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.
- Salbutamol Shortage
- Testosterone enanthate injection
- 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:
- 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.
- 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.
- 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.
- 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.
- If there is not a therapeutic equivalent, check treatment guidelines and recommend a drug from another pharmacologic class. Monitor and titrate to desired effect.
- CPS: Therapeutic Choices and Minor Ailments (available at SHIRP)
- RxFiles
- Others, e.g. CMA Infobase Clinical Practice Guidelines, Canadian Healthcare Network Key Clinical Guidelines and Statements (requires log in)
- 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
- 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.
- Currently nothing of note.
- A-B
Drug
Availability / Alternatives 5-aminosalicylic acid (5-ASA) 400 mg EC tablet
Teva 5-ASA 400 mg enteric coated (EC) tablet (generic of Asacol, which has been discontinued), is shorted with earliest availability of mid to late-Feb 2025.
There are no products interchangeable with Teva 5-ASA EC tablets; however other 5-ASA modified release tablets are available with similar sites of action (terminal ileum to the rectum). These include:
- Mezavant® 1.2 g delayed release (DR) tablet
- Salofalk® 500 mg EC tablet
- Octasa® 800 mg, 1600 mg DR tablet
- Mezera® 500 mg DR tablet
- Pentasa® 500 mg, 1g extended release tablet (note: this product's site of action extends from the duodenum to the rectum)
For more information, see RxFiles Inflammatory Bowel Disease. RxFiles is available through SHIRP.
Last updated: Jan 24, 2025
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, 2024
Adefovir
Adefovir 10 mg tablets. Indeterminate availability
For therapeutic alternatives see RxFiles Hepatitis B Drug Therapy. RxFiles is available through SHIRP.
Last reviewed: Jan 15, 2025
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 reviewed: Jan 15, 2025
Antibiotics - adult formulations
Adult formulations of commonly used antibiotics may be undergoing shortages.
- For specifics, see listing under individual medication.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: Jan 17, 2025
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, 2023
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, 2022
Betahistine tablets
All strengths and brands are on short. Earliest availability: mid Feb 2025
For therapeutic alternatives, see CPS - Vertigo & Dizziness. CPS is available through SHIRP.
Last updated: Jan 27, 2025
Betamethasone dipropionate w/glycol 0.05% topical lotion
Teva-Topilene is the only brand and is shorted until early Feb 2025.
- See RxFiles Topical Corticosteroids for agents of similar potency. Note that betamethasone dipropionate topical lotion without glycol is less potent. RxFiles is available through SHIRP.
Last updated: Jan 27, 2025
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, 2024
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, 2024
Bosentan 62.5 mg tablet
All brands of bosentan 62.5 mg tablets are shorted with earliest estimated availability of April 2025.
- Bosentan 125 mg tablets are currently available. These are immediate release tablets that are considered teratogenic. If they are to be split, they need to be handled accordingly. A pill-splitter should be used to split tablets to ensure less variation in size and reduce risk of injury. As a general rule, tablets should not be split in advance to minimize exposure to light and moisture; however, some patients may not be able to split their own tablets due to low vision, lack of dexterity, or other reasons.
Last updated: Dec 19, 2024
Budesonide nasal spray
Mylan 64 & 100 mcg nasal spray: indeterminate availability.
Rhinocort® Aq 64 mcg is available.
For alternative corticosteroid nasal sprays, see CPS (subscription) - Allergic Rhinitis. CPS is available through SHIRP.
Last reviewed: Jan 15, 2025
Budesonide nebules
All brands and strengths are shorted with earliest availability of Apr 2025.
Alternatives:
- Pulmicort® turbuhaler
- Nebulized solution can be compounded
- For therapeutic alternatives, see RxFiles Asthma, available through SHIRP.
Last updated: Jan 16, 2025
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, 2023
- C
Drug Availability Chlordiazepoxide capsule
To be discontinued by the manufacturer.
