Drug Shortages and Discontinuations

Quick Access

These are commonly accessed documents placed here for quick access. Also look in the entries below for additional information (e.g., return dates, alternatives) and links to other resources.

Background Information

Drug shortages can occur for a variety of reasons and may include, but are not limited to, shortages of raw materials, quality control issues which lead to voluntary withdrawal and longer production times for some products, and competition among drug manufacturers. For more details see the  Multi-Stakeholder Toolkit (last revised 2017).

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. Confirm that the drug is shorted. For certain drugs, manufacturers are required by law to report anticipated and actual drug shortages and discontinuations. These reports are available and searchable at www.drugshortages.ca.
  2. 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.
  3. 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 prescriber, 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 the 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 prescriber, start at appropriate dose, titrate to desired effect (especially if narrow therapeutic index), and monitor for therapeutic 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 the Health Canada Drug Product Database for other dosage forms that may be available and proceed as above.
    • As necessary, consult SPDP regarding coverage for substituted product.
  4. 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.
    • RxFiles Charts (available at SHIRP)
    • CPS (available at SHIRP)
  5. If there is not a therapeutic equivalent, check treatment guidelines and recommend a drug from another pharmacologic class. Monitor and titrate to desired effect.
  6. Compound products when no commercial agents are available.

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 has 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.                             

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.

Specific Drug Shortages & Discontinuations

Drugs are listed by generic name   
A-B

Drug

Availability / Alternatives

Abatacept subcutaneous injection

Orencia®  mg/ml pre-filled syringes, the only brand of abatacept solution, are shorted until the end of 2024

Health Canada has imported products from the United States and Saudi Arabia. These products have the same active ingredient, strength, dosage form, volume, product formulation, and route of administration as the Canadian product. 

  • The labels of these imported products differ slightly from the Canadian product in terms of indications, dosing, contraindications, language (no French), and lack of DIN. Always refer to the Canadian product monograph.
  •  Risk communications outlining these differences are available.
  • The imported products are being distributed by Bristol-Myers Squibb through Innomar.
  • Orencia®  250 mg/ml intravenous solution is still available.

For therapeutic alternatives, see RxFiles: Rheumatoid Arthritis: DMARDs. RxFiles is available through SHIRP.

Last updated: Jul 17/24

Acyclovir oral suspension

Zovirax® oral suspension has been discontinued by the manufacturer.

Alternatives:

  • Acyclovir tablets can be dispersed in 20-50 ml of water.

  • An oral suspension can be compounded. Medisca supplies a formula.

Last updated: May 27/24

Adefovir

Adefovir 10 mg tablets. Indeterminate availability

For therapeutic alternatives see RxFiles Hepatitis B Drug TherapyRxFiles is available through SHIRP 

Last updated: July 12/24

Antibiotics - pediatric formulations

Pediatric formulations of many commonly used antibiotics are undergoing shortages -  For specifics, see listing under individual medication.

Pharmacists may help minimize the shortages:

Last updated Jun 14/23

Auralgan Otic Drops (antipyrine 5.4% & benzocaine 1.4%)

Auralgan Otic drops have been discontinued by the manufacturer.

Possible alternative: Polysporin® Plus Pain Relief Ear Drops. These contain lidocaine 50 mg/mL & polymyxin B sulfate 10 000 IU/mL.

Last updated: Jul 27/22

Betamethasone dipropionate 0.05% with glycol topical cream

Topilene cream is shorting. Estimated availability: late Jul/24

Alternatives:

  • Topilene 0.05% topical ointment and lotion are available
  • For topical corticosteroid creams of similar potency, see RxFiles Topical Corticosteroids. RxFiles is available through SHIRP

Last updated: Jul 17/24

Betamethasone dipropionate 0.05%/salicylic acid 2% scalp lotion

Ratio-Topisalic scalp lotion  - expected availability of late Aug/24

See CPS (subscription) - Dandruff & Seborrheic Dermatitis or Psoriasis for alternative treatments.

Last updated: Jul 12/24

Betamethasone valerate 0.05% topical lotion

Ectosone 0.05% topical lotion - estimated availability of September/24

For corticosteroid lotions of similar potency, see RxFiles Topical Corticosteroids. RxFiles is available through SHIRP

Last updated: Jun 14/24

Budesonide nasal spray

Mylan 64 & 100 mcg nasal spray: indeterminate availability.

Rhinocort® Aq 64 mcg is in stock

For alternative corticosteroid nasal sprays, see CPS (subscription) - Allergic Rhinitis. CPS is available through SHIRP.

Last updated: Apr 25/24

Budesonide nebules

All strengths & brands are shorted with indeterminate availability.

Alternatives:

  • Pulmicort® turbuhaler
  • Nebulized solution can be compounded
  • For therapeutic alternatives, see RxFiles Asthma, available through SHIRP.

Last updated: Jul 24/24

Buprenorphine Implant

Probuphine®  80 mg implant has been discontinued.

Information from manufacturer: The reason for discontinuation is due to the inability to successfully acquire continued supply and is unrelated to any safety concerns.

Last updated: Jul 5/23

C
DrugAvailability

Carbamazepine oral

On short:

  • The 200 mg and 400 mg CR tablets. Earliest availability: late Jul/24
  • All brands of the 200 mg immediate-release (IR) tablets - intermittent availability

Alternatives:

  • Health Canada has approved importation of US-labelled carbamazepine extended-release tablets by Septa pharmaceuticals.  Only a limited quantity will be available. See the DPEB bulletin for risk communication and billing details.
  • Carbamazepine chewable 100 and 200 mg tablets are available.
    • To switch from IR to chewable tablets:
      • Straight switch - same dose and frequency.
    • To switch from CR to IR/chewable tablets:
      • The dose frequency of IR/chewable products depends on the indication and may range from twice daily to four times daily. 
      • The total daily dose of carbamazepine may need to be reduced if switching from CR to IR/chew for seizure disorder.
      • Monitor plasma levels (when relevant, such as for seizure disorder) and clinical response. 
  • Tegretol 100mg/5 mL suspension is available.
    • To switch from IR tablets to suspension:
      • Use the same daily dose. The suspension produces higher peak levels than the same dose in tablet form therefore should be dosed TID-QID.
      • Monitor plasma levels (when relevant, such as for seizure disorder) and clinical response. 
  • CPhA has a drug shortage document based on recommendations from the Canadian League Against Epilepsy.

