Drug Shortage information Action Plan Acetylcysteine
Inhalation Solution
The shortage is due to manufacturing delays and another manufacturer voluntarily suspending production.
Hospira has a limited supply available and other manufacturers are unable to
estimate a release date.
CPOE alert implemented asking prescribers to utilize alternative for inhalation orders. PO/IV is currently restricted to acetaminophen overdose in adults, regardless of shortage. Memo distributed, posted on Methodist MD.
Acyclovir Inj A few manufacturers suspended their production leading to this shortage. Currently no products are available.
Shortage reviewed at Dec P&T that includes ganciclovir as an alternative.
Atropine Inj Manufacturers have suspended the
production leading to delays. Using vials for EH carts and trays. Black Widow
Antivenin Merck has low inventory of Antivenin Latrodectus Mactans. The company cannot estimate when regular distribution will resume.
Memo created and sent to ED staff and pharmacy on process on how to obtain emergency supply through Merck.
Merck (medical team) 1-800-672-6372
If after normal business hours, contact the same number and follow prompts
Bleomycin The shortage is due to manufacturer discontinuing the product in May 2011 and increased demand by other
manufacturers. 15 unit and 30 unit vials available in limited supply.
A communication letter has been sent to oncologists/hematologists to notify them of the shortage. Alternatives: For Hodgkin's Lymphoma, omit bleomycin or use an alternative regimen. For testicular cancer, use the EP or VIP regimen. See Chemo action plan for plans on select critical chemo shortages-approved by P&T
Calcium chloride and calcium
gluconate
Shortage is due to manufacturing
problems Conservation plan implemented for TPN and boluses. CPOE alert on calcium gluconate to alert prescribers. Calcium chloride stock reduced/removed from emergency
carts/procedural trays. Cytarabine The shortage is due to manufacturing
issues. Some products are available. Alternatives: For AML, use Mitoxantrone+Etoposide. For ALL, use alternative regimens or omit Cytarabine. See Chemo action plan for plans on select critical chemo shortages-approved by P&T.
Daunorubicin The shortage is due to suspension of
manufacturing and manufacturing issues. A communication letter has been sent to oncologists/hematologists to notify them of the shortage. Use alternative anthracycline or an alternative regimen for lymphomas, metastatic breast cancer, or sarcomas.
Doxorubicin The shortage is due to manufacturing issues. The duration of the shortage is unknown.
A communication letter has been sent to oncologists/hematologists to notify them of the shortage. Use alternative anthracycline or an alternative regimen for lymphomas, metastatic breast cancer, or sarcomas.
Epinephrine The shortage is due to manufacturing issues. The duration of the shortage is currently unknown.
The epinephrine count on the Emery House carts has been decreased from 10 to 5. Slips were placed in the EH cart as reminders.
Foscarnet Hospira has presentations on hold due to quality improvement activities. Hospira cannot estimate a release date.
FDA allowing temporary importation of Foscavir from Clingen Healthcare in the United Kingdom. Product available at wholesaler and stock is being obtained for system by University.
Fosphenytoin Akorn and American Regent no longer manufacture. Hospira had a voluntary recall. Other manufacturers’ reason unknown.
Stock low. There is a CPOE order alert active, asking prescribers to utilize alternatives:
Alternative injectables include (adult dosing):
Phenytoin injection (use same dose and frequency as fosphenytoin) Levetiracetam (Keppra) 20mg/kg load; 1000 mg bid for
prophylaxis/maintenance dose
Valproate sodium 20mg/kg load; 10-15 mg/kg/day divided q8-12 hours maintenance dose
Furosemide The shortage is due to increased demand
and manufacturing delays. Stock is being tracked on a weekly basis. Prescribers are encouraged to order po over IV where possible. If IV is clinically necessary, a 48 hour automatic stop will be applied. A CPOE order alert is active for the shortage with conversion information for IV to po as it is not a 1:1 conversion.
Influenza vaccine Shortage is due to increased demand. Prefilled syringes are short – supply of multi-dose vials is adequate to meet expected needs for remainder of season. When supply of prefilled syringes is exhausted, will switch to draw-on-demand.
Intravenous fat
emulsion The shortage is due to increased demand and manufacturing issues. Conservation plan is in place. Patients on long-term TPN will receive IV lipids on Tuesdays and Fridays. See plan for further details. Kanamycin APP is unable to obtain raw materials to
manufacture kanamycin injection. APP has on long term backorder with no estimated release date. There are no other
presentations available.
Removal of Kanamycin from heart boxes approved by anesthesia
Labetalol The shortage is due to manufacturing delays.
No carpujects available – doses will be drawn up in IV room and dispensed on demand.
Leucovorin inj The shortage is due to increased demand
and manufacturing issues. P&T approved pharmacist interchange from leucovorin to levoleucovorin if needed. Leucovorin tablets are currently available and are not affected by the shortage. A communication letter has been sent to oncologists/hematologists to notify them of the shortage.
Mannitol The shortage is due to increased demand and manufacturing delays. The expected duration of the shortage is unknown.