For alternatives, see RxFiles (subscription) - Benzodiazepines. RxFiles is available through SHIRP.
Last updated: Jan 31, 2025
Chlorthalidone tablet
All strengths of chlorthalidone tablets are shorted with earliest availability of Apr 2025.
See RxFiles - Diuretics and CPS - Thiazide Diuretics for alternatives. RxFiles and CPS are available through SHIRP.
Last updated: Jan 27, 2025
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, 2024
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, 2024
Clarithromycin oral suspension
There is limited inventory of 125 mg/5 mL and 250 mg/5 mL oral suspension.
- Medisca provides compounding formulae.
- Immediate release tablets can be split or crushed; however, unpleasant taste is a consideration. Note that clarithromycin is a skin irritant.
- See the Antibiotics - pediatric formulations entry for administration and stewardship information.
- For alternative antibiotic options see indication in Bugs & Drugs.
Last updated: Feb 5, 2025
Clindamycin oral granules
Dalacin® C granules 75 mg/5 ml are shorting. Estimated availability: Jul 2025
- The bulk powder is available. Contact a compounding pharmacy for more information.
- The capsules may be opened and contents sprinkled, however, unpleasant taste is a consideration. Note that clindamycin is a skin irritant.
- See the Antibiotics - pediatric formulations entry for administration and stewardship information.
- For alternative antibiotic options see indication in Bugs & Drugs.
Last updated: Sep 19, 2024
Clioquinol 1%/ flumethasone pivalate 0.02% otic drops
Locacorten® Vioform® eardrops are shorted until early Mar 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: Feb 3, 2025
Clioquinol 3%/ flumethasone pivalate 0.02% topical cream
Locacorten® Vioform® cream. Estimated availability is Sep 2025.
- Lotriderm® and Vioform® HC∗ are combination antifungal/corticosteroid creams that may be suitable alternatives
- ∗ no longer stocked at McKesson
Last updated: Dec 23, 2024
Clomiphene
Clomid® and Serophene® have been discontinued.
Alternatives:- Compounded by compounding pharmacy or pharmacological alternatives - see document
Last updated: Nov 18 , 2020
Colchicine 0.5 mg extended-release tablet
Myinfla™ - shorting until May 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: Jan 6, 2025
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, 2024
Colestipol
Colestid® tablets and granules are shorted with 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: Jan 24, 2025
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.
Cosopt® PFSee dorzolamide/timolol preservative-free ophthalmic solution. Co-trimoxazole (sulfa- methoxazole /trimethoprim) Oral Suspension
No manufacturer is marketing sulfamethoxazole/trimethoprim oral suspension.
Pharmaceutical Alternatives- If the dose is easily obtained from a tablet (full tablet or ½ tablet), crush the tablet immediately before administration and mix with soft food or water. A pediatric tablet is available, although it is not chewable (Sulfatrim Pediatric tablet 100 mg/20 mg).
- Compounding
- A study published in CJHP assessed the stability of oral suspension compounded from bulk powder and tablets (Apotex).
- The suspensions compounded with bulk powder were suitable.
- The suspensions compounded with tablets were not acceptable. When compounded with Oral Mix SF, the product was too viscous. When compounded with Oral Mix, a persistent layer of foam was observed. The authors suggest the foam may have resulted from excipients in the tablets that act as surfactants (e.g., methylcellulose, sodium-lauryl sulfate).
- Some formulae using tablets cite Wu 1999. The tablets used in this compound were from Taiwan Sbionogi & Co and may have included different excipients from tablets available in Canada.
- Ideally, compounded suspensions should be prepared using bulk powder.
- A study published in CJHP assessed the stability of oral suspension compounded from bulk powder and tablets (Apotex).
Therapeutic Alternatives
- See Bugs&Drugs for appropriate alternative antimicrobial selection.
Last updated: Feb 4, 2025
Cromolyn sodium ophthalmic solution
Cromolyn is the only brand and is shorted with indeterminate availability.