Last updated: Jul 24/24

Chlordiazepoxide capsule

To be discontinued by the manufacturer. Some 25mg capsules may be available until Dec/24

For alternatives, see RxFiles (subscription) - Benzodiazepines. RxFiles is available through SHIRP.

Last updated: Jul 12/24

Cholestyramine oral powder

All brands/formulations are shorting. Estimated availability:

  • Cholestyramine light formulations - late Aug/24
  • Cholestyramine regular - Sep/24

Alternatives:

  • There are supply challenges with all bile acid sequestrants, however, Glenmark Pharmaceuticals US-labelled Colesevelam 625 mg tablets are now available. See details in the colesevelam listing. A CPhA comparison of bile acid sequestrants is available here
  • Diarrhea: see CPS (subscription) Diarrhea.
  • Cholestatic pruritus: cholestyramine is an option for symptomatic treatment. Other options include rifampin, naltrexone, sertraline.
  • Dyslipidemia: see CPS (subscription) Dyslipidemias or RxFiles (subscription) Lipid Lowering Therapy

CPS and RxFiles are available through SHIRP.

Last updated: Jul 24/24

Ciclopirox olamine 1.5% shampoo

Stieprox®  shampoo has been discontinued by the manufacturer.

Indication: topical treatment and prophylaxis of dandruff or the treatment of seborrheic dermatitis in which the yeast M. furfur is involved.

For therapeutic alternatives, see RxFiles Antifungals Chart or CPS Dandruff and Seborrheic Dermatitis. CPS and RxFiles are available through SHIRP.

Last updated: Feb 16/24

Ciprofloxacin XL

Cipro® XL 500 mg and 1000 mg have been discontinued. The only brand currently marketed, pms-Ciprofloxacin XL 500 mg, is shorted with indeterminate availability.

Alternatives:

  • Ciprofloxacin XL is only indicated for urinary tract infection.
    • Consider if other antibiotics, such as nitrofurantoin, are appropriate and available. 
    • For alternative UTI treatments, see Bugs & Drugs, RxFiles, or CPS. RxFiles and CPS are available through SHIRP.
    • Ciprofloxacin regular 250 mg and 500 mg tablets remain available.

Last updated: Jul 10/24

Clioquinol 3%/ Flumethasone pivalate 0.02% topical cream

Locacorten® Vioform® cream. Estimated availability of Oct/24

  • Lotriderm® and Vioform® HCare combination antifungal/corticosteroid creams that may be suitable alternatives
    • ∗ no longer stocked at McKesson

Last updated: Jun 10/24

Clomiphene

Clomid® and Serophene® - discontinued     

Alternatives:      
Compounded by compounding pharmacy or pharmacological alternatives - see  document

Codeine multi-agent cough and cold syrups

Intermittent shortages of some codeine-containing cough and cold syrups.

Breakdown of medications in the marketed products listed at McKesson :

ProductAntitussiveDecongestantAntihistamineExpectorant
CalmylinCodeine 3.33mg/5ml Diphenhydramine 12.5mg/5mlAmmonium Cl 125mg/5ml
Calmylin ACECodeine 10mg/5ml Pheniramine 7.5mg/5mlGuaifenesin 100mg/5ml
Calmylin PSE Codeine 3.33mg/5mlPseudoephedrine 30mg/5ml Guaifenesin 100mg/5ml
CotridinCodeine 10mg/5mlPseudoephedrine 30mg/5mlTriprolidine 2mg/5ml 
Cotridin ExpCodeine 10mg/5mlPseudoephedrine 30mg/5mlTriprolidine 2mg/5mlGuaifenesin 100mg/5ml
Damylin Codeine 3.33mg/5mlDiphenhydramine 12.5mg/5mlAmmonium Cl 125mg/5ml

Last updated: Feb 15/24

Colesevelam

Apo-colesevelam 625mg tablets - estimated availability of late Aug/24

Lodalis 625mg tablets: estimated availability of early Aug/24

Health Canada has approved importation of Glenmark Pharmaceuticals US-labelled Colesevelam 625 mg tablets and these are now available. For product differences and other considerations, see their risk communication

Formulary status of the imported Glenmark Pharmaceuticals product: 

  • Temporarily listed as a non-interchangeable full Formulary benefit of SK DPEBB. See bulletin here
  • Temporarily added to the Non-Insured Health Benefits formulary for the duration of the importation and sale approval from Health Canada. 

At this time there are supply challenges with all bile acid sequestrants. A CPhA comparison of bile acid sequestrants is available here

Last updated: Jul 24/24

Colestipol

Colestid® granules and tablets are shorted. No date given for availability. 

Alternatives:

  • There are supply challenges with all bile acid sequestrants, however, Glenmark Pharmaceuticals US-labelled Colesevelam 625 mg tablets are now available. See details in the colesevelam listing. A CPhA comparison of bile acid sequestrants is available here
  • Diarrhea: see CPS (subscription) Diarrhea.
  • Dyslipidemia: see CPS (subscription) Dyslipidemias or RxFiles (subscription) Lipid Lowering Therapy

CPS and RxFiles are available through SHIRP.

Last updated: Jul 12/24

Contraceptives, Hormonal (Oral)

For discontinued or shorted products refer, to SK Formulary for similar ingredients or RxFiles Combined Oral Contraceptives for similar hormonal activity. RxFiles is available through SHIRP.

Co-trimoxazole (sulfa- methoxazole /trimethoprim) Oral Suspension

Suspension is shorted with indeterminate availability date. 

