Drug Shortages

Drug shortages can occur for a variety of reasons.The factors currently affecting drug supply are shortages of raw materials, quality control issues which led to voluntary withdrawal and longer production times for some products and competition among drug manufacturers. The problem is expected to ease somewhat with renewed production in some cases and takeover of supply by another company in others. For more details see the environmental scan on Drug Supply Disruptions recently posted on the CADTH website.

In the meantime, healthcare providers are responsible for ensuring patients continue to receive appropriate drug therapy. A general protocol to follow in handling drug shortages is offered below:

  1. Ensure there is a valid indication for the drug. Review the patient’s drug and medical history. For a checklist of criteria to consider, check the CPhA Drug Shortages Guide pg 4 - 6.
  2. Substitution of a different brand of the same drug (molecule):
    • Check the Saskatchewan Prescription Drug Plan (SPDP) Formulary for interchangeable brands of the same drug; then check for availability of these brands. (Call wholesalers, manufacturers)
    • If none are available, is there a non-interchangeable brand of the same drug.in the same dosage form? Obtain authorization for substitution from doctor, start at same dose or a reduced dose and titrate to desired effect (especially important if drug has a narrow therapeutic index) and monitor for beneficial and adverse effects. Follow-up with the patient in 24 – 48 hours, as indicated by kinetic and pharmacologic characteristics of the drug.
    • If no Formulary drug in the same dosage form is available, check Health Canada Drug Product Database for other brands that may be available and proceed as above.
    • If none available, is there a different dosage form of the same drug? Obtain authorization for substitution from doctor, start at appropriate dose and titrate to desired effect (especially if narrow therapeutic index) and monitor for beneficial and adverse effects. Follow-up with the patient in 24 – 48 hours as indicated by kinetic and pharmacologic characteristics of the drug.
    • If no Formulary drug is available, check Drug Product Database for other dosage forms that may be available and proceed as above.
    • As necessary, consult SPDP regarding coverage for substituted brand.
  3. If no other forms of the same molecule are available, substitution of another drug in the same therapeutic class can be considered. Check the references below for dose equivalence data. This information is not always available. Even when a therapeutically equivalent dose is administered, patients may react differently. Pharmacists should follow-up with the patient frequently until the patient is stabilized on the new medication.
    • Rx Files Charts - www.rxfiles.ca
    • e-therapeutics + (available at SHIRP)
    • Handbook of Clinical Drug Data , 2010, 11th edition - hardcopy text
  4. If there is not a therapeutic equivalent, check treatment guidelines and recommend a drug from another pharmacologic class. Monitor and titrate to desired effect.
  5. Compounding capsules or tablets in the desired doses when other strengths of drug are available or from bulk powders may be another option, especially in instances where there is not a readily available or acceptable substitute.

In order to provide greater information to health care practitioners and the general public, Canada’s Research Based Pharmaceutical Companies (Rx&D) and the Canadian Generic Pharmaceutical Association (CGPA) began collecting information on behalf of their individual member companies on current and impending drug shortages in the fall of 2011. Rx&D has now turned over its database architecture (i.e. the former Rx&D Drug Shortages Database) and opened its use to non-Rx&D members (i.e. all market authorization holders) who are authorized to sell medicines in Canada, and who may need to use the site to report a drug shortage.  Iinformation is being provided on a voluntary basis.  It does not necessarily include all pharmaceutical companies in Canada, and therefore there may be gaps in the data. The new database is called the Canadian Drug Shortages Database:

medSask is not responsible for the content of this database, and does not assume any liability that may arise from any use of or reliance on the information contained therein.  The information in the database been provided by drug manufacturers, and is presented here for reference purposes only.  There is no warranty, representation or guarantee with respect to the accuracy, timeliness or completeness of this information.  medSask accepts no responsibility for any errors or omissions, and expressly disclaims any such responsibility.

medSask cannot accept phone, email, fax, or other inquiries about the content of this information.  Inquiries regarding specific drug shortages should be directed to the appropriate drug manufacturer as identified.  Questions about alternatives for shorted drugs and drug plan coverage for alternatives may be directed to the appropriate provincial drug information service.

The following tables provide suggestions for handling shortages of specific drugs. This information is intended for use by healthcare providers for general informational purposes only.  It remains the responsibility of the healthcare provider to use professional judgment in evaluating this information in light of any relevant clinical or situational data.  This information is provided without warranty of any kind and medSask and the University of Saskatchewan assume no responsibility and/or legal liability whatsoever for any errors, omissions or inaccuracies contained therein.


To check current availability status of parenteral drugs go to the Sandoz website and click on Product Supply Information for Healthcare Professionals.

Click on colored text to link to additional information.

DrugAvailability / Alternatives


Injectable 50mg/ml  10 x 20ml  - no date for availability.

Injectable 50mg/5ml 10 x 10 ml -no date for availability.

Both cream and ointment available.

Alternative route: oral tablets, oral liquid formulation.


Currently available.

Sandoz is the only manufacturer of bretylium.

Indicated as last resort for life-threatening ventricular arrhythmia not responding to adequate doses of first-line antiarrhythmic agents. 

Ventricular Fibrillation - continue with lidocaine, epinephrine, defibrillation, magnesium, procainamide

Ventricular Tachycardia - procainamide is an alternative

Calcitonin, Salmon, Synthetic

Calcimar 200U/ml (2ml) INJECTION available.

