Specific Drug Shortages & Discontinuations

Drugs are listed by generic name   

Notable Anticipated Shortages 

Inventory may still be available for the following products, though a shortage is expected that may require planning. See the alphabetized list for details. 

• Peginterferon alfa-2a (Pegasys®) 

A-B

Drug	Availability / Alternatives
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 Therapy. RxFiles is available through SHIRP.  Last updated: July 12/24
Aermony Respiclick™	See Fluticasone propionate.
Alendronate 5 mg tablet	ACH is the only available brand of alendronate 5 mg tablets.  It is shorting with indeterminate availability. Alternatives: Alendronate 10 mg tablets and 70 mg (for once weekly dosing) tablets remain available. The 10 mg tablets should not be split as alendronate is a GI irritant. A liquid formulation can be compounded from bulk powder. For other osteoporosis treatments, see RxFiles - Osteoporosis. RxFiles is available through SHIRP. Last updated: Sep 24/24
Alfacalcidol 1 mcg cap	Both brands of the 1 mcg capsules are shorting. Estimated availability: early Dec/24 Alternatives: The 0.25 mcg capsules remain available The injectable formulation is available and can be administered orally Last updated: Nov 24/24
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: Ensure that liquid preparations or chewable tablets are needed.  Could the child swallow a tablet/capsule or could the adult product be split/crushed/opened? We have compiled some helpful tips on how to administer adult formulations (whole/opened/split/crushed) to children. Ensure duration of therapy is appropriate. See CPhA's  Optimizing Duration of Therapy: Is Shorter Smarter? Promote proper use of antibiotics and discourage use for viral infections. Some useful resources for patient education: Choosing Wisely Canada Canadian Pediatric Society's  How to make sure antibiotics are the right choice 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
Betahistine tablets	All brands of the 8 mg tablets are on short. Earliest availability: mid-January, 2025 The 16 and 24 mg tablets are available. The 16mg tablets are scored and may be split into halves. As a general precaution, tablets should not be split in advance to minimize exposure to light and moisture. Last updated: Dec 3/24
Betamethasone dipropionate 0.05% topical lotion	Diprosone® is the only brand marketed and is shorted until mid-December/24. Note that betamethasone diproprionate with glycol 0.05% topical lotion (Topilene) is more potent. See RxFiles Topical Corticosteroids for topical lotions of similar potency to betamethasone dipropionate 0.05%. RxFiles is available through SHIRP.  Last updated: Nov 27/24
Betamethasone dipropionate 0.05%/ salicylic acid 2% scalp lotion	Ratio-Topisalic scalp lotion has been discontinued by the manufacturer. No other brands are available. See CPS (subscription) - Dandruff & Seborrheic Dermatitis or Psoriasis for alternative treatments. CPS is available through SHIRP. Last updated: Aug 23/24
Betamethasone valerate 0.05% and 0.1% topical lotion	Teva-Ectosone 0.05% & 0.1% topical lotions: indeterminate availability For corticosteroid lotions of similar potency, see RxFiles Topical Corticosteroids. RxFiles is available through SHIRP.  Last updated: Aug 29/24
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 generics are shorted with earliest availability of January 2025. Pulmicort 0.125 & 0.25 mg/ml nebs are in stock. Alternatives: Pulmicort® turbuhaler Nebulized solution can be compounded For therapeutic alternatives, see RxFiles Asthma, available through SHIRP. Last updated: Nov 22/24
Budesonide rectal foam	Uceris™ is the only brand of budesonide rectal foam and is shorted until late Dec/24.  Alternatives: Budesonide rectal foam is used for induction of remission of mild to moderate distal ulcerative colitis. Alternatives depend on disease severity and distance of colon affected. The only alternative topical corticosteroid is budesonide retention enema (Entocort®). Topical 5-ASA products may be appropriate and are available as suppositories, foam, and enemas. See RxFiles Inflammatory Bowel Disease and CPS Inflammatory Bowel Disease for more information. RxFiles and CPS are available through SHIRP. Last updated: Nov 1/24
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
Bupropion XL tablets	All generics shorting - earliest availability: late Dec/24.  Wellbutrin® XL 150 and 300 mg tablets are available. Convert to different formulations using the same daily dose (up to the maximum recommended dose for a given dosage form), but adjust frequency as indicated: 12-hour sustained release (SR) = once or twice daily depending on dose; twice daily for doses > 150 mg/day 24-hour extended release (XL) = once daily See document for more information.  Last updated: Nov 8/24

