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.

  • Nitroglycerin sublingual spray
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

Acyclovir oral suspension

Zovirax® oral suspension is shorting with indeterminate availability.

Alternatives:

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

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

Last updated: Apr 4/24

Adefovir

Adefovir 10 mg tablets. Estimated availability: July/24

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

Last updated: Sep 1/23

Alfuzosin 10 mg tablets

All brands on short. Estimated availability: early-mid May/24

Alternatives: (please note that there are supply issues with all uroselective alpha1- blockers)

  • Tamsulosin, silodosin and alfuzosin are uroselective alpha1- blockers. Tamsulosin and silodosin 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 eg 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: Apr 25/24

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: July/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: Apr 11/24

Bimatoprost 0.03% ophthalmic drops

Vistitan™ 0.03% ophthalmic drops are shorting. Estimated availability: July/24

Alternatives:

  • a preservative-free bimatoprost 0.03% ophthalmic drop (Zimed® PF) is available
  • bimatoprost 0.01% drops (Lumigan RC®)are available
  • for other ophthalmic prostaglandin analogues, see RxFiles Glaucoma.RxFiles is available through SHIRP. 

Last updated: Apr 25/24                                                                                                                                                 

Budesonide nasal spray

Mylan 64 & 100 mcg nasal spray: indeterminate availability.

Rhinocort® Aq 64 mcg is back in stock

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

Last updated: Apr 25/24

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 CR 200 mg tablets

Earliest availability is mid Aug/24

Alternatives:

  • Carbamazepine controlled release (CR) 400 mg tablets remain available and can be halved. 
  • Carbamazepine immediate release (IR) tablets, chewable tablets, and suspension are available.
    • The dose frequency of IR 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 for seizure disorder.
    • Monitor plasma levels (when relevant, such as for seizure disorder) and clinical response. 

Last updated: Apr 22/24

Cholestyramine oral powder

All brands/formulations are shorting. Estimated availability:

  • cholestyramine light formulations - July/24
  • Olestyr regular - July/24

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

Alternatives:

  • 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: Apr 8/24

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

Clioquinol 3%/ Flumethasone pivalate 0.02% topical cream

Locacorten® Vioform® cream - indeterminate availability.

  • Lotriderm® and Vioform® HC∗ are combination antifungal/corticosteroid creams that may be suitable alternatives

∗ no longer stocked at McKesson

Last updated: Mar 13/24

Clomiphene

Clomid® and Serophene® - discontinued     

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

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

Lodalis™ 625 mg tablets are now available. 

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.

Apo-colesevelam is shorting with estimated availability of mid-late May/24.

Formulary status: 

  • Only Lodalis™ 625 mg tablets are a benefit on the SK formulary. Coverage for the imported US colesevelam tablets is under review. 
  • The imported Glenmark Pharmaceuticals product has been 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: Apr 22/24

Colestipol

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

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

Alternatives:

CPS and RxFiles are available through SHIRP.

Last updated: Apr 17/24

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 PDF for management options.

Last updated: Feb 15/24

D
DrugAvailability

Darifenacin tablet

Both the 7.5 mg & 15 mg strengths are shorted. Earliest estimated availability: Jun/24

For therapeutic alternatives, see RxFiles - Urinary Incontinence or CPS - Urinary Incontinence in Adults. RxFiles and CPS are available through SHIRP.   

Note that SK Drug Plan Exception Drug Status and NIHB Limited Use Benefit criteria for fesoterodine, mirabegron, and trospium are the same as those for darifenacin.

Last updated: Apr 3/24

Desonide ointment

Estimated availability: July/24

Alternatives:

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

Last updated: Apr 25/24

Dextroamphetamine sustained-release (SR) capsules

Dexedrine SR 10 & 15 mg capsules now available at McKesson

Teva brand of both the 10 & 15 mg on short with earliest availability of early May/24. 

Alternatives:

  • Dextroamphetamine immediate-release (IR) 5 mg tablets remain in stock. Switching to IR tablets may not be appropriate due to risk of rebound ADHD symptoms and/or drug diversion.
  • See RxFiles ADHD - Drug Comparison Chart for alternative long-acting stimulants. RxFiles is available through SHIRP.