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: Dec 13, 2024
- Ciprofloxacin XL is only indicated for urinary tract infection.
- D
Drug Availability Desonide ointment
Estimated availability: Dec 2025
Alternatives:
- Desonide topical cream remains available.
- For topical corticosteroids of similar potency, see RxFiles Topical Corticosteroids. RxFiles is available through SHIRP.
Last updated: Jan 13, 2025
Diazepam rectal gel
5 mg shorted with estimated availability mid-Apr 2025. 15 mg shorted, though there is still some inventory. 10 mg remains available.
Alternatives:
- Medisca lists a compounding formula for a rectal gel. Compounding pharmacies can supply.
- Pharmacist's Letter (subscription) - Giving Meds by Alternative Routes has information on rectal administration of diazepam and lorazepam injection and intranasal use of midazolam injection for seizure control.
Last updated: Jan 27, 2025
Dihydroergotamine
1 mg/mL injectableDihydroergotamine 1 mg/mL injectable is shorted until late Mar 2025.
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: Dec 6, 2024
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
- Lifestyle
- 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, 2024
Dorzolamide-containing PF ophthalmic solutions
Trusopt® (dorzolamide 2%) Preservative-Free drops are shorted with estimated availability of Apr 2025.
Cosopt® (dorzolamide 2%/timolol 0.5%) Preservative-Free drops are shorted with estimated availability of mid-Feb 2025.
Alternatives:
- No other preservative-free (PF) dorzolamide products are available. Preserved solutions for both agents are available containing benzalkonium chloride (BAK).
- If BAK is not tolerated, see RxFiles Glaucoma or CPS Glaucoma for therapeutic alternatives. RxFiles and CPS are available through SHIRP.
- See the entry on this page for Glaucoma agents, topical for a table of preservatives found in the various glaucoma agents.
Last updated: Jan 15, 2025
Dulaglutide subcutaneous injection
Availability of both strengths of Trulicity® is fluctuating.
Due to demand uncertainties in the market, an allocation strategy has been implemented. Availability dates at a pharmacy’s usual distributor warehouse may vary. Pharmacies are invited to communicate with their distributor to obtain the product availability date at the distributor, or to contact our Lilly Customer Response Centre at 1-888-545-5972 (Monday-Friday, 9 a.m. to 5 p.m. Eastern Time, excluding holidays) for more information.
The Ozempic® shortage information may help for alternatives.
Last updated: Jan 29, 2025
- 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, 2023
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, 2023
Estalis®See estradiol/norethindrone transdermal patch Estradiol vaginal ring
Estring® - estimated availability mid-Mar 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: Feb 7, 2025
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, 2024
Estradiol/ norethindrone transdermal patch
The 140 mcg/50 mcg strength of Estalis®, the only brand of combination estrogen/progestin transdermal patch for menopause hormone therapy - limited availability.
The 250 mcg/50 mcg patch remains available; however these should not be cut as they may not provide enough progestin.
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 progestin - 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 for information on dosing and coverage. RxFiles is available through SHIRP.
Last updated: Feb 7, 2025
Ethinyl estradiol 35 mcg / norethindrone 1 mg oral tablet
Both brands of ethinyl estradiol 35 mcg /norethindrone 1 mg (Brevicon®, Select) are shorted with earliest estimated availability of mid Feb 2025 (Brevicon® 21 day).
See RxFiles Birth Control: Combined Oral Contraceptives for alternatives with similar hormonal activity if the patient is satisfied with the formulation. This chart also contains information of which hormone profiles to choose to mitigate adverse effects, should they be a problem. RxFiles is available via SHIRP.
Last updated: Jan 20, 2025
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.
Last updated: Apr 1, 2022
5-Fluorouracil 5% topical cream
Efudex®, the only brand of 5-fluorouracil 5% topical cream, is shorting with estimated availability of May 2025.
