11/2012
  • Lot 520-2492; Expiry 02/2013
  • Lot 520-2516; Expiry 02/2013
  • Lot 520-2958; Expiry 05/2013

AmerisourceBergen (Good Neighbor Pharmacy) Infant’s Gas Relief Drops, Antigas

  • Lot 521-1642; Expiry 07/2012
  • Lot 521-1870; Expiry 09/2012
  • Lot 521-2057; Expiry 11/2012
  • Lot 521-2857; Expiry 04/2013
  • Lot 521-3108; Expiry 06/2013

McKesson (Sun Mark) Gas Relief Drops, Infant’s

  • Lot 521-1642; Expiry 07/2012
  • Lot 521-1870; Expiry 09/2012
  • Lot 521-2057; Expiry 11/2012
  • Lot 521-2857; Expiry 04/2013
  • Lot 521-3108; Expiry 06/2013

With the exception of Food City, not a single retailer whose store brand was affected by this recall has posted a consumer-level recall notice. If you have purchased one of these products, please check with your pharmacy, grocery store or “big box” store for instructions.

Or call Guardian Drug Company directly by telephone at 609-860-2600, ext. 109, or by Email (recall@guardiandrug.com).