Action plan approved by P&T Committee. Prescribers are encouraged to use alternatives where possible. Pharmacy is utilizing premix bags to draw up into syringes to conserve current stock. If stock reaches less than 1000 grams across the system, restrictions to the following patient groups will be implemented:
a. Use in kidney transplant recipients (limit of 12.5 grams per case) and liver transplant cases (limit of 25 grams per case)
b. Use in craniotomy procedures
c. Patients with severely elevated intracranial pressure with
neurologic injuries, where concentrated sodium chloride is not an alternative
Nimodipine Manufacturers cannot provide a reason for this shortage. Some stock has been available lately but a limited supply is available.
Limited to no stock in the system. The neurosurgery group has been notified of the shortage.
Nitroglycerin Vials
and Drips The shortage is due to manufacturing delays and the companies cannot estimate a release date.
Shortage plan approved Dec P&T. For non-ACS patients, encourage IV Nicardipine, IV Sodium Nitroprusside
In cath lab, utilizing alternatives for IC use (verapamil or nicardipine) Perflutren lipid
microspheres The shortage is due to manufacturing delays and another manufacturer voluntarily suspending production. The expected duration of the shortage is unknown.
Plan approved at August P&T to allow for non-formulary use of Optison during shortage. Plan implemented on August 3, 2012 due to no stock of Definity in the system. Memo created for Definity and sent to pharmacy/ECHO techs-cardiology.
Phosphate
injections Both sodium phosphate and potassium phosphate injections are short. No known resolution date.
Shortage plan in place. Limit amounts in TPN. For boluses, automatic interchanges to PO are in place if patient meets specific criteria. See shortage plan for further details.
Prochlorperazine
inj The shortage is due to the sole supplier of the product temporarily suspending production and distribution of all drug products in November of 2011
Stock is depleted. Alternatives should be used by prescribers (see memo on Methodist MD). There is a CPOE order alert for this shortage. Dispense on demand.
Propofol inj Propofol is currently a critical shortage due to manufacturing issues, recall, and discontinuation by one manufacturer. The expected duration of the shortage is unknown.
Continues to be short. Procurement from PharMedium has occurred for OR use (pre-drawn syringes). Vials removed from Omnicell. CPOE alert is active encouraging alternative therapy in mechanically ventilated patients.
Protamine Inj The shortage is due to increased demand by the sole manufacturer. The product is currently on allocation, with no estimated duration of the shortage.
An emergency use supply may be drop shipped. All physicians should be aware of this critical shortage.
Rabies Vaccine No products are fully available. RabAvert available but there is a delay in getting orders as the company fulfills current orders.
Email distributed to pharmacy staff on how to obtain: Novartis:
a. Pre-exposure- representative said look at CDC website
(http://www.cdc.gov/rabies/resources/news/2012-09-07.html)
b. Post-exposure- will allow distribution via their customer service (877-683-4732) or local distributor.
Sanofi-Pasteur:
a. Pre-exposure- None
b. Post-exposure- will allow overnight distribution, physician must fill out form and fax to company ( https://www.vaccineshoppe.com/assets/pdf/MKT25657%20Rabi
Sodium
Bicarbonate The shortage is due to manufacturing delays and increased demand for product. FDA has approved temporary importation of sodium bicarbonate 8.4% injection from Australia – will take to P&T for approval to order this product if needed.
P&T approved emergency auto interchange from sodium bicarbonate to normal saline when ordered from the RCN prophylaxis protocol
(implemented Monday 3/26). EH cart par reduced from 2 to 1;
Broselow cart par reduce from 3 to 1 on adult presentation and from 4 to 2 on pediatric presentation. Reduce in cardiac boxes from 6 to 4. CPOE alert: critical national shortage, order alternative therapy
whenever clinically possible; memo on Methodist MD. Pharmacist to call prescriber on all new orders to ask for an alternative.
Sodium
thiosulfate inj American Regent-temporarily d/c of manufacturing. American Regent-on backorder with no release date for the 100 mg/mL 10 mL vial presentation; American Regent and Hope
Pharmaceutical have 250 mg/mL 50 mL vial available.
There is severely limited stock within the entire system and we will probably exhaust our supply at current usage. A minimal supply must be kept in reserve for emergent known cyanide toxicity situations. During the shortage of sodium thiosulfate, nitroprusside infusions will be sent without any sodium thiosulfate added. Pharmacy is notified when a nitroprusside infusion stays on a patient’s profile for greater than 48 hours.
Trace elements Shortage is due to the sole manufacturer
having manufacturing problems. Conservation plan is in place. Patients on long-term TPN will receive trace elements on MWF. Please see plan for further details.
Reference: ASHP’s national current drug shortages list. www.ashp.org. Accessed February 2013.
Recently removed from list: Dopamine, Potassium Chloride, Etomidate, Dexamethasone, Meropenem, Bumetanide Where is information on drug shortages posted?
On MOLLI>>drug information>>drug shortages
On Methodist MD>>Quality and Patient Safety>>Pharmacy and Therapeutics>>Drug Shortages and on Methodist MD under recent news This includes a full report of all national shortages and the above abbreviated report, and specific memos (e.g. propofol, sodium bicarbonate). Updated/new memos are posted under recent news.
On System Pharmacy Sharepoint Page>> Shared documents>>Drug shortages This includes the Excel tracking log used by the pharmacy drug shortage team of all shortages critical to Methodist. This also includes specific drug shortage memos