C

Drug	Availability
Carbamazepine CR tablets	All brands of the 200 mg and 400 mg CR tablets are on short. Estimated availability: early December/24.  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.  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.  CPhA has a drug shortage document based on recommendations from the Canadian League Against Epilepsy. Last updated: Nov 26/24
Chlordiazepoxide capsule	To be discontinued by the manufacturer. Some 25 mg capsules may be available until Dec/24. For alternatives, see RxFiles (subscription) - Benzodiazepines. RxFiles is available through SHIRP. Last updated: Jul 12/24
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
Clindamycin oral granules	Dalacin® C granules 75 mg/5 ml are shorting. Estimated availability: July/2025 The bulk powder is available.  Contact a compounding pharmacy for more information. The capsules may be opened and contents sprinkled, however, bad taste is a consideration. Note that clindamycin is a skin irritant. Last updated: Sep 19/24
Clioquinol 1%/ Flumethasone pivalate 0.02% otic drops	Locacorten® Vioform® eardrops are shorted until January 2025. Clioquinol is active against fungi and gram-positive bacteria.  Fungal otitis externa (OE) is rare; it may respond to cleansing and acidification alone. Clotrimazole and tolnaftate may be alternatives but must be compounded.  See CPS Otitis Externa for alternative antibacterial otic drops for treating bacterial OE. CPS is available through SHIRP. Last updated: Nov 22/24
Clioquinol 3%/ Flumethasone pivalate 0.02% topical cream	Locacorten® Vioform® cream. Estimated availability is July 2025. Lotriderm® and Vioform® HC∗ are combination antifungal/corticosteroid creams that may be suitable alternatives ∗ no longer stocked at McKesson Last updated: Nov 22/24
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 : Product Antitussive Decongestant Antihistamine Expectorant Calmylin Codeine 3.33mg/5ml   Diphenhydramine 12.5mg/5ml Ammonium Cl 125mg/5ml Calmylin ACE Codeine 10mg/5ml   Pheniramine 7.5mg/5ml Guaifenesin 100mg/5ml Calmylin PSE  Codeine 3.33mg/5ml Pseudoephedrine 30mg/5ml   Guaifenesin 100mg/5ml Cotridin Codeine 10mg/5ml Pseudoephedrine 30mg/5ml Triprolidine 2mg/5ml   Cotridin Exp Codeine 10mg/5ml Pseudoephedrine 30mg/5ml Triprolidine 2mg/5ml Guaifenesin 100mg/5ml Damylin  Codeine 3.33mg/5ml Diphenhydramine 12.5mg/5ml Ammonium Cl 125mg/5ml Last updated: Feb 15/24
Colchicine 0.5mg extended-release tablet	Myinfla™ - shorting until June 2025. It is indicated for the reduction of atherothrombotic events in adult patients with existing coronary artery disease Alternatives: colchicine 0.6 mg immediate-release tablets (IR) do not share Myinfla's indication. Consult cardiologist before making a switch to the IR product. Last updated: Nov 27/24
Colesevelam	Lodalis™ and Apotex 625 mg tablets are available.  Pharmacies should dispense the approved Health Canada products listed on the Saskatchewan Formulary when they are available. Health Canada has approved importation of Glenmark Pharmaceuticals US-labelled colesevelam 625 mg tablets and these are available (if Health Canada approved products cannot be ordered). 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 if a Health Canada approved product cannot be ordered. See bulletin here.  Temporarily added to the Non-Insured Health Benefits formulary for the duration of the importation and sale approval from Health Canada.  A CPhA comparison of bile acid sequestrants is available here.  Last updated: Aug 12/24
Colestipol	Colestid®  tablets and granules are shorted; tablets estimated for Jan/25 and granules indeterminate availability. Alternatives: A CPhA comparison of bile acid sequestrants is available here. Colesevelam tablets and cholestyramine light powder are available. 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: Nov 27/24
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
Cromolyn sodium ophthalmic solution	Cromolyn is the only brand and is shorted with expected availability of January 2025.  See medSask Conjunctivitis minor ailment guideline or CPS (Conjunctivitis and/or Red Eye) for alternative treatment options. medSask minor ailment guidelines and CPS are available through SHIRP.  Last updated: Nov 5/24