All nasal spray calcitonin products have been withdrawn and discontinued from the market due to a small increased rate of cancer (up to2.4 %). DINs became inactive October 1st, 2013 at which time prescribing and dispensing should have ceased.  Calcitonin is no longer indicated for osteoporosis. For alternative treatment see ACFP Tools for Practice at http://www.acfp.ca/Portals/0/docs/TFP/20130923_085017.pdf.

Calcitonin (salmon synthetic) injectable remains on the market but is indicated only for Paget’s Disease and hypercalcemia. Due to the increased cancer risk the duration of treatment should be limited to the shortest period of time possible and the minimum effective dose.

Chlorpromazine injection

Sandoz, the sole supplier, has discontinued marketing injectable chlorpromazine in Canada.

Alternate formulations: oral tablets  50 and 100 mg are available.

TEVA 25mg tablets available.

Bulk chemical is listed in Medisca catalogue.

Therapeutic alternatives: See PDF

Cisatracurium besylate injection

Cisatracurium besylate Injection 2mg/mL, multidose 10mL is now available on allocation from Omega Laboratories

Not available through McKesson

Therapeutic alternatives are discussed on the AHSP Shortages database at  http://www.ashp.org/menu/DrugShortages/CurrentShortages/bulletin.aspx?id=1072.

Clindamycin IV

Sandoz 600mg and 900mg Minibags 10 x 50ml available

Sandoz 150mg/10ml 10 x 2ml, 10 x 4ml, 60ml available

Dalacin C (Pfizer) 150mg/ml 60ml, 25 x 2ml, 25 x 4ml, 25 x 6ml available.


Consider oral formulation if patient is not NPO -  bioavailability is almost 100 %
Step down from IV to oral as soon as possible

See PDF for therapeutic alternatives

Co-trimoxazole Injectable

Septra IV is now available.

If necessary Hospitals should contact Aspri Pharma’s Customer Service at (514) 868-8440 (Toll free: 1-855-868-8440) or Info@aspripharma.com.

See PDF document for shortage management suggestions. NB: Note that gentamicin, an alternative for Listeria, is currently also in short supply - see below.


Not available through McKesson.

Existing dacarbazine stock only used to continue treatments that have already been initiated.
No new patients should be initiated on dacarbazine treatment, until further notice.


Cerubidine 20mg/4ml  (Erfa)  is available. 


Sandoz formulations 5mg/ml 5 and 10ml size available

See PDF for indications and alternatives

Dimethyl sulfoxide

Rimso - Myland brand (DMSO 50 % for irrigation) now available.

Other brands - no availability date.

See PDF for shortage management strategies.


The source of dobutamine in Canada is Sandoz:

                Sandoz - 12.5mg/ml (10 x 20ml) available

           Therapeutic alternatives: Dopamine hydrochloride, norepinephrine bitartrate, milrinone.  See PDF for details.


Baxter dopamine hydrochloride and 5% dextrose injection is available from Baxter Canada (1-888-719-9955)

Available now from McKesson

Therapeutic alternative: norepinephrine


Existing doxorubicin stock only used to continue treatments that have already been initiated.
No new patients should be initiated on doxorubicin treatment, until further notice.

Doxorubucin HCL, pegylated liposomal

Caelyx® 2mg/ml  (10 ml) available


Sandoz brand Vasotec Available

Sterimax brand available.

See PDF for therapeutic alternatives. *Note that some of these agents are also in short supply or backordered e.g. phentolamine, esmolol*


Sandoz 50mcg/ml 2ml size, 5ml size, 10ml size, 20ml size and 50ml size are currently available through McKesson.

Procedural sedation -SeePDF

Chronic pain - fentanyl patch - do NOT use in opioid naïve pts

Bulk powder - Medisca, Galenova (Currently unavailable)




Teva and Apotex brands available March 7, 2018

Luvox brand name (BGP Pharma) available January 10, 2018

Folic acid


  • Oral:  5 mg tablets Available

             5 mg IV = 5 mg PO

ENTERAL: Dispersed tablets can be administered via enteral feeding tube


Sandoz 10mg/ml 10 x 4ml available

Teligent brand - 10 x 2 ml available January 10, 2018

Sterimax brand - 25 x 2ml available February 7, 2018


Oral dosage forms available.

Alternative Routes:

     - oral:  20 mg IV = 40 mg PO
     - administration through enteral feeding tube.  It is reasonable to administer furosemide oral solution (can dilute with equal volume water if needed) through a feeding tube.  Caution with doses > 140 mg daily (14 ml) which contain nearly 10 g sorbitol.  10 g sorbitol per day may cause flatulence and bloating; 20 g daily may cause diarrhea and cramping. 

Therapeutic Alternatives:
Ethacrynic acid: 50 mg/vial (close to $500 acquisition cost per vial)
Bumetanide: IV available through Special Access?


