Charleston-area pharmacies are coping with national prescription drug shortages, but patients aren't likely to be stranded without medication.

Most patients likely won't notice an interruption because physicians swap alternative drugs, said Christopher Fortier, manager of pharmacy support services at the Medical University of South Carolina.

Alternative drugs, however, carry a risk of medical error because doctors are less familiar with them, Fortier said. His pharmacists "have been struggling" to wrangle supplies with little or no notice when drugs become unavailable.

"Alternatives are not ideal, but they're better than nothing," Fortier said. "All of a sudden (a drug) is not available. Some of my staff changed job descriptions to stay on top of this."

Although there were critical shortages of about 10 drugs in the past year at MUSC, affecting hundreds of patients, Fortier said he knew of none who went without alternatives.

Carmelo Cinqueonce, CEO of the S.C. Pharmacy Association, cautioned patients not to be alarmed. "I don't want to minimize the hardship of the patient who can't get the drug they so desperately need," he said. "But should people be panicked? I don't believe so."

The number of reported prescription drug shortages nationally nearly tripled between 2005 and 2010, from 61 to 178, according to the Food and Drug Administration. The shortages range from drugs used to treat cancer -- some of which have few or no alternatives -- to those for behavioral disorders.

The reasons for the shortages are varied. In some cases, production is halted because of quality problems or because key ingredients are unavailable. In others, manufacturers discontinue drugs because they're not profitable.

Physicians begin prescribing alternatives, whose supplies also then become strained.

A so-called gray market has sprouted for drugs in short supply. Secondary wholesalers buy up large quantities of in-demand drugs and resell them at a high markup, Fortier said.

"We get calls weekly asking if they can buy our drugs or if we want to buy their drugs," said Fortier, who said MUSC does not do business with such wholesalers.

On Monday, President Barack Obama issued an executive order directing the FDA and Department of Justice to take measures to alleviate drug shortages and prevent price-gouging.

Another reason behind the shortages: The Drug Enforcement Administration allows a limited amount of certain controlled substances to be produced in a year, Fortier said. "It's the end of the year and they're hitting their quotas," he said.

Last week, for example, MUSC learned an injectable painkiller regularly administered during surgical procedures wasn't available. Doctors swapped a different painkiller, Fortier said. Another in short supply is an anti-anxiety drug given to patients before surgical procedures, he said.

At Roper St. Francis Healthcare, "critical medications are still available and in sufficient quantities to meet the needs of our patients," a spokeswoman for the hospital system said in an email.

A spokesman for Trident Health System said in an email: "Every hospital experiences occasional shortages."

East Cooper Medical Center did not respond to a request for comment.

Cinqueonce, of the S.C. Pharmacy Association, said members have reported short supplies and back orders of Adderall, an amphetamine used to treat attention-deficit hyperactivity disorder, since early summer. Distributors cite manufacturing delays and increased demand, he said.

William Randazzo, an MUSC pediatrics professor who regularly sees children during clinics in Charleston County schools, said he has been unable to write prescriptions for the "extended release" version of Adderall -- but he said he dodges the problem by doubling prescriptions for the regular preparation. School nurse and guidance department officials in the Charleston County School District said they were unaware of the problem.

The S.C. Department of Health and Human Services is allowing patients on Medicaid, the government health insurance program for the poor and disabled, to get alternative medications if their regularly approved drugs are unavailable -- "even the more expensive name brand if need be," a spokesman said.

Reach Renee Dudley at 937-5550.