Last updated: Apr 25/24

Diclofenac/misoprostol tablets

McKesson has GD diclofenac/misoprostol 75 mg in stock

All brands of diclofenac/misoprostol 50 mg shorting. Earliest availability: early May/24

Alternatives:

  • diclofenac 25 mg & 50 mg tablets and diclofenac SR 75 mg tablets are available
  • misoprostol 200 mcg tablets are available
  • See RxFiles (subscription) NSAIDS & Other Analgesics for other alternatives. RxFiles is available through SHIRP.

Last updated: Apr 25/24

Dipyridamole/ASA 200/25 mg capsule

Indeterminate availability

See PDF for alternatives.

Last updated: Jan 4/24

Dronedarone 400 mg tablet

Multaq® is the only marketed brand of dronedarone. 
Estimated availability: late Apr/24

Alternatives:

  • dronedarone is a Class III antiarrhythmic used for very specific situations of atrial fibrillation. Any change in medication should be made in consultation with a cardiologist.
  • for more information on antiarrhythmic medications, see RxFiles Atrial Fibrillation. RxFiles is available through SHIRP.

Last updated: Apr 4/24

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: mid-May/24. No other brands are marketed.

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: Apr 15/24

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

Estradiol/ norethindrone transdermal patch (Estalis®)

Estalis® 250/50 mcg - estimated availability of early May/24. There are no other marketed brands of combination estrogen/progestogen patches.

Alternatives:

  • Estalis® 140/50 mcg patches are available
  • Transdermal estrogen (patch, gel) in combination with an oral progestogen. If oral progestogen is not suitable, Mirena® IUD (off-label) is an option.
  • Oral estrogen and progestogen - either separately or in combination. Combination products: Angeliq®, Activelle®, Bijuva™
  • Oral conjugated estrogen plus bazedoxifene (Duavive®). Bazedoxifene is a Tissue Selective Estrogen Complex (TSEC). This is an alternative when endometrial protection is required and a progestogen not desired/tolerated.
  • See RxFiles - Menopause Hormone Therapy (MHT) for information on dosing and coverage. 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 

Palafer® (20 mg/mL) and JAMP (60 mg/mL) are shorted. Earliest estimated availability is mid-late May/24 (Palafer®).

  • 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: Apr 15/24

Fluvastatin oral capsule

Both the 20 & 40 mg strengths are shorting. Estimated availability: late April 2024. 

For therapeutic alternatives, see RxFiles - Lipid Lowering Agents. RxFiles is available through SHIRP.

Last updated: Apr 5/24

Fluphenazine decanoate injection

Both brand name (Modecate®) and generic products have been discontinued.   
See PDF 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

Framycetin, gramicidin,​dexamethasone eye/ear drops 

Sofracort® -indeterminate availability

For alternative antibiotic/steroid otic drops, see CPS - Otitis Externa.

For alternative antibiotic/steroid ophthalmic drops, see CPS - Red Eye. Table 4: Anti-Infectives for Red Eye. CPS is available through SHIRP

Note: Ophthalmic drops and ointments can be used in the ear, but otic products CANNOT be used in the eye.

Last updated: Apr 25/24

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.

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

Not currently available:

  • Proctodan (hydrocortisone, pramoxine, zinc sulfate) - shorted until mid June/24
  • Proctol (hydrocortisone, dibucaine, esculin, framycetin) shorted until late April/24

Available:

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

Last updated: Apr 5/24

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

Ipratropium nasal spray

PMS-Ipratropium 0.03% nasal spray is shorting with estimated availability of late May/24.

AA ipratropium 0.06% (Ipravent) nasal spray is available.  It is not a DPEB benefit, however, it is a benefit under NIHB.

See CPS - Allergic Rhinitis for therapeutic alternatives. CPS is available through SHIRP.

Last updated: Apr 3/24

Iron dextran injection

Dexiron has been discontinued

For alternatives see PDF

L-O
Drug 

Locacorten® Vioform®   topical cream

See clioquinol/flumethasone.