Sandoz 40mg/ml (10 x 2ml) available

Sandoz 10mg/ml  -  not currently available UNDER ALLOCATION. FOR QUESTIONS ON ALLOCATED QUANTITIES, PLEASE CONTACT SANDOZ 1-800-361-3062

Teligent brand  40MG/ML 10X2ML available


Sandoz  available

with preservative VL 0.2MG/ML 1X20ML

preservative free  VL 0.2MG/ML 10X2ML

See PDF for

  • Preoperative inhibition of salivation and excessive respiratory tract excretions
  • Intraoperative and postoperative use
  • Management of gastrointestinal disorders

Haloperidol decanoate

Haloperidol 5mg/ml  (10 x 1ml) available

Haloperidol LA 100mg/ml (5ml) available

Alternative depot antipsyhotic: flupentixol, fluphenazine, paliperidone, pipotiazine, risperidone, zuclopenthixol (See Depot Antipsychotic Shortages PDF)



Some strengths under allocation.


Acute or chronic pain (See Switching Opioids)

  • ORAL: – IR tablet; solution, SR capsule
    1 mg IV = 2 mg PO opioid naïve pts, chronic pain
  • RECTAL  -  3 mg suppository
  • ENTERAL:  Syrup, dispersed IR tablets can be given through enteral feeding tube
  • COMPOUND STERILE SOLUTION for parenteral use (if facilities available) – powder can be purchased from Medisca
Alternative IV analgesics: morphine, fentanyl, methadone

Fentanyl patch for chronic pain only - do NOT use in opioid naïve patients

Hepatitis A (inactivated) and Hepatitis B (recombinant) vaccine (Twinrix)

Twinrix Jr. 0.5ml prefilled syringe MANUFACTURER CANNOT SUPPLY FOR INFORMATION CALL 800-387-7374 December 15, 2017 is the estimated availability date.

Twinrix 1.0ml prefilled syringe currently available. (December 13/17)

For  1 - 15 years old Use Alternate 2 dose Schedule with Twinrix (720/20 1ml) at 0 months and second dose at 6 to 12 months

Single ingredient vaccines can used, however all are either not available with no date given for availability or the single  Havrix and Engerix-B are in limited supply.

Heparin Sodium

All strengths available through McKesson from various manufacturers

Indigo carmine

Indigo carmine 0.8% injectable is unavailable for an indefinite period. For a discussion of therapeutic options see the AHFS Drug shortage memo on indigo carmine at  http://www.ashp.org/menu/DrugShortages/CurrentShortages/Bulletin.aspx?id=861.

Methylene blue is an option for certain indications and McKesson currently has some in stock.


Ketorolac 30 mg/ml -  10 x 1ml available, 25 x 1ml available

Toradol 10mg/ml (5 x 1ml) available.

While shortage is in effect, the following measures are suggested:

  1. Use lowest effective dose
  2. Step down to oral ketorolac or alternative NSAID as soon as therapeutically appropriate
  3. Use oral analgesic e.g. ibuprofen, naproxen if patient is able to eat and drink (See PDF)
  4. Use rectal analgesic or alternative parenteral analgesic if oral oute not available (See PDF)


4mg/ml (10 x 1ml) available

2mg/ml (10 x 1ml) available

  • See PDF for details on treatment alternatives


Available 50mg/ml (10 x 1ml) Sandoz brand

Alternative: IV analgesics e.g. morphine, hydromorphone (Use of oral meperidine not recommended)

See PDF for details.

Methotrimeprazine Injection 25mg/ml

Sanofi-Aventis is the sole Canadian supplier of parenteral methotrimeprazine. Available.
Oral tablets available in 2 mg, 5 mg, 25 mg, and 50 mg
See PDF for therapeutic alternatives for parenteral methotrimeprazine.


Available 5mg/ml in 2ml and 30ml.


Baxter brand 5mg/ml (100ml) available.

See PDF for shortage management strategies.


Mitomycin for injection 20mg available.

Hospitals seeking Mitomycin Injection 20mg on behalf of a patient should contact Health Canada’s Special Access Programme (SAP), who will work with Teva to identify any available product globally and determine if it is suitable to bring into the Canadian market.

See PDF for shortage management strategies.


Sandoz available in 0.5mg/ml, 1mg/ml, 2mg/ml, 10mg/ml, 15mg/ml, 50mg/ml.

Procedural sedation - See PDF for alternatives

Acute  or chronic pain

  • ORAL:  IR tablet; syrup, SR tablet/capsule
    10 mg IV = 20 mg PO opioid naïve pts, chronic pain
  • RECTAL: 5, 10, 20, 30 mg suppository
    10 mg IV = 10 mg PR
  • ENTERAL:  Syrup, dispersed IR tablets can be given through enteral feeding tube
  • COMPOUND STERILE SOLUTION for parenteral use (if facilities available) – powder can be purchased from Medisca, Galenova

Alternative IV analgesics: hydromorphone, fentanyl (See Switching Opioids)

Fentanyl patch for chronic pain only - do NOT use in opioid naïve patients

Moxifloxacin Injectable

Avelox I.V. currently on allocation. According to McKesson it will be available March 15, 2018.  Call Bayer Customer Service: 1-800-268-1432.

Moxifloxacin IV no longer available from McKesson.

Oral moxifloxacin may be suitable. See document for details and alternative agents. 