Efudex® 5% is indicated for premalignant keratoses and superficial basal cell carcinoma. It has been used off-label for anogenital warts.
Actinic Keratosis
- 5-Fluorouracil (5-FU) 4% cream (Tolak®) is available and indicated for treatment of actinic keratosis of the face, ears, and/or scalp.
- Other agents that may be appropriate depending on site and characteristics of the lesion(s) photodynamic therapy and imiquimod (3.75%, 5%, both of which are currently shorted).
Superficial Basal Cell Carcinoma
- Alternatives may include imiquimod 5% (currently shorted), photodynamic therapy.
Last updated: Jan 30, 2025
Fluticasone propionate (Aermony Respiclick™)
Teva Canada has discontinued all strengths of Aermony Respiclick™ for business reasons. There may be some 232 mcg, which will stop shipping Jun 3, 2025.
Alternatives:
- For alternative inhaled corticosteroids - including other inhaled fluticasone products - see RxFiles: Asthma Drug Comparison chart.
Last updated: Nov 12, 2024
Framycetin/gramicidin/ dexamethasone ophthalmic/otic drops
Sofracort® - indeterminate availability
Alaternatives:
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: Feb 3, 2025
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.
- Dyslipidemia/CV Risk Reduction
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, 2024
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.
- If BAK can be tolerated at all:
- For those who are sensitive to BAK:
Last updated: Jan 15, 2025
Gliclazide MR tablets
All strengths and brands are on short (some Diamicron® MR 30 mg tablets may be available and some Apotex MR 30 and 60mg may be available).
- 2x MR 30 mg tablets are equivalent to 1x MR 60 mg tablet.
- 60 mg MR tablets can be halved to attain 30 mg.
Therapeutic alternatives:
- Glimepiride 1 mg, 2 mg, and 4 mg tablets are available (preferred to glyburide because of lower risk of hypoglycemia).
- Consider non-sulfonylurea antihyperglycemics, especially if cardiovascular disease (or high risk), heart failure, and/or chronic kidney disease.
See RxFiles Antihyperglycemic Type 2 Diabetes Agents and each of Diabetes Mellitus and Sulfonylureas in CPS. RxFiles and CPS are available through SHIRP.
Last updated: Jan 15, 2025
Glucagon
Injectable
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.
Nasal Spray
Baqsimi™ is available. A shortage until the end of Feb 2025 has been reported. If ordering rates remain the same, there may be enough product in the supply chain to prevent a complete shortage. Preventing hypoglycemia and discouraging stockpiling will be key. Diabetes Canada has issued a notice with recommendations. Please note that Baqsimi™ is not indicated for use in children < 4 years of age.
Last updated: Jan 27, 2025
- H-K
Drug Availability Hydrocortisone 1%/ pramoxine 1% rectal foam (Proctofoam-HC®)
Proctofoam-HC® is being shorted - indeterminate availability
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, 2024
Hydrocortisone-containing suppositories
- Proctodan HC (hydrocortisone, pramoxine, zinc sulfate) is being shorted - indeterminate availability
- Anusol HC (hydrocortisone, zinc sulfate) is being shorted - estimated availability Apr 15, 2025
Available:
- Anodan HC (hydrocortisone, zinc sulfate); Proctol (hydrocortisone, dibucaine, esculin, framycetin) suppositories
Last updated: Jan 15, 2025
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. Estimated availability is late Jan, 2025 for the 5% and early Apr 2025 for the 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 (4%, 5%*), cryotherapy and/or photodynamic therapy.
- Genital and perianal warts/condyloma acuminata
- Alternatives may include podophyllotoxin, cryotherapy, sinecatechins, or bichloroacetic acid or trichloroacetic acid. 5-fluorouracil (0.5% to 5%*) has been used off-label; evidence is limited.
- 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 (5%*), or photodynamic therapy.
*5-fluorouracil 5% is currently shorted.