The regular, DS, and pediatric tablets are available.

See document for management options.

Last updated: Feb 15/24

D
DrugAvailability

Dapsone topical

Aczone® topical gel is shorting with estimated availability of late Aug/24.  There are no other brands of topical dapsone.

For alternatives see medSask Minor Ailment Acne guideline or CPS Acne. Both are available through SHIRP.

Last updated: Jul 12/24

Desonide ointment

Estimated availability: May 2025

Alternatives:

  • Desonide topical cream remains available.
  • For topical corticosteroids of similar potency, see RxFiles Topical Corticosteroids. RxFiles is available through SHIRP

Last updated: Jul 15/24

Diclofenac/misoprostol tablets

All brands of diclofenac/misoprostol 50 mg are shorting. Earliest availability: late Aug/24

Alternatives:

  • Diclofenac/misoprostol 75 mg tablets are back in stock.
  • Diclofenac 25 mg & 50 mg tablets are available.
  • Misoprostol 100mg & 200 mcg tablets are available.
  • See RxFiles (subscription) NSAIDS & Other Analgesics for other alternatives. RxFiles is available through SHIRP.

Last updated: Jul 24/24

Dipyridamole/ASA 200/25 mg capsule

Estimated availability: January 2025

See document for alternatives.

Last updated: Jul 12/24

E-G
DrugAvailability

Eprosartan and Eprosartan/HCTZ oral tablets

Teveten® and Teveten® Plus have been discontinued by the manufacturer. No other brands of eprosartan are marketed.

See medSask's ARB comparison table for suitable alternatives.

Last updated: Sep 7/23

Erythromycin base oral tab/cap

AA-Erythro 250 mg and Eryc® 333 mg have been discontinued.

No other oral erythromycin products are marketed.

Alternatives:

  • Bulk powder is available for compounding.
  • See Bugs & Drugs for therapeutic alternatives.

Last updated: Apr 28/23

Estradiol vaginal ring

Estring® - estimated availability: late August/24

Alternative vaginal estrogens include:

  • Vagifem® vaginal tablet
  • Imvexxy® vaginal insert
  • Estragyn® and Premarin® vaginal creams

See RxFiles: Menopause Hormone Therapy for details. RxFiles is available through SHIRP.

Last updated: Jul 12/24

Estradiol transdermal patch

Several brands/strengths of estradiol patches are shorting.

  • Estradot®  and Sandoz-estradiol patches are interchangeable.
  • Oesclim® , Estradot®  and Climara® patches are NOT considered interchangeable by the SK drug plan. 
  • Climara® patches are changed once weekly; Oesclim® & Estradot® are changed twice weekly.
  • While cutting transdermal patches is not ideal, it is acceptable for matrix patches of medications with wide therapeutic indices (all of the estradiol patches are matrix).
    • There are limited data regarding stability of cut patches, but some data of estrogen patches (not necessarily the same products available here) suggests cut patches maintain concentrations when returned to the original pouch and stored at labeled storage conditions for up to 1 month after cutting. It seems reasonable to apply this data to all estrogen matrix patches.
    • Cutting square and rectangular-shaped patches on the diagonal may result in more even doses. Considering many people use estrogen patches for symptomatic treatment, dosage accuracy may not be critical, but something to keep in mind if symptoms are not controlled as well using cut patches. 
  • Estradiol gel is another transdermal option.
  • See RxFiles Postmenopausal Therapy for more information. RxFiles is available through SHIRP.

Last updated: Apr 25/24

Evusheld™

Evusheld™ has been discontinued by the manufacturer. See medSask's COVID-19 treatments for alternate treatment options (specific to Saskatchewan only).

Last updated: Apr 5/24

Exenatide Injection

Byetta® 1.2 & 2.4 ml prefilled pens and Bydureon® injection have been discontinued by the manufacturer. No other forms or brands of exenatide are available.

For GLP-1 receptor agonist alternatives see CPS (subscription): Diabetes Mellitus. CPS is available through SHIRP.

Ferrous Fumarate Oral Suspension 

JAMP 60 mg/mL suspension is shorted with estimated availability of December/24.

  • Palafer 20mg/ml suspension is back in stock
  • Ferrous fumarate 300 mg capsules and tablets are available. 
  • Ferrous sulfate liquids in various concentrations available. 
  • Elemental iron content of salts: 
    • Ferrous fumarate: 33%
    • Ferrous sulfate: 20%
    • Ferrous gluconate: 12% 

Last updated: Jul 12/24

Fluphenazine decanoate injection

Both brand name (Modecate®) and generic products have been discontinued.   
See document for alternative antipsychotic depot injectables.

Oral dosage forms are available.

Formula, Infant

A temporary closure of Abbott Nutrition’s U.S. based facility in 2022 resulted in limited supply of infant formula. Specialty formulas were first affected, though the supply of these has largely stabilized. However, strain shifted to supply of regular infant formula in the autumn of 2022 and is expected to continue into the summer of 2023. Supply of liquid formulations has been stable, but the more popular powder formulations are often unavailable. Health Canada continues to import formulas through the interim policy.

See CPhA’s Infant Formula Shortage: Information for Pharmacy Professionals, which has comprehensive information, including Health Canada websites and documents.

Last updated: 09 May 2023

Gemfibrozil tablets

Indeterminate availability

Considerations:

  • Consider if a fibrate is warranted.
    • Dyslipidemia/CV Risk Reduction
      • Primary prevention: fibrates play no role.
      • Secondary prevention: fibrates may be considered if statin intolerance, although ezetimibe and PCSK9 inhibitors are preferred.
    • Hypertriglyceridemia
      • Fibrates are first-line if fasting TG > 10.0 mmol/L despite weight loss, glycemic control, and diet modification.