McKesson currently listing:

Sandoz 0.4 mg/ml 10 ml multiuse vial (Stable for 28 days after 1st use)  AVAILABLE

Teligent brand 0.4mg/ml 10 x 1ml available

Sandoz -  0.4 mg/ml 10 x 1 ml ampoules available

            -  1 mg/ml 2 ml vials availabile

             - preservative-free AMP 0.4MG/ML 10 X1ml available June 30, 2017

NALOXONE KIT WITH OMEGA DRUG(2 VIALS) 1 NO 1899130 ALBERTA INC  - available through McKesson

Omega brands - no information on restocking dates

Contact Poison Control for emergency information in the event naloxone is unavailable.

Pharmacies may provide naloxone kits to patients or their caregivers.At this time kits can only be purchased through a company call the Control Group

Information on PAS (Members) website: https://www.skpharmacists.ca/pharmacists/resources/naloxone

Neostigmine Methylsulfate

Now available

Reversal of Post-op Neuromuscular Blockade
- reduce/ avoid use of muscle relaxants when possible

Urinary Retention
- catheterization

Post-operative Ileus
-no specific therapy

Acute Exacerbation of Myasthenia Gravis
-treatment of underlying cause (e.g. Infection)
-pulmonary physiotherapy
-IVIg: 2 g/kg given over 5 days (400 mg/kg /day) or, if tolerated, over 3-4 days


Omega brand Nitroject 5MG/ML 5X10ML available


  • Sublingual nitroglycerin
    • 0.4 mg every 5 min x 3 doses
  •  I.V./oral beta blockers in absence of contraindication (if so consider non-dihydropyridine calcium channel blocker – avoid immediate release nifedipine)
    • Metoprolol 50 mg PO q12h   OR  if significant,  5 mg I.V. over 2 minutes q 5 minutes up to 15 mg.
    • Atenolol 25-50 mg PO q12h   OR  if significant,  5 mg I.V. over 5 minutes, repeat once after 10 minutes.
  • Morphine sulfate if ischemic pain not adequately treated.
  • Oral  long acting nitrate to prevent recurrent episodes of ischemia

Hypertensive Emergency (HE)/Intraoperative Hypertension (IH)

  • Labetalol (HE)
  • 20-80 mg I.V. bolus q 10 minutes until target BP


  • 0.5-2 mg/minute I.V. infusion to target BP
  • Esmolol (IH)
  • 1.5 mg/kg bolus over 30 seconds.  Follow with 0.15 mg/kg/min.  Adjust rate as required up to 0.3 mg/kg/min to desired heart rate/BP.
  • Phentolamine (HE)
  •  5-15 mg I.V. bolus
  • Sodium nitroprusside  (HE)
  • 0.25 – 10 mcg/kg/minute as immediate I.V. infusion
  • Hydralazine (HE)
  • 10 – 20 mg I.V. q 20-30 minutes as needed for desired BP.


Not yet available through McKesson.

Paclitaxel can also be ordered directly from Biolyse Pharma 1-905-687-8008


Not available.

Available Alternative: rocuronium

See Nondepolarizing Neuromuscular Blocking Agents for more information.


Powder for injection available 40mg/ml

Restriction: Active GI Bleed; dose restricted

Dose: 80 mg IV x 1 dose, followed by 40 mg IV q12h x 6 doses Note: Doses greater than this may be subject to autosubstitution

Patients With No Active GI Bleed (i.e., do not meet restriction criteria):

Dose: Esomeprazole 40 mg PO or via NG once daily

Dose: Lansoprazole Fastabs 30 mg PO once daily (quick dissolving tabs)

Phentolamine Mesylate Injection

Phentolamine mesylate 5mg/ml (10 x 1ml) SDZ available

See PDF for information on therapeutic alternatives.


Sandoz and Sterimax brands 50mg/ml 2ml and 5ml sizes available.

Piperacillin and Tazobactam

Anticipated shortage -  Pip/Tazo manufacturers (e.g. SDZ, Sterimax, Teligent) will have supply issues for the next 16-18 months as one API manufacturing plant is not in production (explosion at the plant) which means that all API has to come from the sole remaining API manufacturer which is challenged in covering the global market.

McKesson currently lists 2 strengths of the Sterimax brand as available.

Pipotiazine palmitate (Piportil L4)


See Depot Antipsychotic Shortages PDF

Prochlorperazine Injectable

Injectable formulation discontinued by manufacturer.

Alternate forms: 5mg and 10 mg oral tablets  available

10 mg rectal suppository Available

Therapeutic alternatives: See PDF

Promethazine Injectable

Injectable formulation has been discontinued by manufacturer

Alternate forms: 50 mg oral tablets indeterminate availability. FOR INFORMATION CALL 866-926-7653

Bulk chemical listed in Medisca catalogue.

Therapeutic alternatives: See PDF



Alternatives: Induction of anesthesia: ketamine, etomidate (SAP)

Procedural sedation - See PDF for alternatives


Sandoz 25mg/ml (10 x 2ml) and Sandoz 25mg/ml 50ml size available.

Change to oral route whenever possible:
-ranitidine 50 mg IV = ranitidine 150 mg PO
-oral solution can be administered NG (Teva oral solution available DIN 02242940)

Change to alternative if required:
Alternative H2 antagonists:
-IV: famotidine (APX, Omega) – in short supply
-Oral: famotidine 40 mg ~ nizatidine 300 mg ~ ranitidine 150 mg BID or 300 mg  HS

Alternative PPIs:
IV: Pantoprazole (currently shorted)
Oral: Pantoprazole 40 mg ~ Lansoprazole 30 mg ~ Omeprazole 20 mg ~ Esomeprazole 40 mg ~ Rabeprazole 20 mg 
Nasogastric administration: lansoprazole, esomeprazole


Currently available.