Last updated: Jan 27, 2025
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, 2024
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, 2023
Ipratropium 0.5 mg/ salbutamol 2.5 mg nebules
Both marketed brands are shorted with earliest availability of early April 2025.
Alternatives:
- 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 [limited supply], 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: Jan 31, 2025
Isosorbide mononitrate 60 mg oral tablet
All brands shorting with estimated availability of Sep 2025.
For alternatives see document.
Last updated: Jan 15, 2025
- L-O
Drug Lamivudine 10 mg/ml oral solution
3TC is the only marketed brand - estimated availability Feb 2025
Alternatives:
- For therapeutic alternatives, see RxFiles - Hepatitis or HIV Overview. RxFiles is available through SHIRP.
- Consultation with an infectious disease specialist is advised.
Last updated: Dec 23, 2024
Locacorten® Vioform® topical cream and otic dropsSee clioquinol/flumethasone 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, 2024
Methotrimeprazine 5 mg tablet
AA Pharma is the only brand marketed and is shorted until mid-Mar 2025. 2 mg, 25 mg, and 50 mg tablets are available.
The manufacturer states the tablets are film-coated but have no special-release properties. The active ingredient is very light-sensitive so the tablets should not be split in advance. However, some patients may not be able to split their own tablets due to low vision, lack of dexterity, or other reasons.
Alternatives:- For therapeutic alternatives, see CPS Phenothiazines. CPS is available through SHIRP.
Last updated: Feb 3, 2025
Methylprednisolone acetate 20, 40, and 80 mg/mL
There have been shortages of all strengths and formats of Depo-Medrol®, though there may be intermittent supply of some formats.
Alternatives:
- Routes of administration of Depo-Medrol® include intra-articular (IA), intramuscular (IM), intra-synovial, intralesional. Other injectable corticosteroids:
- betamethasone acetate/betamethasone sodium phosphate 3 mg/3 mg per mL (IA, IM, intralesional, local/soft tissue)
- dexamethasone sodium phosphate 4 mg/mL, 10 mg/mL (IM, intralesional, local/soft tissue)
- triamcinolone acetonide 10 mg/mL (IA, intrabursal, intradermal, tendons)
- triamcinolone acetonide 40 mg/mL (IA, intrabursal, IM)
See CPS Corticosteroids: Systemic for dosing equivalents but also consult specific product monographs. CPS is available through SHIRP.
Last updated: Feb 6, 2025
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, 2024
Misoprostol 100 mcg and 200 mcg oral tablet
Single-ingredient misoprostol 100 mcg and 200 mcg tablets are shorted with indeterminate availability.
Alternatives:
- Treatment and prevention of gastroduodenal ulcers
- H. pylori eradication if applicable.
- Proton pump inhibitors (more effective than histamine2-receptor antagonists)
- For those taking NSAIDS:
- Reassess patient ulcer risk (see RxFiles).
- Prophylaxis recommended for those with moderate or high risk of NSAID GI toxicity.
- If low cardiovascular risk and moderate GI risk:
- Combination misoprostol/diclofenac or NSAID plus PPI
- If low cardiovascular risk and high GI risk:
- COX-2 inhibitor (celecoxib) plus PPI
- If high cardiovascular risk and low to moderate GI risk:
- Naproxen + PPI
- If low cardiovascular risk and moderate GI risk:
- For more information, see RxFiles Acid Suppression Drugs and CPS Dyspepsia and Peptic Ulcer Disease. RxFiles and CPS are available through SHIRP.
- H. pylori eradication if applicable.
- Termination of intrauterine pregnancy
- The preferred regimen for medical termination of pregnancy is mifepristone + misoprostol. Note that Mifegymiso, which contains both of these agents, is available.
- Also see the 2023 SOGC statement (note that circumstances surrounding the shortage may differ from what is presented in the document).