D

Drug	Availability
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: Nov 27/24
Diclofenac potassium oral tablets	Diclofenac potassium 50 mg tablets: earliest availability is mid-late December/24.  Diclofenac sodium tablets available:  IR: 25 mg, 50 mg SR: 75 mg, 100 mg See RxFiles NSAIDS and Coxib Analgesics for more options. RxFiles is available through SHIRP.  Last updated: Nov 15/24
Dihydroergotamine  1 mg/mL injectable	Dihydroergotamine 1 mg/mL injectable is shorted until mid-Feb/24. Alternatives: Dihydroergotamine intranasal spray 4 mg/mL (Migranal®) Consider triptans or other agents for acute migraine.  See CPS Headache in Adults or RxFiles Migraine for more details. CPS and RxFiles are available through SHIRP.  Last updated: Nov 4/24
Dipyridamole/ASA 200/25 mg capsule	There are currently no oral dipyridamole/ASA products marketed in Canada. Management Address and optimize modifiable risk factors: Lifestyle  diet (including sodium intake), physical activity, tobacco use, alcohol use, recreational drug use (e.g., cocaine, amphetamines) Blood pressure Diabetes mellitus Dyslipidemia Estrogen-containing agents (combined hormonal contraceptives, menopause hormone therapy Pharmacological Alternatives (long-term secondary prevention following acute treatment) ASA 81 mg to 325 mg PO once daily Clopidogrel 75 mg PO once daily Clopidogrel is somewhat more effective than ASA but ASA is more effective than placebo and considered an appropriate option. For more details see Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke. Last updated: Aug 14/24
Duavive™	see estrogens (conjugated)/bazedoxifene acetate

E-G

Drug	Availability
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
Estalis®	see Estradiol/Norethindrone
Estradiol vaginal ring	Estring® - estimated availability: late January 2025 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: Nov 15/24
Estradiol transdermal patch	Several brands/strengths of estradiol patches are shorting. All strengths of Oesclim® have been discontinued.  Estradot®  and Sandoz-estradiol patches are interchangeable. Estradot®  and Climara® patches are NOT considered interchangeable by the SK drug plan.  Climara® patches are changed once weekly; Estradot® patches 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: Aug 13/24
Estradiol/Norethindrone 140/50 mcg transdermal patch	Estalis® 140/50 mcg patch is on short with estimated availability of mid-late December/24. Estalis® 250/50 mcg is in stock. Alternatives: 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: Nov 22/24
Estrogens (conjugated)/ bazedoxifene acetate	Duavive™ - estimated availability of mid-December 2024 Indication: treatment of moderate to severe vasomotor symptoms associated with menopause.  For alternatives see RxFiles Postmenopausal Therapy. RxFiles is available through SHIRP. Last updated: Nov 15/24
Evusheld™	Evusheld™ has been discontinued by the manufacturer. See medSask's COVID-19 treatments for alternate treatment options (specific to Saskatchewan). Last updated: Sep 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.
Famciclovir 250 mg tablets	Famciclovir 250 mg oral tablets are shorted. Estimated availability: late Dec/24 Famciclovir 125 and 500 mg tablets are available. The 500 mg 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: Dec 3/24
Ferrous Fumarate Oral Suspension	JAMP 60 mg/mL suspension is shorted with estimated availability of January 2025. Palafer 20 mg/ml suspension is available. 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: Nov 27/24
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.
Fluticasone propionate (Aermony Respiclick™)	Teva Canada has discontinued all strengths of Aermony Respiclick™ for business reasons. There may be some inventory in circulation. The 55 mcg has officially stopped shipping from Teva Canada’s warehouse. The 113 mcg will stop shipping Dec 2/24 & the 232 mcg will stop shipping Jun 3/25. Alternatives: For alternative inhaled corticosteroids - including other inhaled fluticasone products - see RxFiles: Asthma Drug Comparison chart. Last updated: Nov 12/24
Framycetin/Gramicidin/Dexamethasone Ophthalmic/Otic Drops	Sofracort® - estimated availability: January 2025 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: Nov 22/24
Framycetin/Gramicidin/ Phenylephrine Nasal Spray	Soframycin® Nasal Spray is shorting. Expected availability of mid-Dec/24. Indications: Local treatment of infections and/or congestion caused by susceptible organisms in acute rhinosinusitis, crusting rhinitis, nasal conditions accompanying the common cold, post-op care of patients who have undergone intranasal or sinus surgery. Prophylactic use - Reduction of nasal carriage of staphylococci. See CPS or RxFiles for therapeutic alternatives as per indication. CPS and RxFiles are available through SHIRP. Last updated: Dec 3/24
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: Fenofibrate and bezafibrate are available. For more information on these medications, see CPS - Fibric Acid Derivatives (Fibrates). CPS is available through SHIRP.  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.
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) is available.  Please note that Baqsimi™ is not indicated for use in children < 4 years of age. Last updated: Oct 8/24