See Nondepolarizing Neuromuscular Blocking Agents for more information.

Sodium Bicarbonate Injection 8.4%

Pfizer Sodium Bicarbonate Syringe 8.4% 10 x 50ml available.


Refer to document developed by PA Parkland Health Region

For more information on recalled lots and predicted availability dates:

June 20, 2017 Client Letter (download PDF, 798KB)

June 21, 2017 Second Notification (download PDF, 798KB)


Teligent brand 20mg/ml  available
Alternatives: rocuronium - see Nondepolarizing Neuromuscular Blocking Agents


Delatestryl (testosterone enanthate)  200mg/ml x 5ml available

Pfizer depo-testosterone cypionate 100mg/ml available.

Option: Testosterone enanthate and testosterone cypionate (100 mg/ml) can be substituted at same mg/dose and same frequency (Note different concentrations of testosterone cypionate products and Delatestryl - e.g. a patient receving 0.5 ml (100 mg) Delatestyl would require 1 ml (100 mg) of testosterone cypionate.)

Alternatives: Oral or topical formulations of testosterone (See PDF)

Thyrotropin alpha

Not currently available

Tirofiban .05mg/ml NS IV


Vitamin B 12


Reserve current stock for patients with cancer protocols which require periodic injections of vitamin B!2 to prevent toxicity

Restrict parenteral use to patients with severe neurologic involvement or with vomiting, diarrhea or bowel resection, or chidlren with severe deficiency when rapid restoration of stores is desired

Alternatives: Oral or sublingual route:

Adult - 1,000 to 2,000 mcg/day inititally to treat deficiency, followed by maintenance dose of 1000 mcg/day
Children - Not well defined. Doses of up to 1000 mcg/day orally are used for pernicious anemia.

Vitamin K

Baxter 10mg/ml, 10x1ml now available, 1.0mg/0.5ml available.

ORAL:   Vitamin K 5 mg tablets- Special Access Drug.  No restrictions per SAP.

COMPOUND: Vitamin K powder  available from Galenova, Medisca  - prepare capsules, powders, suspensions


DrugAvailability / Alternatives


AAPharma 250mg available.

Glaucoma – methazolamide
Altitude sickness - dexamethasone
Migraine (off-label) - methazolamide

Allopurinol (Zyloprim)

All strengths and brands available from various manufacturers.

Zyloprim - all strengths available.

Discontinuation in patients with mild gout and no attacks for years may be considered.

Xanthine oxidase inhibior: febuxostat (Uloric) 80 mg PO once daily. (new, $$)
2nd line prophylaxis:
Colchicine 0.6 - 1 mg PO once daily; reduce dose in elderly, renal impairment
Uricosuric agents: ineffective if CrCl <50 ml/min; not in urate over-producers; not if history of nephrolithiasis; liberal fluid intake required:
- Probenecid: inital dose 250 mg PO BID, titrate to 0.5 - 2 g / day in two to three divided doses
- Sulfinpyrazone: inital 100-200 mg PO BID, increase dose to 200 - 400 mg PO BID


Amantadine capsules 100MG 100 PDP long-term short as per Pendopharm - No availability date.

Amantadine Syrup 50MG/5ML 500ML - Available 


All strengths of Elavil and all generic brands available.

Nortriptyline (convert at roughly ½ the dose of amitriptyline and titrate as needed), Imipramine (convert at same dose as amitriptyline); beta-blockers (migraine prophylaxis); SSRIs, SNRIs


Amoxicillin/Clavulanate 250/125 tablets, 500/125 tablets, 875/125 tablets available

Apo suspensions 125-31.25/5ml and 250-62.5/5ml available March 2018 according to McKesson

Clavulin 125-31.25/5ml, 200mg-28.5mg/5ml, 250mg/62.5mg/5ml and 400mg-57mg/5ml suspensions available.

Options for amoxicillin clavulanate 875/125 mg:
500/125 mg TID or if BID dosing is desired, 500/125 mg BID PLUS amoxicillin 500 mg BID.

Therapeutic alternatives:
macrolides, clindamycin (but not if need Gram neg coverage), fluroquinolones, cefixime, cefuroxime

Ampicillin Oral Suspension

No manufacturers are currently marketing oral ampicillin suspension.

Ampicilllin 250 and 500mg capsules available.

Compound suspension from oral ampicillin capsules (See detail document)
Substitue a different antibiotic which is active against the organism causing the infection


25mg, 50mg and 100mg available from various manufacturers.
TEVA Atenolol / chlorthalidone combination available as well as Tenoretic.

See PDF for information on handling shortage.

Budesonide/ sodium chloride Enema

Entocort Enema 0.02mg/ml  7 x 115ml  Available


Dostinex: Available

Apotex brand available - now listed as a benefit on SK Formulary

Co-Cabergoline - no availability date

See PDF for details.