Alternatives:

 Last updated: Jul 12/24                

Glaucoma Agents, Topical

  • Intermittent shortages of various topical products for primary open-angle glaucoma have been occurring in Canada.
  • RxFiles (Topical Ophthalmics for Primary Open Angle Glaucoma),CPS (Glaucoma), and other resources are available through SHIRP to help determine best therapeutic alternatives if the patient’s current agent is not available.
  • While several different products are available, options are limited for patients who are sensitive to the preservative benzalkonium chloride (BAK).
    • For those who are sensitive to BAK:
      • If BAK can be tolerated at all:
        • consider use of a product with a lower concentration.
        • when > 1 agent is required, use a combination product when available to reduce overall exposure to BAK
      • When possible, choose a preservative-free product (few exist) or a product with an alternate preservative.
      • This table lists the agents available in Canada and indicates the preservative contained in each.

Gliclazide MR 60 mg  tablets

All brands shorting with earliest availability: late August/24

Gliclazide MR 30mg tablets are now available

  • 2x MR 30 mg tablets are equivalent to 1x MR 60 mg tablet.

Last updated: Jul 12/24

Glucagon for Injection 1 mg/mL 

Eli Lilly and Novo Nordisk have discontinued their injectable glucagon products; currently there are no Canadian products available.  

Health Canada has imported a US-labelled glucagon 1 mg/mL (Amphastar). Note that this product is very similar to the Canadian emergency kit products in terms of how supplied and dose. However, the products are not considered equivalent and US labelling needs to be followed. Monitor closely for effect.

See DPEB Bulletin (including PseudoDIN) and risk communication.

Baqsimi™ (glucagon nasal spray) remains in stock. Please note that Baqsimi™ is not indicated for use in children < 4 years of age.

Last updated:  Jan 22/24

H-K
DrugAvailability

Hydrocortisone sodium succinate (Solu-Cortef®

Various vial sizes are reported as shorted. Some formats may be available by allocation. Contact Pfizer 1-888-999-8750; ALLOCATION@PFIZER.COM 

Until further notice, the SK Drug Plan & Extended Benefits Branch has temporarily added Solu-Cortef®, 500 mg vials to Full Formulary status.

See English or French documents for conservation strategies and alternatives.

Last updated: Feb 16/24

Hydrocortisone 1%/ Pramoxine 1% rectal foam (Proctofoam-HC®)

Proctofoam-HC® is being shorted - no availability date given.

Alternatives:

Last updated: Feb 26/24

Hydrocortisone-containing suppositories

  • Proctodan (hydrocortisone, pramoxine, zinc sulfate) - estimated availability: Sep/24
  • Proctol (hydrocortisone, dibucaine, esculin, framycetin) -  estimated availability: late Aug/24

Available:

  • Anusol-HC, Anodan-HC (hydrocortisone, zinc sulfate)   

Last updated: Jul 24/24

Indacaterol Breezhaler®

Onbrez® Breezhaler® has been discontinued by the manufacturer. There are no other products containing indacaterol alone.

Alternatives:

  • There are inhalation products containing indacaterol in combination:
    • Atectura® Breezhaler® - indacaterol & mometasone
    • Ultibro® Breezhaler® - indacaterol & glycopyrronium
    • Enerzair® Breezhaler® - indacaterol, mometasone & glycopyrronium
  • For LABA alternatives, see RxFiles COPD Drug Comparison chart. RxFiles is available through SHIRP.

Infant Formula

See "Formula, Infant"

Insulin - premixed

Novolin® GE 40/60 and 50/50 penfills have been discontinued by the manufacturer. 

See RxFiles Insulin Comparison Chart for alternate insulin choices. RxFiles is available through SHIRP.

Last updated: April 6/23

Iron dextran injection

Dexiron has been discontinued

For alternatives see document

Isosorbide mononitrate 60 mg oral tablet

McKesson has some Apotex in stock

All brands shorting with estimated availability of Sep/24

For alternatives see document.

Last updated: Jul 12/24

L-O
Drug 

Lithium 300 mg sustained-release tablet

Lithmax® is the only sustained-released (SR) lithium product marketed. Expected availability of early Aug/24.

Lithium immediate-release (IR) capsules remain available. 

  • At the beginning of therapy, IR is typically administered in 2 to 3 daily doses and SR in 2 daily doses. For both formulations, after several weeks at an established dose, the dose can be consolidated to one dose at bedtime.
    • For patients who have been on a once daily dose of SR and have tolerated it well, it is possible to convert to IR at the same once daily dose; however, this may increase the risk of adverse effects. If adverse effects are of concern, consider dividing the same daily dose into 2 doses at initial switch to IR. This can then be consolidated to a once daily dose at bedtime after a few weeks if tolerated. 
    • For patients who have been on 2 daily doses of SR, convert to IR at the same dose and frequency, though if not tolerated, the daily dose can be administered in 3 divided doses.
  • Monitor:
    • Adverse effects: fatigue, fine tremor in hands, nausea, loose stools
    • Symptom control
    • Lithium levels 5 days after a change in formulation. Drawing 12 hours after the last dose is preferred, but if this is not possible, draw at least 8 hours after the last dose.  

Last updated: Jul 12/24

Locacorten® Vioform®   topical cream

See clioquinol/flumethasone.

Loxapine oral tablet

The 10 mg tablets are on short.  Earliest availability:  mid-Sep/24

The 2.5 and 25 mg tablets are available.

For information on alternative antipsychotics, see RxFiles: Antipsychotics. RxFiles is available through SHIRP.

Last updated: Jul 24/24

Loxapine 50mg/ml injection

On allocation - for more information contact Sandoz at 1-800-361-3062 or info.clients@sandoz.com 

For alternative antipsychotic injections, see RxFiles: Antipsychotics. RxFiles is available through SHIRP.

Last updated: Jun 5/24

Megestrol 160 mg tablet

Estimated availability - Sept/24.  Only the AA brand is marketed.

The 40 mg tablets are now available.

Last updated: Jun 14/24

Methadone, Metadol®-D liquid (OAT)

There have been intermittent periods in which Metadol®-D is not available. 