H-K

Drug	Availability
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: Proctodan HC rectal ointment contains 0.5% hydrocortisone and 1% pramoxine (as well as zinc sulfate). See CPS Hemorrhoids and Pharmacologic Therapy for Prevention and Management of Side Effects of Cancer Therapies and Radiation Therapy for therapeutic alternatives. CPS is available through SHIRP. Last updated: Feb 26/24
Hydrocortisone-containing suppositories	Proctodan (hydrocortisone, pramoxine, zinc sulfate) - indeterminate availability Anusol HC (hydrocortisone, zinc sulfate) - indeterminate availability  Available: Anodan-HC (hydrocortisone, zinc sulfate); Proctol (hydrocortisone, dibucaine, esculin, framycetin) suppositories Last updated: Nov 15/24
Imiquimod 3.75% and 5% topical cream	Imiquimod is marketed as 3.75% (Vyloma®, Zyclara®) and 5% (Aldara® P, generic) topical creams. All imiquimod creams are reporting shortages until early Jan/25 (5%) and early Apr/25 (3.75%). Vyloma® and Zyclara® are both 3.75% topical creams made by the same manufacturer (Bausch Health) and have the same non-medicinal ingredients; however, they have different indications. Vyloma® is indicated for external genital and perianal warts/condyloma acuminata in immunocompetent adults Zyclara® is indicated for treatment of multiple clinically typical visible or palpable actinic keratoses (AK), of the face or balding scalp in immunocompetent adults. The indications of imiquimod 5% include those of Vyloma®, Zyclara®, in addition to biopsy-confirmed, primary superficial basal cell carcinoma (sBCC). Pharmaceutical Alternatives (if any of these products are available): It is reasonable to use Vyloma® for Zyclara® and vice versa, with informed consent of the patient for the off-label use and ensuring that dosing and directions are adjusted for the appropriate indication. Aldara® P can be used for the same indications of Vyloma® and Zyclara® though close attention needs to be paid to dosing (frequency and duration) as they differ among products. See CPS CPhA Imiquimod monograph for more information (available through SHIRP).  Therapeutic Alternatives: Actinic keratosis Alternatives may include 5-fluorouracil, cryotherapy and/or photodynamic therapy. Genital and perianal warts/condyloma acuminata Alternatives may include podophyllotoxin, cryotherapy, 5-fluorouracil, sinecatechins, or bichloroacetic acid or trichloroacetic acid. For more details, see Canadian Sexually Transmitted and Blood-Borne Infection Guides - Anogenital Warts Guide: Treatment and Follow-up. Superficial basal cell carcinoma Alternatives may include surgical excision, 5-fluorouracil, or photodynamic therapy.  Last updated: Nov 22/24
Indacaterol Breezhaler®	Onbrez® Breezhaler® has been discontinued by the manufacturer. There are no other single-agent indacaterol products. Alternatives: Indacaterol combination inhalation products:  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. Last updated: Sep 10/24
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 0.5 mg/ salbutamol 2.5 mg nebules	Both marketed brands are shorted with earliest estimated availability of late January 2025. Alternatives: Ipratropium and salbutamol nebules individually, though supply of salbutamol nebules is also limited. Combivent® Respimat® inhaler - spacer is typically not required; ODAPT is a spacer marketed in Canada for Respimat® inhalers but may not be available in community supply chains. Consider if short-acting bronchodilators alone (salbutamol, terbutaline, ipratropium) may be appropriate, taking into account available delivery devices. Take this opportunity to discuss/optimize non-pharmacological management including smoking cessation, review of vaccination status, assessment of inhaler technique, and pulmonary rehabilitation. For more information regarding treatment of COPD, see RxFiles COPD  or CPS Chronic Obstructive Pulmonary Disease (COPD), both available through SHIRP. Last updated: Nov 26/24
Iron dextran injection	Dexiron has been discontinued For alternatives see document
Isosorbide mononitrate 60 mg oral tablet	All brands shorting with estimated availability of January 2025 For alternatives see document. Last updated: Nov 1/24