Calcitonin nasal spray

All nasal spray calcitonin products have been withdrawn from the market and discontinured due to a small increased rate of cancer (up to2.4 %). DINs became inactive October 1st, 2013 at which time prescribing and dispensing should have ceased.  Calcitonin is no longer indicated for osteoporosis. For alternative treatment see ACFP Tools for Practice at http://www.acfp.ca/Portals/0/docs/TFP/20130923_085017.pdf.

Calcitonin (salmon synthetic) injectable remains on the market but is indicated only for Paget’s Disease and hypercalcemia. Due to the increased cancer risk the duration of treatment should be limited to the shortest period of time possible and the minimum effective dose.


Available both Suprax and generic

Therapeutic alternatives: ceftriaxone IM, azithromycin PO

See PDF for details

Charcoal, Activated Suspension

 Charac-25 SUSP PED 125ML available

Charac-50 SUSP 225ml available

Charactol-50 250ml suspension available

No availability date for the Pendopharm products

Tablets and powder are available.

Premeasured activated charcoal powder can be ordered from McKesson or Galenova. See PDF


AA Pharma 50mg (single ingredient) available.

Other brands are only combination products.

Teva atenolol/chlorthalidone 100/25 and 50/25 available. 

NYC azilsartan/chlorthalidone available.

Tenorectic 50/25 available.

If also on atenolol and strengths match, can go to the combination product (Tenoretic, generics)
Hydrochlorothiazide at equivalent dose for hypertension or edema

Clindamycin palmitate granules for solution

Dalacin C granules for solution 75mg/5ml is available

Options: capsules (150, 300 mg) can be opened up and mixed with water of food (not an approved method of administration) - see PDF for more details; parenteral injection for severe infection

Therapeutic alternatives - See PDF


APO - available

Frisium - available

Alternatives: clonazepam (or other benzodiazepine); anticonvulsant appropriate for seizure disorder

Clobazam must be tapered before stopping if not switching to another BZD - see PDF.

The Canadian League Against Epilepsy has also issued a document


Clomid - discontinued

Serophene - discontinued

Alternatives: compounded by compounding pharmacy or pharmacological alternatives.


Capsules currently available in both strengths. 

TEVA 125mg/5ml (100ml size) suspension available.

Cephalexin is an appropriate alternative for an infection in which cloxacillin is indicated:
abscess (breast)/mastitis (mild); carbuncles (mod-severe); bursitis, septic; cellulitis (extremities and facial); dacrocystitis in adult; impetigo (mod-severe); osteomyelitis (step down in children)

Co-trimoxazole (sulfamethoxazole/trimethoprim)

Both DS and regular strength tablets available from either Teva or Apotex


Options: Use other methods of administration.

Alternatives: A different antibiotic with a similar spectrum of activity


Dantrolene sodium capsules 25mg(Dantrium®) available.

100mg discontinued.

Options:  Parenteral product is available (Dantrium Intravenous®).  Extemporaneous compouding via bulk powder through Medisca is an option.

See PDF for details about alternatives.


All strengths available.

Nortriptyline and desipramine are both secondary amine TCAs and generally better tolerated than tertiary amine TCA's (convert to nortripytline at roughly ½ the dose of desipramine and titrate as needed), Imipramine, amitriptyline, clomipramine (convert at same dose as desipramine); beta-blockers (migraine prophylaxis); SSRIs, SNRIs


Diltiazem CD, ER - all strengths available - manufacturers vary.

Tiazac XC available in all strengths.

See medSask Hot Topic: Comparison of Long-Acting Diltiazem Products (293 KB) August, 2016

Same daily dose of alternative dilitazem formulations
Hypertension: verapamil, amlodipine, felodipine and nifedipine XL
Stable angina: amlodipine, nifedipine, and verapamil IR are indicated. IR diltiazem and IR nifedipine not recommended for monotherapy.

Diphenoxalate HCl - Atropine sulfate (Lomotil)


Divalproex sodium


In the event of a shortage:

Substitute same strength valproic acid formulation. May be increased GI adverse effects - take with food. Monitor for continued control of seizures / mood.


Erythromycin Base 250mg tablets, Eryc 250mg and 333mg capsules (Erythromycin enteric coated delayed release pellets) Available
Erythro S (stearate) 250 mg available.
Erythromcin ophthalmic ointment NOW available
Erythromycin Estolate 250mg/5ml suspension (100ml) available
Erythromycin IV is also available.

Erythromycin Ethylsuccinate suspensions - Discontinued by manufacturers

Alternatives: other macrolides are available as liquid formulations ie. Azithromycin, Clarithromycin. Compounding not recommended as cost-prohibitive, lack of formulas readily accessible and other options readily available.


Fenofibrate Micro 200mg available from various manufacturers.

145mg (EZ) Nanocrystal formulations and 160mg (Supra) Microcoated, micronized formulations are equivalent to the 200mg micronized formulations and are available from various companies.

Fenofibrate 48mg and 100mg available.


All strengths available.

Generics available

Important considerations:

  • Dependence and withdrawal can be severe - see PDF for details
  • Medication overuse headache - see PDF for details


50 mg and 100 mg strengths available from AA Pharma.

Name brand Tambocor - discontinued.

In case of shortage, refer to proprafenone document. 

In the likely event both fleicanide and propafenone are short, no blanket recommendation can be made.  Please phone medSask for individual assessment and include as much patient history as possible including - but not limited to: the type of arrhythmia being treated; current medications, past medications for the arrythmia and reason for discontinuation, if known; other medical conditions; allergies. 