Last updated: Feb 11, 2025
Moxifloxacin 400 mg tablet
Most brands are shorting. Earliest availability: early Feb 2025.
Auro brand may be available.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: Jan 15, 2025
Naproxen sustained-release tablet
Naprosyn® SR 750 mg 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, 2024
Nevirapine 200 mg tablet
Indeterminate availability
For alternatives, see RxFiles HIV Drug Comparison chart. RxFiles is available through SHIRP.
Last updated: Dec 27, 2024
Nitrofurantoin
- Nitrofurantoin BID 100 mg capsules (macrocrystal/monohydrate) - late Feb 2025
- Nitrofurantoin 50 mg capsules (macrocrystal) - late Feb 2025
- Nitrofurantoin 100 mg capsules (macrocrystal) - late Feb 2025
- Nitrofurantoin 50 mg tablets - early Apr 2025
- Nitrofurantoin 100 mg tablets - 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 (when used for treatment). It is reasonable to split AA Pharma Nitrofurantoin 100 mg tablets, which are scored; nitrofurantoin may be a skin irritant. A pill-splitter should be used to split tablets to ensure less variation in size and reduce risk of injury. As a general rule, tablets should not be split in advance to minimize exposure to light and moisture; however, some patients may not be able to split their own tablets due to low vision, lack of dexterity, or other reasons.
- 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: Jan 16, 2025
Nystatin oral suspension
Intermittent availability.
Bulk powder is available for compounding.
- Medisca provides several compounding formulae .
- Contact DPEB regarding coverage for compounded suspensions.
Last updated: Jan 13, 2025
Olsalazine 250 mg capsule
Dipentum® 250 mg capsules shorting. Expected to be available early Mar 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: Feb 3, 2025
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 2025. An oral suspension can be compounded. Contact a compounding pharmacy for more information.
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, 2024
- P-R
Drug Availability Peginterferon alfa-2a (Pegasys®)
Pegasys® is the only marketed brand of peginterferon alfa-2a and is shorted with indeterminate availability.
- 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 has been depleted before a new batch could be produced. 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.
Last updated: Jan 14, 2025
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, 2024
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, 2024
Pizotifen 1 mg tablet
Sandomigran DS - shorting until mid-Mar 2025
For therapeutic alternatives, see RxFiles - Migraine: Acute & Prophylaxis. RxFiles is available through SHIRP.
Last updated: Dec 23, 2024
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, 2024
Potassium chloride
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, 2024
Praziquantel 600 mg oral tablet
Biltricide® is shorting with an unknown end date.
- Health Canada has authorized importation of Middle Africa-labelled Biltricide®, which shares the same active ingredient, strength, and dosage form of the Canadian product.
- The Middle Africa product has different indications and dosage regimens - refer to the Canadian product monograph, which will be distributed with the imported product, as well as the risk communication.
- See the DPEBB bulletin for pseudoDIN and billing/dispensing information.
- Note that the Middle Africa product is packaged in bottles of 4 tablets, whereas the Canadian product is bottles of 6 tablets.
Last updated: Jan 23, 2025
Prazosin 5 mg oral tablet
Canadian prazosin 5 mg tablets are shorted with indeterminate availability. Canadian-labelled 1 mg and 2 mg tablets are now available.
US-labelled 5 mg capsules have been imported and are 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.
Last updated: Feb 6, 2025
Prevnar 13See Pneumococcal 13-valent conjugate vaccine Prochlorperazine injectable
Injectable formulation discontinued by manufacturer.
Alternate forms: 5 mg and 10 mg oral tablets and 10 mg rectal suppositories are still marketed.
Therapeutic alternatives: See document
Last updated: Dec 6, 2024
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)
- motor symptoms (tremor) of Parkinson's disease
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, 2024
Progesterone effervescent vaginal tablet
Endometrin® is shorting with indeterminate availability.
- Crinone® vaginal gel or micronized progesterone capsules inserted vaginally may be suitable alternatives. Consult with fertility specialist.