  • The only other methadone products that can be used for opioid agonist therapy (OAT) are: 
    • Methadose™ Sugar Free (and generics, Jamp, Odan) 
    • Methadose™ Cherry Flavoured (and generic, Odan)
  • Methadose™ Sugar Free (or generics) is preferred because there have been reports of destabilization following switches to the Cherry Flavoured (and generic) product. 
  • A new prescription is required when switching to a different methadone product as they are not interchangeable. 
  • See Commercially Available Methadone for Opioid Agonist Therapy.

Notes: 

  • Metadol® cannot be used for opioid agonist therapy because it holds Exceptional Drug Status (SK Drug Plan) and Limited Use Benefit (NIHB) status for pain only. 
  • Methadone solutions cannot be compounded while commercial product is available as per Health Canada policy.

Last updated: Feb 15/24

Methazolamide tablets

AA-methazolamide 50mg tablets are shorted with expected availability of Oct/24

No other strengths or brands are manufactured.

Alternatives:

  • Acetazolamide is the only other oral carbonic anhydrate inhibitor available.

  • See CPS Glaucoma for acetazolamide dosing & alternative treatments. CPS is available through SHIRP.

Last updated: Jun 5/24

Methylphenidate, Long Acting

Biphentin®, Foquest®, generic methylphenidate ER-intermittent shortages of some strengths.

Alternatives:

  • Some strengths of the formulations may be available.
  • Concerta® is available but is NOT interchangeable with the generic methylphenidate ER.
  • Note that Biphentin®, Foquest® and Concerta® are not interchangeable.

Ritalin® SR and Sandoz-methylphenidate SR tablets have been discontinued.  Apo-methylphenidate SR 20 mg is still marketed.

Last updated: Oct 14/22

Methylprednisolone 
 tablet

Medrol™ 4 mg is on short. Estimated availability: late Aug/24. No other brands are available. 

Alternatives:

  • The 16 mg tablets are available and can be quartered (cross-scored) for a 4 mg dose.  These are immediate-release tablets and no safety/efficacy concerns regarding splitting have been identified.  As a general rule, a pill-splitter should be used to split tablets to ensure less variation in size and tablets should not be split in advance to minimize exposure to light and moisture.
  • Dependent on indication. Consult specialist or contact medSask with details.
  • See CPS - Corticosteroids: Systemic for equivalent dosing.

Last updated: Jul 24/24 

Mounjaro®

See Tirzepatide

Moxifloxacin 400 mg oral tablet

McKesson has the Auro brand in stock

Moxifloxacin 400 mg oral tablets are shorted with earliest availability: end of Sept/24.

Management

Last updated: Jul 22/24

Mumps, Measles, Rubella (MMR) Vaccine

Inventory of MMR vaccine is limited due to increased demand. Currently, it is not available for private purchase. Refer to Public Health, which has some supply. 

Last updated: Mar 27/24

Nevirapine 200mg tablet

Estimated availability: September/24

For alternatives, see RxFiles HIV Drug Comparison chart.  RxFiles is available through SHIRP.

Last updated: Jul 12/24

Nitrofurantoin

Intermittent availability of PMS-nitrofurantoin BID 100 mg capsules (macrocrystal/monohydrate).

Nitrofurantoin 100 mg capsules (macrocrystal) - expected availability: mid-Aug/24

Nitrofurantoin 50mg tablets - expected availability: mid-Sep/24

Nitrofurantoin 50 capsules (macrocrystal) and nitrofurantoin 100 mg tablets are available.

Note the differences in dosing frequency among the different nitrofurantoin forms:

  • BID nitrofurantoin products (original brand MacroBID®), including PMS-Nitrofurantoin BID, contain nitrofurantoin as macrocrystals (25%) and monohydrate (75%). Nitrofurantoin monohydrate (but not macrocrystals) forms a gel matrix when exposed to intestinal fluids. This matrix releases nitrofurantoin over time, which allows for twice daily dosing.
  • AA Pharma Nitrofurantoin tablets and Teva-Nitrofurantoin capsules do not contain monohydrate and need to be administered four times daily.
    • Dosing of these products for treatment of cystitis is 50 mg to 100 mg, four times daily. 50 mg four times daily has been found to be as effective as 100 mg twice daily of the BID product and is appropriate in most situations. If the only product on hand is 100 mg, go with that (QID). 

See CPS - Nitrofurantoin (CPhA Monograph) for dosing of all nitrofurantoin products. CPS is available through SHIRP. 

See Bugs & Drugs: Urinary Tract Infections for therapeutic alternatives. 

Last Updated: Jul 17/24

Nitroglycerin spray

RHO Nitro and Nitrolingual pump sprays are back in stock!

Health Canada has approved importation of a UK-authorized nitroglycerin spray. This product has been temporarily listed on the Saskatchewan Drug Plan formulary and is not interchangeable with the currently listed products. See the Drug Plan bulletin for pseudoDIN, product differences, and FAQs. The risk communication is here.

Last updated: Jul 12/24

Nystatin cream, topical

Nyaderm is the only marketed brand and is shorted until early Aug/24.

For treatment of cutaneous or mucocutaneous infections caused by C albicans (e.g., diaper dermatitis), alternative topical antifungals include imidazoles (clotrimazole, miconazole) (preferred), ciclopirox, and ketoconazole.

See CPS Diaper Dermatitis or RxFiles OTC Products. Both are available through SHIRP

Last updated: Jul 12/24

Nystatin oral suspension

All brands shorting - estimated availability: mid-Aug/24

Bulk powder is available for compounding.

  • Medisca provides several compounding formulae .
  • Contact DPEB regarding coverage for compounded suspensions.

Last updated: Jul 12/24

Olsalazine 250 mg capsule

Dipentum®  250 mg capsules shorting. Estimated availability: Sep/24. No other strengths or brands are marketed.

Alternatives:

Last updated: Jul 12/24

Orencia® subcutaneous injection

see abatacept

Oxybutynin: long-acting formulations and topical gel

Ditropan XL® tablets, Oxytrol® transdermal patches and Gelnique®  topical gel have been discontinued by the manufacturers.