Lodoxamide 0.1% ophthalmic solution

Alomide is the only brand of lodoxamide ophthalmic drops and is shorted with estimated availability of late Apr/24

  • The only other ophthalmic mast cell stabilizer available is sodium cromoglycate 2%.
  • Dual mechanism mast cell stabilizer/antihistamines may be appropriate and include bepotastine and olopatadine.

For more information, see RxFiles Dry Eye Disease (DED) and Ocular Allergy  or CPS Conjunctivitis. RxFiles and CPS are available through SHIRP. 

Last updated: Apr 11/24

Loxapine oral tablet

Xylac™ 2.5 mg & 25 mg are on short. Estimated availability: mid May- early Jun/24

The 10 mg tablets are still available. 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 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: Apr 15/24

Memantine 5 mg tablet

PMS-memantine 5 mg tablets shorting. Estimated availability: mid-May 2024. No other brands of 5 mg tablets are marketed.

Memantine 10 mg tablets are available. 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.

Last updated: Apr 15/24

Methadone, Metadol® oral  (pain only)

Metadol® 10 mg/ml liquid is shorting. Earliest estimated availability of mid- Apr/24

All other Metadol strengths/formulations are now in stock.

  • Apotex tablets are now available in 1 mg, 5 mg, 10 mg, 25 mg strengths. These are not on NIHB or DPEB formularies and interchangeability has not been determined. 
  • DPEB covers compounding for pain conditions meeting EDS criteria - use DIN 00990079.
  • Please note: Metadol®-D and Methadose™ liquids cannot be used for pain management. These are indicated for opioid agonist therapy only.

Last updated: Apr 8/24

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

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 
4 mg tablet

Medrol 4mg is shorted with indeterminate availability. No other brands are available. 

16 mg tablets can be quartered (cross-scored).  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.

Last updated: Mar 20/24 

Metronidazole 10% vaginal cream

Flagyl® 10% vaginal cream has been discontinued by the manufacturer. No other brands are marketed.

Metronidazole 0.75% vaginal gel (Nidagel®) is available.

For alternate treatments for trichomoniasis or bacterial vaginosis, see Bugs & Drugs

Last updated: Mar 29/24

Mometasone nasal spray

All brands shorting. Earliest availability: late April/24

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

Last updated: Apr 11/24

Mounjaro®

See Tirzepatide

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

Nitrofurantoin

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

Teva-nitrofurantoin 100 mg capsules (macrocrystal) are shorting. Estimated availability: early May/24

Nitrofurantoin 50 capsules (macrocrystal) and nitrofurantoin 50 mg & 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: Apr 4/24

Nitroglycerin sublingual 

McKesson has RHO Nitro Pump Spray in stock!

All brands of the sublingual spray are shorting. 

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.

The shortage of the spray is leading to increased demand for and sporadic availability of the sublingual tablets. 

Health Canada has been in contact with the manufacturers of the sublingual spray regarding extensions of expiry dates. Certain extensions have already been granted and Health Canada is asking consumers to:

  • only obtain what they need from their pharmacy,
  • keep expired product, and
  • check this chart to confirm which products can be used beyond the original expiry date.

Other Management Strategies:

  • A guidance tool has been developed (in partnership with CCS, CCPN, and supported by CPhA).
  • Q&A for Pharmacy Professionals by CPhA.
  • Optimize angina prophylaxis (nitroglycerin patches remain available). For details see RxFiles - Angina Treatment. RxFiles is available through SHIRP.
  • Isosorbide dinitrate 5-10 mg sublingually prn is an option for pre-emptive treatment (prior to activity expected to cause angina). For details see RxFiles - Angina Treatment. RxFiles is available through SHIRP.

Last updated: Apr 8/24

Nystatin cream, topical

Nyaderm is the only marketed brand and is shorted until Jul/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: Mar 27/24

Nystatin cream, vaginal

Nyaderm is the only marketed brand and is shorted until late May/24.

For treatment of vulvovaginal candidiasis, alternative options are preferred, including vaginal imidazoles (clotrimazole, miconazole) or oral fluconazole.