Framycetin sulfate / gramicidin / dexamethasone

Sofracort Eye/Ear Drops available January 31, 2018.

Proctosedyl ointment (suppositories d/c), Proctol, Proctosone and Proctomyxin ointment and suppositories currently available.

Nasal Spray available.

Soframycin ointment is discontinued.

Sandoz Opticort is discontinued.

Sofratulle bandage not available - McKesson says no date for availability

Alternatives: Blephamide (sulfacetamide/prednisolone) ophth oint; Ciprodex (ciprofloxacin/dexamethasone) otic susp; Maxitrol (polymyxin B/neomycin/dexamethasone) ophth susp and oint; Tobradex (tobramycin/dexamethasone) ophth susp.


TEVA gemfibrozil 300mg and 600mg available.

Apo-gemfibrozil 300mg and 600mg backordered until March 8, 2018.

Other brands discontinued.

Therapeutic alternatives: fenofibrate, bezafibrate, statins, niacin, fish oil (See PDF for details)

Gliclazide MR

All brands and strengths available.

Gliclazide 80 mg immediate release (various brands) - to substitute for MR, start with 80 mg IR per 30 mg MR. Doses higher than 160 mg daily should be divided BID. Dose should be adjusted based on blood glucose monitoring after switch.

Hyoscine butylbromide (Buscopan(R))

Buscopan 10 mg tablets available.

Buscopan 20 mg/ml injection and Sandoz hyoscine butylbromide injection available; much more expensive than oral tablets.

Therapeutic alternatives: dicyclomine, pinaverium, trimebutine, peppermint oil.


Apo-Indapamide 1.25mg and 2.5mg currently available.

Lozide 1.25mg  and 2.5mg currently available.

Other brands - various dates for availablity

Iron Dextran

Ferrlecit 12.5mg/ml - available

Dexiron 50 mg/ml -available

Venofer 20mg/ml - available

Infufer 50 mg/ml and Feraheme discontinued by manufacturer.

Isosorbide mononitrate (ISMN)

Imdur 60 mg - available 

Apo-ISM 60 mg - available 

PMS-ISMN 60 mg - indeterminate availability

Lithium Carbonate

Apotex 150mg and 300mg Lithium Carbonate - available

AA Pharma Lithmax 300mg -availability changes daily - currently available 

Bulk powder is not listed in the catalogues for either Medisca or Xenex.

In general, when switching from IR lithium to SR, the total daily dose of lithium is the same. Lithmax given either BID or at HS can be used.
The CPhA Product Monograph states that: Once patients are stabilized on a maintenance dose, the dosage schedule may be changed to a once-daily regimen.
The Product Monograph for LITHMAX ( https://www.aapharma.ca/downloads/en/PIL/2016/Lithmax-PM.pdf) states that: Lithium carbonate sustained-release tablets should be swallowed whole or broken in half. They should not be chewed or crushed. N.B.: Blood samples for serum lithium determination should be drawn prior to the next dose and when lithium concentrations are relatively stable (i.e. 10 to 14 hours after the previous dose of lithium). Total reliance must not be placed on serum levels alone. Accurate patient evaluation requires both clinical assessment and laboratory analyses.

Medroxyprogesterone acetate

All strengths available.

Options: Compound capsules from bulk powder

Alternatives: micronized progesterone, norethindrone acetate, megestrol acetate, estradiol/progestin combinations
(See PDF for detailed information.)


100mg and 200mg AA Pharma brand available

Therapeutic alternatives: See PDF


TEVA brand FOR INFORMATION CALL 800-268-4127 

Cesamet brand name FOR INFORMATION CALL 800-361-4261 - Only 0.25mg currently available.

According to McKesson

Nabilone 0.25mg will be available July 7, 2018

Nabilone 0.5mg  will be available  July 7, 2018

Nabilone 1mg  will be available  July 7, 2018

TEVA/ACT - Activis for INFORMATION CALL 800-268-4127 

Nabilone 0.5mg  will be available December 15, 2017

Nabilone 1mg  will be available December  15, 2017

Pharmascience (PMS) No availability date for either strength

Naproxen suppositories

All brands of naproxen suppositories are unavailable.

Therapeutic alternatives: See PDF.


MacroBID- available

TEVA Macrocrystals 50mg and 100mg capsules  - available

AA Pharma   50mg tablets, 100mg tablets - available

Nystatin Oral Suspension


Refer to compounding pharmacy
Therapeutic alternatives: fluconazole, gentian violet, clotrimazole

Ofloxacin 0.3 % ophthalmic solution

All brands of tablets discontinued

Allergan Ocuflox 0.3% ophthalmic available

Apo-ofloxacin 0.3% ophthalmic available April 4, 2018.

See PDF for suggestions on therapeutic alternatives.

Opium and Belladonna Rectal Suppositories


Therapeutic Alternatives: Hyoscine (Buscopan) injectable, morphine suppositories, NSAID suppositories - See PDF for more details.

Paromomycin (Humatin)

Only manufacturared by Erfa. 

Humatin 250mg capsules now available.