Last updated: Jan 7, 2025
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, 2023
Proparacaine 0.5% ophthalmic solution
Alcaine, the only brand, is shorted until end of Jun 2025.
According to the Ophthalmic Essential Medication List for Canada, tetracaine 0.5% or 1% is a suitable alternative.
Last updated: Jan 24, 2025
Quinagolide
Quinagolide (Norprolac®) has been discontinued.
For alternatives see document
Last updated: Jul 16, 2021
Quinapril tablets
McKesson has Auro Quinapril/HCTZ 10/12.5 & 20/12.5 mg in stock.
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.A pill-splitter should be used to split tablets to ensure less variation in size and reduce risk of injury. As a general rule, tablets should not be split in advance to minimize exposure to light and moisture; however, some patients may not be able to split their own tablets due to low vision, lack of dexterity, or other reasons.
For alternatives see RxFiles - ACEI Comparison Chart and CPS - ACE Inhibitors. Both are subscription only but available through SHIRP.
Last updated: Dec 24, 2024
Rabies vaccine Both rabies vaccines, Imovax® and Rabavert, are unavailable through pharmacy suppliers. Rabavert is not expected until Nov 2025 and return of Imovax® is indeterminate.
Refer patients to Public Health where this vaccine may be available.
Last updated: Jan 7, 2025
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, 2024
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, 2024
Risperidone ODT
Mylan risperidone 0.5 mg oral disintegrating tablet (ODT) has been discontinued by the manufacturer. No other brands or strengths of ODTs are available.
Alternatives:
- An oral liquid is available.
- 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: Jan 16, 2025
- Background
- S-Z
Drug Availability Safinamide oral tablets
Onstryv® is the only marketed safinamide product. Both strengths are shorted with estimated availability of end of Mar 2025 (50 mg) and early Apr 2025 (100 mg).
- Safinamide is a monoamine oxidase B (MAO-B) inhibitor used in the treatment of Parkinson's Disease.
- Alternatives MAO-B inhibitors that are available include rasagiline and selegiline.
- Depending on symptoms and stage of disease, other agents (e.g., COMT inhibitors, dopamine agonists) or strategies (adjusting levodopa dose, frequency, and/or dosage form) may be beneficial.
- See RxFiles Parkinson's Disease or CPS Parkinson Disease. RxFiles and CPS are available through SHIRP.
Last updated: Feb 3, 2025
Salbutamol for inhalation
Shortages have been reported for all formats. Currently there is inventory of some pressurized metered dose inhalers (pMDIs) and the dry powder inhaler (Diskus).
- Supply has been impacted by increased demand and manufacturing disruptions. Manufacturers are allocating supply based on historical demand and supply is expected to be constrained throughout Q1 2025. Allocations are in place and are expected to remain in place until at least April 2025.
- Health Canada has declared a Tier 3 shortage, which has allowed for exploration of mitigation strategies such as importation, if suitable foreign supply can be sourced.
- It is crucial to refrain from stockpiling.
See medSask/CPhA document regarding potential alternatives.
Last updated: Feb 5, 2025
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.
Last updated: Dec 1, 2022
Sevelamer powder for suspension
Renvela® powder for suspension is to be discontinued by Mar 31, 2025. No other brands are marketed.
Note that both sevelamer carbonate and sevelamer HCl (Renagel®) oral tablets are available.
For those who are unable to swallow tablets, consult dialysis units. Options may include:
- Calcium carbonate: while there are generally reasons why calcium carbonate is not appropriate for patients needing sevelamer, variables may have changed in some cases and it may be worth exploring again
- Lanthanum carbonate (generic): a chewable tablet
- Sucroferric oxyhydroxide (Velphoro®): a chewable tablet; note this product may be unpalatable and/or associated with GI intolerance
Last updated: Dec 18, 2024
Sofracort® eye/ear drops
See Framycetin/gramicidin/dexamethasone Somatropin injection
Nutropin Aq® has been discontinued, though stock may still be available. Humatrope® will be discontinued by the end of 2025.