See RxFiles Antifungals, available through SHIRP. 

Last updated: Apr 11/24

Ofloxacin ophthalmic drops

Ocuflox® 0.3% ophthalmic drops are shorting with estimated availability of Jun/24. No other brands are marketed. 

Management:

  • In most cases of adult conjunctivitis, antibacterial therapy is not necessary as the etiology is likely viral and mild bacterial infections are self-limiting. 
  • For bacterial conjunctivitis, reserve fluoroquinolones for serious / severe cases and contact lens wearers because of concerns of resistance. 
  • Alternative ophthalmic antibacterial products for acute bacterial conjunctivitis: 
    • gramicidin/polymyxin drops; erythromycin ointment; fusidic acid drops; tobramycin drops or ointment
  • Alternative ophthalmic fluoroquinolone products: 
    • besifloxacin, ciprofloxacin, gatifloxacin, moxifloxacin

See medSask Conjunctivitis Minor Ailment Guideline for more information.

Last updated: Apr 3/24

Olsalazine 250 mg capsule

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

Alternatives:

Last updated: Mar 23/24

Omeprazole 10 mg tablets

Teva-omeprazole 10 mg tablets are on short. Estimated availability: late Apr/24. No other brands are marketed.

Alternatives:

  • 20 mg tablets are available but these are delayed-release and should not be split
  • an oral suspension may be compounded

Last updated: Apr 4/24

Oxcarbazepine 150 mg tablets

Estimated availability: late May/24

  • the 300 mg tablets remain available.  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.
  • a 60 mg/ml suspension is available.

Last updated: Apr 15/24

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

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: Feb 15/24

Pizotifen 1 mg tablet

Sandomigran DS - estimated availability: mid-May/24

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

Last updated: Feb 26/24

Pneumococcal 13-Valent Conjugate Vaccine (Prevnar 13)

Prevnar 13 has been discontinued and is no longer available for purchase by pharmacies. Note that in Saskatchewan, Public Health will continue to provide Prevnar 13 (and not Prevnar 20™) until further notice. 

Prevnar 20™ is a non-publicly funded vaccine that is available for purchase for use by those who are not eligible for publicly funded Prevnar 13 or who prefer Prevnar 20™.    

Last updated: Feb 20/24

Posaconazole 100 mg tablet

Intermittent availability.

Limited supply of posaconazole injectable and oral suspension (40 mg/mL) are currently available. Dosing differs among the dosage forms. See product monograph.  

Oral suspension is indicated for oropharyngeal candidiasis; however, preferably use alternative agents for moderate to severe oropharyngeal candidiasis (e.g., fluconazole, itraconazole) to reserve posaconazole for prophylaxis or treatment of invasive fungal infections.

Last updated: Mar 27/24

Potassium chloride (Slow-K®)

Slow-K® (NPN 80040226) 600 mg KCl (8 mEq K+) slow release matrix tablets 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 

Note: These products contain the same strength of KCl in a similar dosage form to Slow-K® 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)

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® 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)

Last updated: Jan 26/23

Prazosin tablets

All strengths/brands of prazosin tablets are shorting.  Earliest estimated availability: October 2024.

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 PDF 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: Apr 4/24

Prednicarbate 0.1% ointment

Dermatop® 0.1% ointment has been discontinued.

The 0.1% cream is still available. 

Last updated: Feb 14/23

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 PDF

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.

Progesterone effervescent vaginal tablet

Endometrin®  is shorting. Estimated availability: June/24

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

Last updated: Jan 4/24

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 PDF

Last updated: May 5/23

Quinagolide

Quinagolide (Norprolac®) has been discontinued.

For alternatives see PDF

Quinapril 5 mg 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: Feb 16/24

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: Dec 4/23

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.      
                 
Extemporaneous compounding: See PDF for details.                       

Alternatives: See PDF for details

Last updated: Feb 15/24

Risperidone ODT

Mylan risperidone 0.5 mg ODT has been discontinued by the manufacturer. No other ODT brands or strengths 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 is shorting. Indeterminate availability.

