Acetylcysteine Inhalation Solution

Transcription

1 Drug Shortage information Action Plan delays and another manufacturer voluntarily suspending production. Hospira has a limited supply available and other manufacturers unable to estimate a release date. Acetylcysteine Inhalation Solution Black Widow Antivenin Bleomycin Merck has low inventory of Antivenin Latrodectus Mactans. The company cannot estimate when regular distribution will resume. 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. 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, requested for posting on Methodist MD. Memo created and sent to ED staff and pharmacy on process on how to obtain emergency supply through Merck. 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 Bumetanide inj Butorphanol inj Cytarabine delays and another manufacturer voluntarily suspending production. The duration of shortage expected to last at least through October System stock is being tracked. Currently, no supply is available. The shortage is due to multiple reasons including increased demand and suspension of manufacturing. The duration of the shortage may last at least through October issues. CPOE alert indicating critical national shortage asking for PO orders when possible. Plan approved at P&T for automatic stop on IV diuretics if needed. Memo/education released to OB (also posted on Methodist MD) for alternative, nalbuphine. 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.

2 Daunorubicin Diazepam inj Dobutamine Doxorubicin Epinephrine The shortage is due to suspension of manufacturing and manufacturing issues. Currently, stock is unavailable due to manufacturing delay by the sole supplier of the medication. Intermittent backorder- Hospira releasing product as it becomes available. issues. The duration of shortage expected to last at least through December issues. The duration of the shortage is issues. The duration of the shortage is currently 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. Medication pulled from Omnicell except pediatric and ED Omnicells to conserve current stock. Remove from the EH cart by November 1. Will remove permanently from EH carts; cath lab will still need access in Omnicell. 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. The epinephrine count on the Emery House carts has been decreased from 10 to 5. Slips were placed in the EH cart as reminders. Erythromycin Lactobionate Injection Etomidate Hospira is the sole supplier of erythromycin lactobionate. The company has both presentations on back order due to an increased demand for the product. Hospira estimates release date of mid- October, Product is currently unavailable through Methodist's wholesaler due to manufacturing issues. Duration of the shortage is expected to be at least through October Encourage IV to PO where possible Stock to be returned to ICU and ED Omnicell but alternatives are encouraged where possible (see specific memo). Stock will remain removed from anesthesia trays and placed on OR cardiac boxes for anesthesia use to conserve stock.

3 Fluconazole inj The shortage is due manufacturing delays. The company estimates release date of mid-october, Encourage IV to PO where possible Foscarnet Fosphenytoin Hospira has presentations on hold due to quality improvement activities. Hospira cannot estimate a release date. Product may be ordered through Hospira. Hospira has all foscarnet presentations on hold and the company cannot estimate a release date. Hospira has Clinigen Healthcare s Foscavir on backorder with an estimated release date by mid- October, Emergency supply is available. Akorn and American Regent no longer manufacture. Hospira had a voluntary recall. Other manufacturers reason Hospira estimated release date of mid-october FDA allowing temporary importation of Foscavir from Clingen Healthcare in the United Kingdom. Need P&T approval to order during shortage 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; mg/kg/day divided q8-12 hours maintenance dose Phenobarbital 20mg/kg load; mg BID or TID maintenance dose Furosemide and manufacturing delays. Duration of the shortage is expected to be at least through late October Stock is being tracked on a weekly basis. Prescribers are encouraged to order po over IV where clinically appropriate. There is a CPOE order alert active for this shortage.

4 Hydromorphone inj Kanamycin Leucovorin inj Mannitol Metoclopramide inj Morphine inj delays compounded by a recent FDA recall. Duration of shortage is expected to be at least through October 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. and manufacturing issues. The expected duration of the shortage is through at least October and manufacturing delays. The expected duration of the shortage is issues and regulatory issues with one manufacturer. The company is releasing product as available. The shortage is due to multiple reasons including manufacturing delays and increased demand. Hospira has product on intermittent back order and releasing as it becomes available. Inventory is being counted on a daily basis. Removal of Kanamycin from heart boxes approved by anesthesia 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. 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 P&T approved automatic conversion from IV to po in patients that meet certain criteria. Pharmacists were reminded that the oral disintegrating tablet is not included in the conversion plan as it is currently nonformulary and also on national shortage. Prescribers are encouraged to order po over IV where clinically appropriate. Medication will be pulled from all Omnicells to conserve current stock. A CPOE order alert is active. CPOE alert currently active to encourage oral therapy where possible. Also on daily inventory count.

5 Naloxone Perflutren lipid microspheres Potassium Chloride Prochlorperazine inj Propofol inj Protamine Inj Rabies Vaccine The shortage is due to multiple reasons from manufacturers, including suspension of manufacturing, discontinuation of product, and increased demand. Estimated resolution of the shortage is at least October delays and another manufacturer voluntarily suspending production. The expected duration of the shortage is delays and increased demand. Expected duration of shortage is at least through October The shortage is due to the sole supplier of the product temporarily suspending production and distribution of all drug products in November of The expected duration of the shortage is Propofol is currently a critical shortage due to manufacturing issues, recall, and discontinuation by one manufacturer. The expected duration of the shortage is by the sole manufacturer. The product is currently on allocation, with no estimated duration of the shortage. No products are fully available. RabAvert available but there is a delay in getting orders as the company fulfills current orders. Any new orders should be supplied by mid-october Imovax available but Sanofi-Pasteur is releasing this product for post-exposure emergency All vials have been removed off of Emery House carts. A notice slip was placed in the cart as a reminder. Naloxone vials are currently stocked on the Omnicells, and additional doses can be requested from Pharmacy. 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. Memo distributed asking pharmacists to call physician to recommend premix presentation (e.g. 20 meq or 40 meq) when bolus dosing is ordered that requires compounding (30 meq). CPOE pop up implemented on 30 meq order sentence and PharmNet alert. Stock is depleted. Alternatives should be used by prescribers (see memo on Methodist MD). There is a CPOE order alert for this shortage. Conservative measures in the OR have been implemented (reduce par on anesthesia trays and then subsequently begin drawing up from 50 ml vial in pharmacy to 10 ml syringes and provide to OR for sufficient stock of cases each day). Recommend practitioners consider alternative therapy where possible for ventilated patients. There is a CPOE order alert active for this currently. An emergency use supply may be drop shipped. All physicians should be aware of this critical shortage. distributed to pharmacy staff on how to obtain: Novartis: a. Pre-exposure- representative said look at CDC website ( b. Post-exposure- will allow distribution via their customer service ( ) or local distributor. Sanofi-Pasteur:

6 Sodium Bicarbonate Sodium thiosulfate inj use only. The company could not estimate when Imovax would be readily available again. delays and increased demand for product. Expected duration of the shortage is through October 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. a. Pre-exposure- None b. Post-exposure- will allow overnight distribution, physician must fill out form and fax to company ( es%20post%20exposure%20form%20revised%20final.pdf ) 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. Cerner announcement week of Oct 15. 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 48hours. Reference: ASHP s national current drug shortages list. Accessed October 2012.