Alternatives:
- See medSask's comparison of somatropin products
Last updated: Feb 3, 2025
Stieprox® shampoo
This has been discontinued. See the ciclopirox olamine 1.5% shampoo listing for details. Sulfamethoxazole /trimethoprimSee 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, 2023
Testosterone, injectable
Testosterone cypionate:
- Taro-testosterone cypionate 100 mg/ml: estimated availability of mid-Feb 2025
- Depo-Testosterone 100 mg/ml: indeterminate availability
Testosterone enanthate:
- Hikma testosterone enanthate is on allocation. Contact your wholesaler for details.
See medSask's Testosterone Products Available in Canada for pharmaceutical alternatives.
Last updated: Dec 31, 2024
Timolol 0.25%, 0.5% ophthalmic solution
Gel-forming formulation (XE): both strengths shorted with earliest availability Mar 2025.
Regular formulation: both strengths shorted with earliest availability Mar 2025.
Alternatives:
- See CPS - Glaucoma (available through SHIRP) and medSask's Glaucoma Agents, Topical for alternatives.
Last updated: Feb 4, 2025
Tobramycin inhalation powder
Tobi® Podhaler® is the only brand of tobramycin inhalation powder and is shorted until late Feb/25.
Currently, Tobi® and Teva-tobramycin inhalation solutions are available.
- Both the Podhaler and the inhalation solution products are indicated for the management of cystic fibrosis patients with chronic pulmonary Pseudomonas aeruginosa infections.
- If the products designated for inhalation are unavailable, 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: Jan 9, 2025
Tolterodine LA capsule 2mg and 4mg
All generic brands are shorting. Estimated availability: early Feb 2025. There is intermittent supply of Detrol® LA.
Alternatives:
- Tolterodine IR (immediate release) tablets are in stock, however, there are shortage reports for these. 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: Jan 7, 2025
Tramadol extended release tablets (Tridural®, Taro-Tramadol ER)
All strengths of Tridural® tablets are shorted with estimated availability of mid-Apr 2025.
Taro-Tramadol ER has the same kinetics as Tridural® and is considered interchangeable by some formularies; 100 mg tablets are available but 200 mg and 300 mg tablets are not.
Durela®, Ralivia®, and Xytram XL® are long-acting tramadol products ; these products have varying kinetics as detailed in medSask's comparison table.
Last updated: Feb 4, 2025
Tretinoin, 0.05% topical cream
Retin-A® 0.05% cream is shorted with estimated availability of late Feb 2025. All strengths of Stieva-A® and Vitamin A Acid have been discontinued.
Alternatives:
- Retin-A® 0.025% gel is available.
- Retin-A® Micro gel (0.04% and 0.1%) are available.
- Other 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: Feb 3, 2025
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, 2024
Trifluridine ophthalmic solution
Viroptic® ophthalmic solution 1% has been discontinued.
Alternatives:- Eyezirgan® (Ganciclovir) ophthalmic gel 0.15% is available (indicated for herpes simplex keratitis).
Last updated: Jan 31, 2025
Trimeprazine tablets
Panectyl tablets have been discontinued by the manufacturer. No other brands are marketed.
Last updated: May 10, 2024
Valproic acid 500 mg EC capsules
Shorted with an estimated availability late May 2025.
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: Feb 7, 2025
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, 2024
Zolmitriptan 2.5 mg orally dissolving tablets (ODT)
All brands are shorted with earliest availability May 2025.
Alternatives:
- Zolmitriptan 2.5 mg regular tablets
- Zolmitriptan nasal sprays (2.5 & 5 mg)
- See RxFiles Migraine or CPS Headache in Adults for therapeutic alternatives. RxFiles and CPS are available through SHIRP.
Last updated: Feb 7, 2025
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