Salbutamol 2mg/ml 2.5 ml nebules shorting. Estimated availability: mid-May/24

Alternatives:

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

Last updated: Apr 15/24

Scopolamine transdermal patch

Transderm V transdermal patches have been discontinued by the manufacturer. 

See therapeutic alternatives for select indications.

Silodosin 4 mg capsule

All brands are shorting. Earliest availability: late Apr/24

The 8 mg capsules remain in stock.

For therapeutic alternatives, see CPS: Alpha1-Adrenergic Receptor Antagonists. CPS is available through SHIRP.

Last updated: Apr 4/24

Sofracort®  eye/ear drops

See framycetin, gramicidin,​dexamethasone eye/ear drops.

Somatropin injection

Certain formats and sizes of somatropin are shorted. The Drug Plan and Extended Benefits Branch should be contacted regarding any patients affected by the Norditropin® NordiFlex® shortage who require an alternative product immediately. 

Last updated: Aug 2/23

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 Blepharitis.  CPS is available through SHIRP.

Sulfamethoxazole /trimethoprim
See Co-trimoxazole.

Tamsulosin CR tablets

All brands are shorting; earliest availability mid-May/24.

Alternatives:

  • Tamsulosin, silodosin and alfuzosin are uroselective alpha1- blockers. Alfuzosin and silodosin 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 eg 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: Apr 15/24

Tamsulosin SR capsules

All brands are shorting; earliest availability-late Apr/24

Alternatives:

  • Tamsulosin, silodosin and alfuzosin are uroselective alpha1- blockers. Alfuzosin and silodosin 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: Apr 4/24

Tapentadol tablets

Intermittent availability of all strengths - both IR & ER

See RxFiles Opioid Analgesics for alternatives. RxFiles is available through SHIRP.

Last updated: Apr 15/24

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

Tirzepatide (Mounjaro®)

All strengths shorting with earliest availability: Jun/24

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: Apr 15/24

Tramadol extended release tablets (Tridural®)

Tridural® 200 and 300 mg tablets shorted with indeterminate availability.

Tridural® 100 mg tablets are available.

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 Apr 15/24

Tretinoin, topical

Retin-A®  0.05% cream is shorting. Estimated availability of late June/24

All strengths of Stieva-A® and Vitamin A Acid have been discontinued. Retin-A® is the only available product.

Alternatives

  • Retin-A® 0.025% gel, Retin-A® Micro gel (0.04% and 0.1%) are available.
  • Other topical retinoids include adapalene, tazarotene, and trifarotene.

Last updated: Apr 17/24

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).

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. Estimated availability of early May/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: Apr 15/24

Verapamil immediate-release (IR)  tablets

Verapamil IR 80 mg tablets are shorting. Estimated availability: early May/24

  • Apotex 120 mg IR tablets remain available.

  • IR capsules may be compounded.

  • For therapeutic alternatives, see RxFiles - Calcium Channel Blocker (CCB). RxFiles is available through SHIRP

Last updated: Apr 15/24

Verapamil sustained-release (SR) tablets

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

Alternatives:

  • Some 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: Apr 3/24

Vigabatrin oral

Sabril® tablets are back in stock!

Sabril® tablets and sachets are shorting with indeterminate availability.

Dr. Reddy’s Laboratories Limited’s US-labelled Vigabatrin for Oral Solution, USP is being imported and are available. See the Risk Communication for important product details, including different reconstitution instructions from the Canadian product. This imported product is listed temporarily as a full benefit on the SK Formulary and is non-interchangeable with vigabatrin sachets. See DPEB Bulletin. 

Vigabatrin 500 mg tablets are also being imported from the US and are now available. Contact DPEB for a pseudoDIN and billing instructions. 

For therapeutic alternatives see RxFiles Seizures: Antiepileptics. RxFiles is available through SHIRP.

Last updated: April 15/24

Vitamin D 50,000 IU oral capsule

All brands shorting. Estimated availability: late Jun/24

The 10,000 IU oral formulations remain in stock.

Last updated: Apr 4/24

Documents of Resolved Drug Shortages