L-O

Drug
Locacorten® Vioform®  topical cream and otic drops	See clioquinol/flumethasone
Mefenamic acid  250 mg capsule	AA Pharma mefenamic acid 250 mg capsule is the only brand and strength and is shorted until late Dec/24.  Note that mefenamic acid has been considered by some to be a superior NSAID for dysmenorrhea; however, there is no clinical evidence to support superiority of any one NSAID.  See RxFiles NSAIDs and Coxib Analgesics or CPS Nonsteroidal Anti-inflammatory Drugs (NSAIDs) (CPhA monograph) for alternative NSAIDs. Last updated: Nov 19/24
Megestrol tablet	Both the 40 mg and 160 mg tablets are shorting with estimated availability of March 2025.  Only the AA brand is marketed. Alternatives: For use in cancer or cancer-related indications, contact oncology team. Cyproheptadine, mirtazapine, cannabinoids, oral corticosteroids have been used as appetite stimulants. Cost, side effect profile, drug interactions and comorbidities need to be considered when choosing a megestrol alternative. Last updated: Nov 1/24
Metronidazole 10% vaginal cream	Flagyl® is the only marketed brand of metronidazole 10% vaginal cream and has been discontinued. The indications are treatment of trichomonal infections and treatment of bacterial vaginosis. Metronidazole 10% vaginal cream is not recommended for treatment of these infections. Preferred agents:  Trichomoniasis:  Oral metronidazole Bacterial Vaginosis Metronidazole, oral or 0.75% vaginal gel Clindamycin, oral or 2% vaginal cream See Bugs&Drugs or CPS Sexually Transmitted Infections for dosing regimens and treatment durations. CPS is available through SHIRP.  Last updated: Nov 20/24
Moxifloxacin 400 mg tablet	All brands are shorting. Earliest availability: late Dec/24. Management: Ensure antimicrobial therapy is warranted See medSask Antimicrobial Stewardship for resources. Determine if other antimicrobials with narrower spectrums are appropriate. Resources with treatment of specific infections: Bugs & Drugs CPS (available through SHIRP RxFiles (available through SHIRP) Last updated: Nov 27/24
Naproxen sustained-release tablet	Naprosyn® SR 750mg tablets are on short with indeterminate availability. Alternatives: To switch to naproxen immediate-release or enteric coated tablets, use the same daily dose and divide BID - TID Both diclofenac and ketoprofen are available in a sustained-release formulation For more information on these and other NSAID alternatives, see CPhA's NSAID monograph in CPS. CPS is available through SHIRP. Last updated: Nov 8/24
Nevirapine 200 mg tablet	Estimated availability: mid-Dec/24 For alternatives, see RxFiles HIV Drug Comparison chart.  RxFiles is available through SHIRP. Last updated: Nov 22/24
Nitrofurantoin	Nitrofurantoin BID 100 mg capsules (macrocrystal/monohydrate) - expected availability of mid-December/24 Nitrofurantoin 50 and 100 mg capsules (macrocrystal) - expected availability of mid-December/24 Nitrofurantoin 50 & 100 mg tablets - intermittent availability 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 (when used for treatment). It is reasonable to split AA Pharma Nitrofurantoin 100 mg tablets, which are scored; nitrofurantoin may be a skin irritant. Dosing 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 capsules, go with that (QID).  Dosing for cystitis prophylaxis is 50 mg to 100 mg post-coitus x 1 dose or 50 mg to 100 mg once daily at bedtime for long-term prophylaxis.  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: Nov 22/24
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
Nizatidine 150mg capsule	Axid® 150mg capsules are on short until mid-Dec/24.  There are no other brands or strengths of nizatidine. See RxFiles - Acid Suppression for alternative H2-receptor antagonists. RxFiles is available through SHIRP. Last updated: Nov 22/24
Nystatin cream, topical	Nyaderm is the only marketed brand and is shorted until mid-Dec/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: Dec 3/24
Nystatin oral suspension	All brands shorting - intermittent availability. Bulk powder is available for compounding. Medisca provides several compounding formulae . Contact DPEB regarding coverage for compounded suspensions. Last updated: Nov 12/24
Olsalazine 250 mg capsule	Dipentum®  250 mg capsules shorting. Expected to be available by February 2025. No other strengths or brands are marketed. Alternatives: Sulfasalazine See RxFiles (subscription) IBD: Ulcerative Colitis vs. Crohn's Disease. RxFiles is available through SHIRP. Last updated: Nov 1/24
Oxybutynin: long-acting formulations, topical gel, and oral syrup	Ditropan XL® tablets, Oxytrol® transdermal patches and Gelnique®  topical gel have been discontinued by the manufacturers. Oxybutynin 1 mg/mL syrup is shorted with estimated availability Mar/25 Alternatives: Generic oxybutynin 2.5 mg & 5 mg immediate release tablets are available. For therapeutic alternatives, see RxFiles: Urinary Incontinence. RxFiles is available through SHIRP. Last updated: Oct 10/24

