Drug shortages are significant public health threats. They can delay, or even deny, critical care for patients. Here are the four drugs in shortage that are among the most problematic.
Drug shortages are a significant public health threat that can delay, and in some cases even deny, critical care for patients.
A recent article in The Wall Street Journal featured a bladder cancer patient's inability to access BCG to treat her cancer due to a shortage of the drug. According to the University of Utah Drug Information Services, the number of drugs in short supply in the United States has risen 74% from 5 years ago to approximately 265.
Related: Drug shortages mobile app launched by FDA
Dr BenjaminHere, Bona E. Benjamin, BS Pharm, director, Medication-Use Quality Improvement and coordinator, Drug Shortages Resources Center for Medication Safety and Quality, American Society of Health-System Pharmacists (ASHP), and the University of Utah Drug Information Service, helps identify the 4 drugs in short supply that are among the most problematic.
Additional information can be found at the ASHP’s drug shortages page and at FDA’s drug shortages page.
These drugs are the most common drugs used for treating nausea and vomiting.
Droperidol
Reason for droperidol shortage:
Estimated resupply dates:
For more on droperidol, see ASHP’s shortage bulletin.
Promethazine injection
Reason for shortage:
Estimated resupply dates:
For more on promethazine injection see ASHP’s shortage bulletin.
Prochlorperazine Edisylate Injection
Prochlorperazine is a phenothiazine antiemetic used to control nausea and vomiting produced by a variety of causes. During this shortage use alternative antiemetics. Oral and rectal prochlorperazine products are effective, however these routes may not be practical for all patients.
Reason for shortage:
Alternative agent/management:
No single agent can be substituted for prochlorperazine injection. The choice of alternative agents must be patient-specific and based on the clinical situation.
Estimated resupply dates:
For more on prochlorperazine injection, see ASHP’s shortage bulletin.
Ondansetron injection
Reasons for shortage:
Estimated resupply dates:
For more on ondansetron injection, see ASHP’s shortage bulletin.
NEXT: Nitroglycerin injection shortages
Nitroglycerin is a vasodilating agent. Intravenous nitroglycerin is used in conditions such as cardiac arrest to increase flow of oxygenated blood through blood vessels.
“No one alternative drug is therapeutically equivalent to nitroglycerin,” according to Dr Benjamin.
Reasons for shortage:
Alternative agent/management:
No single agent can be substituted for this drug. Alternatives will depend on the specific therapeutic indication and patient characteristics.
Estimated resupply date:
For more, see ASHP’s shortage bulletin.
NEXT: Methylene blue injection and indigo carmine injection shortages
These are 2 marker dyes commonly used in diagnostic procedures. The dye used depends on the type of procedure, as well as physician discretion, according to Dr Benjamin.
Reasons for shortage (methylene blue injection):
Alternative agent/management:
There’s no single dye that can replace methylene blue; consider reserving a supply of methylene blue for the treatment of methemoglobinemia. A recommended stocking level is five 10-mL vials to treat 1 patient.
Estimated resupply date:
For more on methylene blue injection, see ASHP’s shortage bulletin.
Indigo carmine is indigotindisulfonate sodium, a marker dye used during cystoscopy and ureteral catheterization.
Reasons for shortage (indigo carmine injection):
Alternative agent/management:
There is no single dye that can replace indigo carmine.
Estimated resupply date:
American Regent has indigo carmine 8 mg/mL 5 mL ampules on back order and the company cannot estimate a release date.
For more on indigo carmine injection, see ASHP’s shortage bulletin.
NEXT: Vancomycin shortages
Vancomycin is an antibiotic used for serious infections and pretreatment of certain patients at risk for infection before surgery, according to Dr Benjamin. Vancomycin is active against gram-positive bacteria, including staphylococcal species, streptococcal species, and enterococcal species.
“It is usually reserved for certain organisms, patients allergic to other drugs, and patients requiring prophylaxis for certain surgical procedures,” she said.
Reasons for shortage:
Alternative agent/management:
Institutions should not stockpile vancomycin injection and should adhere to the Centers for Disease Control and Prevention (CDC) recommendations for avoiding unnecessary vancomycin use and thus preventing the spread of vancomycin resistance.
Estimated resupply date:
For more, see ASHP’s shortage bulletin.
FormularyWatch/Source: ASHP Drug Shortages Resource Center
Read next: [BLOG]: Effective collaboration can help mitigate drug shortages
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