Dientamoeba fragilis
No treatment required if asymptomatic.Symptomatic: iodoquinol* 650 mg PO TID (adult) or 30-40 mg/kg/day PO div TID (max 650 mg/dose, children) x 20 days
Alternative: metronidazole^ 500-750 mg PO TID (adult) or 35-50 mg/kg/day PO div TID (children) x 10 days
^High failure rate to metronidazole

Entamoeba histolytica (Amoebiasis)
Asymptomatic: iodoquinol* 650 mg PO TID (adult) or 30-40 mg/kg/day PO div TID (max 2g/day, pediatric) x 20 days or paromomycin
Symptomatic: metronidazole 500-750 mg PO TID (adult) or 35-50 mg/kg/day PO div TID (pediatric) x 7-10 days Followed by iodoquinol (dose as above) x 20 days or paromomycin

Giardia lamblia / duodalis / intestinalis (Giardiasis)
First line treatment is metronidazole 250 mg PO TID (adult) or 15 mg/kg/kday PO div TID (pediatric) x 5-7 days Alternatives: paromomycin, nitazoxanide (available through Special Access Programme), quinacrine (available through Special Access Programme)

*Iodoquinol (Diodoquin) is made by Glenwood as 210 mg and 650 mg tablets.  As of Feb.17, 2014, only the 210 mg tablets are available.  Diodoquin is not available through McKesson but is distributed through Khol and Frisch, AmerisourceBergen, Procurity, uniPHARM.

Penicillin V

300mg tablets currently available.

Suspension 125mg/5ml and 300mg/5ml not currently available - resupply now anticipated April 8, 2018 according to McKesson catalogue

Grp A Strep throat : amoxicillin, amoxicillin-clavulanate, cephalexin, clindamycin, azithromycin, clarithromycin

Grp A vulvovaginitis: clindamycin

Dental infection prophylaxis and treatment: clindamycin (alternative for penicillin V +/- metronidazole)


Currently available.

Trental name brand discontinued.

Alternatives: aspirin, clopidogrel, dipyridamole, ticlopidine

Permethrin 5% cream and lotion

Kwellada-P Lotion 5% available.

Nix 5% Cream available.

Therapeutic alternatives (see PDF for details):

  • Crotamiton 10 % cream (Eurax)
  • Sulfur 5 - 10 % in petrolatum (once daily application for 3 to 7 days)
  • Ivermectin - may be available on a case-by-case basis through the Special Access Program


APO-Perphenazine 2, 4 and 8 mg tablets currently available.

Therapeutic alternatives: See PDF


All strengths of all oral dosage forms are available.

Alternatives: Infatabs, oral suspension, injectable.
Important - see PDF for instructions on switching.

Pizotifen (Sandomigran)

Sandomigran 1mg available.

Sandomigran 0.5mg discontinued.

Polymyxin B + Gramicidin Ophthalmic

Polysporin Pink Eye drops and Ear drops with lidocaine are available

Ophthalmic ointment d/c

Therapeutic alternatives:

- RX alternatives: tobramycin, ciprofloxacin or erythromycin ophth ointment

Promethazine 50mg


See PDF for injectable promethazine for alternatives


Both 150mg and 300mg available from various manufacturers.

Rythmol 150mg and 300mg available

In the likely event both fleicanide and propafenone are short, no blanket recommendation can be made.  Please phone medSask for individual assessment and include as much patient history as possible including - but not limited to: the type of arrhythmia being treated; current medications, past medications for the arrythmia and reason for discontinuation, if known; other medical conditions; allergies. 

Pyrantel pamoate suspension

Combantrin suspension has been discontinued. Combantrin 125 mg tablets are available.

For patients unable to take tablets, the tablet can be crushed and mixed with a soft food immediately before administering. 

Ranitidine oral solution (15mg/ml)

Generics available

If dose corresponds to tablet strength (75, 150, 300 mg), tablet can be crushed and mixed with soft food such as applesauce immediately before administering.

Extemporaneous compounding: See PDF for details

Sodium Phosphate effervescent tablets

Phosphate-Novartis - discontinued

Jamp-Sodium Phosphate - available

See PDF for alternatives.


Apotex 80 mg and 160mg - Indeterminate availabilty.

PMS 80mg sotalol available intermittently. Check McKesson catalogue.

Jamp brand and PMS other strengths available January - February 2018 according to McKesson.

Alternatives depend on the indication for which sotalol is being used.

See PDF for management suggestions.


TEVA brand available.

Pfizer Aldactone 25mg  available January 10, 2018

Pfizer Aldactone 100mg available January 10, 2018

See updated PDF for more information on alternatives.


Pfizer SALAZOPYRIN EN-TABS TB EC 500MG 100 available


Non-enteric tablets 500mg (PMS) -Indeterminate availability

Thyroid (dessicated)

Thyroid 125mg - available mid-January 2018.

Thyroid 30mg -available mid-January 2018.

Thyroid 60mg - available mid-January 2018.


Mavik 0.5mg, 1mg, 2mg and 4mg available


All strengths currently available from various manufacturers.

Immediate release at same daily dose (or as close as possible)
Hypertension: amlodipine, diltiazem (CD, Tiazac reg, Tiazac XC), felodipine , nifedipine (XL)
Stable angina: amlodipine, diltiazem and nifedipine XL are indicated. IR diltiazem and IR nifedipine not recommended for monotherapy.