P-R

Drug	Availability
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
Peginterferon alfa-2a (Pegasys®)	Pegasys® is the only marketed brand of peginterferon alfa-2a. Inventory is currently available, though it will be depleted.  Background A final batch of peginterferon alfa-2a was produced in 2017 that was expected to last 10 years, enough time for establishment of a new active product ingredient manufacturer. However, due to increased demand, the last batch will be depleted before a new batch can be produced. There is currently some inventory, but once this is depleted, a shortage until at least December 2025 is expected.   Indications Treatment of HBeAg-positive and HBeAg-negative chronic hepatitis B in adult patients with compensated liver disease, liver inflammation and evidence of viral replication (both cirrhotic and non-cirrhotic disease). Treatment of chronic hepatitis C in adult patients without cirrhosis and adult patients with compensated cirrhosis (including HCV/HIV co-infected patients with stable HIV disease with or without antiretroviral therapy). No other peginterferon products indicated for hepatitis are available. Peginterferon alfa-2a is not first line therapy and is more likely to be used for chronic hepatitis B. Oral antiviral agents such as nucleos(t)ide analogues (especially entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide) may be appropriate for chronic hepatitis B.  Combination direct-acting antiviral therapy including glecaprevir/pibrentasvir (Maviret®), sofosbuvir/velpatasvir (Epclusa®), sofosbuvir/ledipasvir (Harvoni®), and  sofosbuvir/velpatasvir/voxilaprevir (Vosevi™) may be considered for chronic hepatitis C. Work with prescribers to make a plan prior to inventory depletion. Last updated: Nov 25/24
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
Pentoxifylline SR oral tablet	Both brands of pentoxifylline 400 mg SR tablets are shorted with earliest estimated availability mid-January 2025. While this agent is indicated for treatment of chronic occlusive peripheral vascular disorders, it is generally not recommended for this use due to lack of benefit. See Thrombosis Canada for treatment of peripheral arterial disease, which focuses on managing cardiovascular risk factors and antithrombotic therapy when appropriate.  SK health care providers can contact medSask if alternatives are needed for an off-label use. Last updated: Dec 3/24
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 short. Expected to return to stock in mid- December 2024. Alternatives: Pharmacists licensed in SK can contact medSask for a compounding formula using tablets. 15 mg, 30 mg, 60 mg, and 100 mg oral tablets are available. Last updated: Nov 22/24
Pizotifen 1 mg tablet	Sandomigran DS - shorting until January 2025 For therapeutic alternatives, see RxFiles - Migraine: Acute & Prophylaxis. RxFiles is available through SHIRP. Last updated: Nov 15/24
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, Sandoz/Euro K8 (DIN 02246734), and Sandoz-K 20 (NPN 02242261) 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 that there are supply challenges with all brands and only intermittent availability. 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 that there are supply challenges with all tablet and capsule formulations of potassium chloride and availability is intermittent 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+: Odan K-20 (NPN 80004415) JAMP K-20 (NPN 80013007) PRZ K20 (NPN 80107649) M-K20 (NPN 80071412) Please note that there are supply challenges with all brands and availability is intermittent 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: Nov 1/24
Prazosin oral tablet	All strengths/brands of prazosin tablets are shorting—earliest estimated availability: February 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: Nov 1/24
Prevnar 13	See Pneumococcal 13-Valent Conjugate Vaccine
Prochlorperazine injectable	Injectable formulation discontinued by manufacturer.  Alternate forms: 5 mg and 10 mg oral tablets are still marketed. Therapeutic alternatives: See document Last updated: Sep 21/22
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: mid-January 2025 Crinone® vaginal gel or micronized progesterone capsules inserted vaginally may be suitable alternatives. Consult with fertility specialist. Last updated: Nov 22/24
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
Ranitidine injectable	Product has been discontinued.  Change to alternative H2RA if required: IV: famotidine (APX, Omega)  Oral: famotidine 40 mg ~ nizatidine 300 mg ~ ranitidine 150 mg BID or 300 mg HS      Alternative PPIs: IV: pantoprazole - currently shorted        Oral: pantoprazole 40 mg ~ lansoprazole 30 mg ~ omeprazole 20 mg ~ esomeprazole 40 mg ~ rabeprazole 20 mg Nasogastric administration: esomeprazole, lansoprazole Last updated: Oct 10/24
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
Ritonavir 100 mg tablets	Both brands of ritonavir 100 mg oral tablets are shorted with earliest availability of mid-Jan/25. Ritonavir is used in treatment of HIV infection as a pharmacokinetic booster; cobicistat may be an appropriate alternative in some, but not all cases. Consult HIV specialist. Last updated: Nov 22/24