Alternatives:

  • Generic oxybutynin 2.5 mg & 5 mg immediate release tablets and 1 mg/ml syrup are available.
  • For therapeutic alternatives, see RxFiles: Urinary Incontinence. RxFiles is available through SHIRP.

Last updated: May 5/22

P-R
DrugAvailability

Panectyl 2.5 & 5 mg tablets

Panectyl tablets have been discontinued by the manufacturer. No other brands of trimeprazine are marketed.

Last updated: May 10/24

Penicillin G - benzathine

Bicillin® L-A is on allocation. 

If you have questions or need to increase your allocation, contact Pfizer at 1-888-999-8750 or allocation@Pfizer.com 

Last updated: Feb 15/24

Periciazine oral capsule

Neuleptil® capsules are shorting with indeterminate availability.

Neuleptil® oral solution 10 mg/ml is available.

For therapeutic alternatives, see CPS (subscription): Phenothiazines: CPhA monograph. CPS is available through SHIRP

Last updated: Jun 5/24

Phenobarbital Elixir 5 mg/ml

The only available brand - Pendopharm - is shorted. Expected return to stock: November 2024.

Alternatives:

  • Contact medSask for a compounding formula using tablets.
  • 15 mg, 30 mg, 60 mg, and 100 mg oral tablets are available.

Last updated: Jul 17/24

Pizotifen 1 mg tablet

Sandomigran DS - estimated availability: mid-Sep/24

For therapeutic alternatives, see RxFiles - Migraine: Acute & Prophylaxis. RxFiles is available through SHIRP.

Last updated: Jul 24/24

Pneumococcal 13-Valent Conjugate Vaccine (Prevnar 13)

Prevnar 13 has been discontinued and is no longer available for purchase by pharmacies. 

Last updated: Jun 17/24

Potassium chloride (Slow-K®)

Slow-K® (NPN 80040226) 600 mg KCl (8 mEq K+) slow release matrix tablets and Sandoz/Euro K8 (DIN 02246734) have been discontinued.                      

Alternative long-acting tablets providing 8 mEq K+:

  • Jamp K-8 (NPN 80013005) 600 mg long acting tablet
  • M-K8 (NPN 80035346) 600 mg long acting tablet 
  • PRZ-K8 (NPN 80108882) long acting tablet
    • Please note: all of these are currently on short. Earliest availability: early Aug/24.

Note: These products contain the same strength of KCl in a similar dosage form to Slow-K® and Sandoz/Euro K8 and are the closest alternatives. However, the products are not interchangeable. If patient is near the high or low ends of the potassium reference range or if patient has a history of frequent fluctuations, closer monitoring after transition is prudent.                                        
Note: Inventory of the above products seems to fluctuate frequently.

Alternative solid dosage forms providing 8 mEq K+:

  • Jamp Potassium Cl ER 600 mg capsules (NPN 80062704)
    • Please note: this is on short with indeterminate availability.

Note: These capsules contain the same strength of KCl in a different, yet still modified release, dosage form. If patient is near the high or low ends of the potassium reference range or if patient has a history of frequent fluctuations, closer monitoring after transition is prudent.

Alternative liquid providing 1.33 mEq/ml KCl+:

  • Odan-Potassium Chloride (NPN 80046782)
  • Jamp KCl liquid (NPN 80024835)
  • PMS KCl liquid (DIN 02238604)

Note: Because the absorption pattern will be quite different between Slow-K®/ other long-acting oral KCl tablets and the liquid, closer monitoring of all patients after transition is prudent.

Alternative long-acting tablets providing 20 mEq K+:

  • Sandoz-K 20 (NPN 02242261)
  • Odan K-20 (NPN 80004415)
  • JAMP K-20 (NPN 80013007)
  • PRZ K20 (NPN 80107649)

Note: K-Dur tablets are no longer available, but were scored, sustained-release tablets that could be broken in half or dispersed in water. Though Sandoz K-20 tablets (NPN: 02242261) are also scored, sustained-release tablets, Sandoz suggests that K-20 long-acting tablets should not be split and must be swallowed whole to retain their sustained-release properties. Jamp Pharma confirmed that dividing their K-20 tablets (NPN: 80013007) would compromise the sustained-release properties of the tablets. This could be clinically significant as modified release formulations slow the release of potassium to avoid high local concentrations which may lead to gastric irritation. (Note: modified release solid dosage forms have been associated with a low risk of GI ulceration/bleeding in some circumstances and caution is necessary in people with delayed GI transit or impaired GI motility.) Splitting tablets may also lead to dose inaccuracy.

Last updated: Jul 24/24

Prazosin oral tablet

All strengths/brands of prazosin tablets are shorting.  Earliest estimated availability: January 2025.

US-labelled 1 mg, 2 mg, and 5 mg capsules have been imported and will be temporarily listed on the Saskatchewan Drug Plan Formulary. See DPEBB bulletin for details. 

  • See document regarding use for hypertension and PTSD.
  • Therapeutic alternatives for most other indications can be found in the CPS: Alpha1 Adrenergic Receptor Antagonists. CPS is available through SHIRP.
  • Some compounding pharmacies are compounding capsules until commercial product is available or for strengths (e.g., 0.5 mg) not attainable with available product.

Last updated: Jul 12/24

Prednicarbate 0.1% ointment

Dermatop® 0.1% ointment has been discontinued.

The 0.1% cream is still available. 

Last updated: Feb 14/23

Prednisone 1 mg oral tablet

Prednisone 1 mg tablets are shorted until early Sept/24.

Alternatives:

  • 1 mg/mL prednisolone oral solution
  • 5 mg oral tablets
    • If doses of 1.25 mg are reasonable. 
    • These are immediate-release tablets and no safety/efficacy concerns regarding splitting have been identified. They only have a straight score so splitting into quarters may result in uneven doses (due to uneven distribution of the drug). As a general rule, a pill-splitter should be used to halve/quarter tablets to ensure less variation in size and tablets should not be split in advance to minimize exposure to light and moisture.