S-Z

Drug	Availability
Salbutamol solution for inhalation	Ventolin® 5 mg/ml respirator solution - indeterminate availability Nebules (2.5 mL): intermittent availability of all strengths (0.5 mg/mL, 1mg/mL, 2 mg/mL)- earliest estimated availability of late Feb/25.  Last updated: Nov 15/24
Salbutamol 2.5 mg/ ipratropium 0.5 mg nebules	See Ipratropium 0.5 mg/ salbutamol 2.5 mg nebules
Scopolamine transdermal patch	Transderm V transdermal patches have been discontinued by the manufacturer.  See therapeutic alternatives for select indications.
Sofracort® eye/ear drops	see Framycetin/Gramicidin/Dexamethasone
Soframycin® Nasal Spray	see Framycetin/Gramicidin/Phenylephrine Nasal Spray
Stieprox® Shampoo	This 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.
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, injectable	Taro-Testosterone cypionate 100 mg/mL, Depo-Testosterone (cypionate) 100mg/ml, and Hikma Testosterone enanthate 200 mg/mL injections are shorting; earliest estimated availability mid-December 2024. See medSask's Testosterone Products Available in Canada for alternatives. Last updated: Dec 2/24
Timolol  0.25 & 0.5% gel-forming  ophthalmic solution	Timoptic® XE 0.5% and Sandoz timolol EX 0.25 & 0.5% gel-forming solutions are on short. Estimated availability: February 2025. No other brands are marketed.  Alternatives: Timolol 0.25% & 0.5% regular ophthalmic formulations remain available. See CPS - Glaucoma for details and other alternatives. CPS is available through SHIRP. Last updated: Nov 12/24
Tobramycin inhalation powder	Tobi® Podhaler® is the only brand of tobramycin inhalation powder and is shorted until mid-Feb/25. Currently Tobi® Inhalation Solution is available, however this product will be shorted. Both Tobi products are indicated for the management of cystic fibrosis patients with chronic pulmonary Pseudomonas aeruginosa infections. If neither product is available, preservative-free IV tobramycin may be administered via inhalation.  For details and information on alternative cystic fibrosis treatments, see RxFiles - Cystic Fibrosis. RxFiles is available through SHIRP. Last updated: Nov 13/24
Tolterodine LA 2 & 4 mg capsule	All generic brands are shorting. Detrol® LA may be available. Alternatives: Tolterodine IR (immediate release) tablets are in stock. To switch between LA and IR, use the same daily dose but divide BID. Monitor for increased side effects. For alternative incontinence/overactive bladder treatments, see RxFiles - Urinary Incontinence. RxFiles is available through SHIRP. Last updated: Nov 29/24
Tramadol extended release tablets (Tridural®)	All strengths of Tridural® tablets are shorted. Estimated availability: late Dec/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 as detailed in medSask's comparison table. Last updated: Nov 22/24