Last updated: Jul 23/24

Prevnar 13

See Pneumococcal 13-Valent Conjugate Vaccine

Prochlorperazine injectable

Injectable formulation discontinued by manufacturer. 

Alternate forms: 5 mg and 10 mg oral tablets

Therapeutic alternatives: See document

Last updated: Sep 21/22

Prochlorperazine 10 mg rectal suppository

Sandoz has discontinued this product.  Odan may take over production in the future, but no suppositories are available at this time.

For therapeutic alternatives see RxFiles (subscription) Migraine: Acute Therapy; Nausea & Vomiting Comparison. RxFiles is available through SHIRP.

Last updated: Apr 6/23

Proctofoam-HC®

See Hydrocortisone 1%/Pramoxine 1% rectal foam.

Procyclidine oral tablets and elixir

All strengths and formulations of procyclidine have been discontinued.

  • Procyclidine is an anticholinergic that has been used to treat:
    • motor symptoms (tremor) of Parkinson's disease
      • not first line; consider if anticholinergic therapy is still appropriate
    • drug-induced parkinsonian symptoms (e.g., from antipsychotic agents)   

For information about alternative anticholinergic agents or alternative treatment agents, See CPS Parkinson Disease, Schizophrenia and Related Psychotic Disorders; RxFiles Parkinson's Disease.

CPS and RxFiles are available through SHIRP.

Last updated: Jun 4/24

Progesterone effervescent vaginal tablet

Endometrin®  is shorting. Estimated availability: January 2025

  • Crinone® vaginal gel or micronized progesterone capsules inserted vaginally may be suitable alternatives. Consult with fertility specialist.

Last updated: Jun 5/24

Promethazine injectable

Injectable formulation has been discontinued by the manufacturer. For information call 1-866-926-7653.

Alternate forms: 50 mg oral tablets

Therapeutic alternatives: see document

Last updated: May 5/23

Quinagolide

Quinagolide (Norprolac®) has been discontinued.

For alternatives see document

Quinapril tablets

Quinapril 5 mg and all strengths of quinapril/HCTZ are shorting. Availability is indeterminate.

Quinapril 10 mg, 20 mg & 40 mg tablets, as well as HCTZ tablets, are in stock. Quinapril 10 mg tablets may be halved.  These are immediate-release tablets and no safety/efficacy concerns regarding splitting have been identified. As a general rule, a pill-splitter should be used to split tablets to ensure less variation in size and tablets should not be split in advance to minimize exposure to light and moisture.

For alternatives see RxFiles - ACEI Comparison Chart and CPS - ACE Inhibitors. Both are subscription only but available through SHIRP.

Last updated: Jun 6/24

Rabeprazole oral tablets

All strengths and brands are shorting - intermittent availability

Use alternative oral PPIs:       
Rabeprazole 20 mg ~ Pantoprazole 40 mg ~ Lansoprazole 30 mg ~ Omeprazole 20 mg ~ Esomeprazole 40 mg       

Last updated: Jun 12/24

Ranitidine injectable

Product has been discontinued. 

Change to alternative H2RA if required:

  • 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            
  • Oral: pantoprazole 40 mg ~ lansoprazole 30 mg ~ omeprazole 20 mg ~ esomeprazole 40 mg ~ rabeprazole 20 mg
  • Nasogastric administration: esomeprazole, lansoprazole

Ranitidine oral solution

Indeterminate availability.      
      
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.      
                 
See documents for extemporaneous compounding and therapeutic alternatives.

Last updated: Feb 15/24

Risperidone ODT

Mylan risperidone 0.5 mg ODT has been discontinued by the manufacturer. No other brands or strengths of ODTs are available.

Alternatives:

  • An oral liquid is available although this is currently on short (see listing below).
  • The regular tablets can be dispersed in 10 to 20 mL water (may take 5 mins).
  • If unable to swallow, Risperdal® Consta injections could be an option. For oral equivalent dosing and information on alternative antipsychotics, see RxFiles: Antipsychotics. RxFiles is available through SHIRP.

Last updated: Dec 8/23

S-Z
DrugAvailability

Salbutamol solution for inhalation

Ventolin® 5 mg/ml respirator solution - indeterminate availability

Salbutamol 2mg/ml 2.5 ml nebules - estimated availability: mid-Aug/24

Alternatives:

  • Salbutamol 0.5 mg/ml and 1 mg/ml 2.5 ml nebules are in stock

Last updated: Jul 22/24

Scopolamine transdermal patch

Transderm V transdermal patches have been discontinued by the manufacturer. 

See therapeutic alternatives for select indications.

Stieprox® ShampooThis has been discontinued. See the ciclopirox olamine 1.5% shampoo listing for details.

Sulfacetamide/ prednisolone ophthalmic

Blephamide® ophthalmic drops and ointment have been discontinued.  No other brands are available.

For therapeutic alternatives see CPS (subscription): Eyelid conditions: Stye, Chalazion and BlepharitisCPS is available through SHIRP.

Sulfamethoxazole /trimethoprim
See Co-trimoxazole.

Tamsulosin CR tablets

All brands are shorting. Earliest availability: early Aug/24.

Alternatives:

  • Jalyn® (tamsulosin/dutasteride 0.4/0.5 mg) capsules are available.
  • Silodosin and alfuzosin are uroselective alpha1- blockers, which may be available. These can be initiated at the full maintenance dose.
  • The non-selective alpha1-blockers doxazosin and terazosin are equally effective for BPH but have a higher incidence of side effects e.g., orthostatic hypotension. Start with low dosage and titrate to minimize these effects.
  • For more detailed information, see CPS: Alpha1-Adrenergic Receptor Antagonists and Lower Urinary Tract Symptoms & Benign Prostatic Hyperplasia. CPS is available through SHIRP.

Last updated: Jul 22/24

Tamsulosin SR capsules

McKesson has Jamp capsules in stock

Earliest availability: early Aug/24.