Tretinoin, 0.05% topical cream	Retin-A®  0.05% cream is shorting. Estimated availability: mid-Dec/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 available topical retinoids include adapalene, tazarotene, and trifarotene. See RxFiles Acne Pharmacotherapy or CPS Acne for more details.  RxFiles and CPS are available through SHIRP.  Last updated: Nov 4/24
Triacomb Cream	see triamcinolone/nystatin/neomycin/gramicidin
Triamcinolone/nystatin/ neomycin/gramicidin cream	Viaderm K.C.® cream and Triacomb cream are on short. Earliest availability: mid-Dec/24 Viaderm K.C.® ointment - the only ointment form of this combination - is available Last updated: Nov 27/24
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.
Ursodiol tablets	All brands and strengths of ursodiol are shorted with earliest estimated availability of mid-January 2025. Pharmaceutical Alternatives Compounding pharmacies may be able to compound capsules, though at a significantly higher price than the commercially available tablets and there may be a delay in receiving product. If 500 mg tablets are available and 250 mg is required, 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. Therapeutic Alternatives Ursodiol's main role is in management of primary biliary cholangitis (PBC), where it's first line pharmacological therapy. Pharmacological alternatives: Obeticholic acid (OCA) (Ocaliva®) OCA can be used in those without cirrhosis or Child-Pugh class A compensated cirrhosis with no evidence of portal hypertension. It is contraindicated in Child-Pug class B or C decompensated cirrhosis or with Child-Pugh class A compensated cirrhosis and evidence of portal hypertension. This product is ~$3000/month and only available through the manufacturer. Patients may be eligible for the Patient Support Program.  Fibrates Bezafibrate and fenofibrate may be options, the evidence is limited and mostly confined to combinations with ursodiol or OCA.  Potential hepatotoxicity may be a concern. Whenever possible, consult a specialist.  Last updated: Dec 3/24
Valproic Acid EC Capsules	Valproic Acid EC 500 mg capsules. Estimated availability: mid-December/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: Nov 15/24
Verapamil sustained-release (SR) tablets	Verapamil SR 180 mg & 240 mg tablets are shorting with indeterminate availability. Alternatives: The 120 mg 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: Nov 15/24
Viaderm® K.C. Cream	see triamcinolone/nystatin/neomycin/gramicidin
Zolmitriptan 2.5 mg tablets	All brands of the 2.5 mg ODT are shorting with indeterminate availability. The regular 2.5mg tablets and nasal sprays are available. See RxFiles Migraine or CPS Headache in Adults for therapeutic alternatives. RxFiles and CPS are available through SHIRP. Last updated: Dec 3/24

Documents of Resolved Drug Shortages

• Antipsychotics, Depot
• Fludrocortisone (Florinef®) English, French
• H2-Receptor Antagonists
• Hydrocortisone Tablets (Cortef®) English, French
• Medroxyprogesterone Tablets
• Ropinirole 0.25 mg Tablets
• Semaglutide (Ozempic®) for Diabetes, Obesity
• Testosterone, Injectable and Oral