Alternatives:

  • Jalyn® (tamsulosin/dutasteride 0.4/0.5 mg) capsules are available.
  • Silodosin and alfuzosin are uroselective alpha1- blockers, which may be available. These can be initiated at the full maintenance dose.
  • The non-selective alpha1-blockers doxazosin and terazosin are equally effective for BPH but have a higher incidence of side effects e.g., orthostatic hypotension. Start with low dosage and titrate to minimize these effects.
    • Consider these if needing an agent that can be crushed.  
  • For more detailed information, see CPS: Alpha1-Adrenergic Receptor Antagonists and Lower Urinary Tract Symptoms & Benign Prostatic Hyperplasia. CPS is available through SHIRP.

Last updated: Jul 24/24

Tazarotene 0.05% & 0.1% cream and gel

All Tazorac® products have been discontinued for business reasons.

  • Tazarotene is now only available as a 0.045% topical lotion: Arazlo™. This is only indicated for acne.
  • For alternatives, see CPS (subscription): Acne or Psoriasis. CPS is available through SHIRP

Last updated: Oct 4/23

Testosterone enanthate 200mg/ml injection

Delatestryl® has been discontinued by the manufacturer.  Hikma testosterone enanthate 200 mg/mL is shorted with indeterminate availability.

Last updated: Jul 17/24

Timolol 
regular & EX 0.25%
 ophthalmic solution

Sandoz timolol 0.25% regular ophthalmic solution is on short. No other brands are marketed. Estimated availability: late Jul/24

Sandoz timolol EX 0.25% gel-forming solution is on short. No other brands are marketed. Estimated availability: Oct/24

Alternatives:

  • Timolol 0.5% regular and EX ophthalmic formulations remain available.
  • See CPS - Glaucoma for details and other alternatives. CPS is available through SHIRP.

Last updated: Jul 12/24

Tirzepatide (Mounjaro®)

Intermittent availability

The mymounjaro™ Patient Support Program was designed to provide patients with a seamless and supportive experience and it is an option for Canadian patients. Enrollment into the PSP includes support to find product in a patient’s region, in addition to a number of other resources.

Information that has been developed for the Ozempic® shortage may apply to tirzepatide: 

  • A quick guide, more comprehensive guidance document, and resources pertaining to use in diabetes are available on our shortage page.
  • Therapeutic alternatives for obesity are here.

Last updated: Jul 15/24

Tobramycin 60 mg/ml for inhalation

Both brands shorting. Earliest availability: mid-Aug/24.

Alternatives:

  • This formulation of tobramycin is indicated for the management of cystic fibrosis patients with chronic pulmonary (P. aeruginosa) infections. Any change in therapy should be directed by the CF team
  • Tobi® podhaler is available
  • Preservative-free IV tobramycin may be administered via inhalation. For details and information on alternative CF treatments, see RxFiles - Cystic Fibrosis. RxFiles is available through SHIRP.

Last updated: Jul 5/24

Tramadol extended release tablets (Tridural®)

All strengths of Tridural® tablets are shorted. Estimated availability: late Sept/24

Taro-Tramadol ER has the same kinetics as Tridural® and is considered interchangeable by some formularies. 

Durela®, Ralivia®, and Xytram XL® are long acting tramadol products ; these products have varying kinetics .

Last updated: Jun 14/24

Trifluoperazine

All strengths are shorting with indeterminate availability.

For therapeutic alternatives, see CPS (subscription) - Phenothiazines (CPhA monograph). CPS is available through SHIRP.

Last updated: Feb 15/24

Trifluridine

Viroptic® ophthalmic solution 1% has been discontinued.   
                    
No other topical ophthalmic antivirals are currently available in Canada.                       

Viral conjunctivitis does not usually require treatment, however, cold compresses and ocular lubricants may be used.                       
If absolutely necessary - oral antiviral treatment.                       

For more information, see CPS: Red Eye (available through SHIRP).

Trimeprazine tablets

Panectyl tablets have been discontinued by the manufacturer. No other brands are marketed.

Last updated: May 10/24

Ulipristal 

Ulipristal 5 mg (Fibristal) has been voluntarily withdrawn from the market in Canada due to risk of drug-induced liver injury.

See Health Canada's risk communication

Valproic Acid EC Capsules

Valproic Acid EC 500 mg capsules shorting with estimated availability of Sep/24

Alternatives:

  • Valproic acid 250 mg capsules and 50 mg/ml syrup are available. Doses > 250 mg/day should be divided BID-TID.
  • Divalproex sodium tablets – not interchangeable with valproic acid, but dosing is approximately the same. Switch to the same daily dosing schedule; once stabilized, it may be possible to reduce the frequency of doses (while maintaining the same total daily dose). Monitor for continued control of seizures / mood.

Last updated: Jul 12/24

Verapamil sustained-release (SR) tablets

Verapamil SR 180 mg & 240 mg tablets are shorting with indeterminate availability.

Alternatives:

  • The 120mg SR tablets remain available - these should not be halved.
  • Verapamil immediate release (IR) tablet strengths remain available. If converting from SR to IR tablets, use the same total daily dose (or closest possible) divided TID or QID. Monitor and adjust dose as required.
  • SR capsules can be compounded.
  • For therapeutic alternatives, see RxFiles - Calcium Channel Blocker (CCB). RxFiles is available through SHIRP.

Last updated: May 13/24

Vitamin D 50,000 IU oral capsule

All brands shorting. Estimated availability: Sep/24

The 10,000 IU oral formulations remain in stock.

Please note that the 10,000 IU and most 50,000 IU products are Vitamin D3 (cholecalciferol). Some older 50,000 products were Vitamin D2 (ergocalciferol). Cholecalciferol and ergocalciferol are not considered interchangeable. See RxFiles Vitamin D: Q & A for more details. RxFiles is available through SHIRP.

Last updated: Jul 22/24

Documents of Resolved Drug Shortages