Specific Drug Shortages & Discontinuations

Drugs are listed by generic name   

A-B

Drug	Availability / Alternatives
Abatacept subcutaneous injection	Orencia® subcutaneous injection is on short with indeterminate availability. This has been deemed a Tier 3 shortage and Health Canada has approved importation of the US-labelled and the Saudi Arabia-labelled Orencia® SC.  Risk communications:  US imported  Saudi Arabia imported  For therapeutic alternatives, see RxFiles: Rheumatoid Arthritis: DMARDs. RxFiles is available through SHIRP. Last updated: Jul 15/24
Acyclovir oral suspension	Zovirax® oral suspension has been discontinued by the manufacturer. Alternatives: Acyclovir tablets can be dispersed in 20-50 ml of water. An oral suspension can be compounded. Medisca supplies a formula. Last updated: May 27/24
Adefovir	Adefovir 10 mg tablets. Indeterminate availability For therapeutic alternatives see RxFiles Hepatitis B Drug Therapy. RxFiles is available through SHIRP  Last updated: July 12/24
Alfuzosin 10 mg tablets	Intermittent availability of the IR tablets. Alternatives: (please note that there are current supply issues with all uroselective alpha1- blockers) Alfuzosin XR 10mg tablets are available. Tamsulosin, silodosin and alfuzosin are uroselective alpha1- blockers. Tamsulosin and silodosin can be initiated at the full maintenance dose. The non-selective alpha1-blockers doxazosin and terazosin are equally effective for BPH but have a higher incidence of side effects eg orthostatic hypotension. Start with low dosage and titrate to minimize these effects. For more detailed information, see CPS: Alpha1-Adrenergic Receptor Antagonists and Lower Urinary Tract Symptoms & Benign Prostatic Hyperplasia. CPS is available through SHIRP. Last updated: Jul 12/24
Antibiotics - pediatric formulations	Pediatric formulations of many commonly used antibiotics are undergoing shortages -  For specifics, see listing under individual medication. Pharmacists may help minimize the shortages: 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
Betamethasone dipropionate 0.05% with glycol topical cream	Topilene cream is shorting. Estimated availability: late Aug/24 Alternatives: Topilene 0.05% topical ointment and lotion are available For topical corticosteroid creams of similar potency, see RxFiles Topical Corticosteroids. RxFiles is available through SHIRP.  Last updated: Jun 24/24
Betamethasone dipropionate 0.05%/salicylic acid 2% scalp lotion	Ratio-Topisalic scalp lotion  - expected availability of late Aug/24 See CPS (subscription) - Dandruff & Seborrheic Dermatitis or Psoriasis for alternative treatments. Last updated: Jul 12/24
Betamethasone valerate 0.05% topical lotion	Ectosone 0.05% topical lotion - estimated availability of September/24 For corticosteroid lotions of similar potency, see RxFiles Topical Corticosteroids. RxFiles is available through SHIRP.  Last updated: Jun 14/24
Budesonide nasal spray	Mylan 64 & 100 mcg nasal spray: indeterminate availability. Rhinocort® Aq 64 mcg is in stock For alternative corticosteroid nasal sprays, see CPS (subscription) - Allergic Rhinitis. CPS is available through SHIRP. Last updated: Apr 25/24
Budesonide nebules	The 250 mcg/mL and 500 mcg/mL nebules are shorting with indeterminate availability. Alternatives: Pulmicort® 125 mcg/mL nebules Pulmicort® turbuhaler Nebulized solution can be compounded For therapeutic alternatives, see RxFiles Asthma, available through SHIRP. Last updated: Jul 15/24
Buprenorphine Implant	Probuphine®  80 mg implant has been discontinued. Information from manufacturer: The reason for discontinuation is due to the inability to successfully acquire continued supply and is unrelated to any safety concerns. Last updated: Jul 5/23

C

Drug	Availability
Carbamazepine oral	On short: The 200 mg and 400 mg CR tablets. Earliest availability: mid-Aug/24 All brands of the 200 mg immediate-release (IR) tablets - intermittent availability Alternatives: Health Canada has approved importation of US-labelled carbamazepine extended release tablets by Septa pharmaceuticals.  Only a limited quantity will be available. See the DPEB bulletin for risk communication and billing details. Carbamazepine chewable 100 and 200 mg tablets are available. To switch from IR to chewable tablets: Straight switch - same dose and frequency. To switch from CR to IR/chewable tablets: The dose frequency of IR/chewable products depends on the indication and may range from twice daily to four times daily.  The total daily dose of carbamazepine may need to be reduced if switching from CR to IR/chew for seizure disorder. Monitor plasma levels (when relevant, such as for seizure disorder) and clinical response.  Tegretol 100mg/5 mL suspension is available. To switch from IR tablets to suspension: Use the same daily dose. The suspension produces higher peak levels than the same dose in tablet form therefore should be dosed TID-QID. Monitor plasma levels (when relevant, such as for seizure disorder) and clinical response.  CPhA has a drug shortage document based on recommendations from the Canadian League Against Epilepsy. Last updated: Jul 12/24
Chlordiazepoxide capsule	To be discontinued by the manufacturer. Some 25mg capsules may be available until Dec/24 For alternatives, see RxFiles (subscription) - Benzodiazepines. RxFiles is available through SHIRP. Last updated: Jul 12/24
Cholestyramine oral powder	All brands/formulations are shorting. Estimated availability: Cholestyramine light formulations - late Aug/24 Olestyr regular - Nov/24 Alternatives: There are supply challenges with all bile acid sequestrants, however, Glenmark Pharmaceuticals US-labelled Colesevelam 625 mg tablets are now available. See details in the colesevelam listing. A CPhA comparison of bile acid sequestrants is available here.  Diarrhea: see CPS (subscription) Diarrhea. Cholestatic pruritus: cholestyramine is an option for symptomatic treatment. Other options include rifampin, naltrexone, sertraline. Dyslipidemia: see CPS (subscription) Dyslipidemias or RxFiles (subscription) Lipid Lowering Therapy.  CPS and RxFiles are available through SHIRP. Last updated: Jul 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
Clioquinol 3%/ Flumethasone pivalate 0.02% topical cream	Locacorten® Vioform® cream. Estimated availability of Oct/24 Lotriderm® and Vioform® HC∗ are combination antifungal/corticosteroid creams that may be suitable alternatives ∗ no longer stocked at McKesson Last updated: Jun 10/24
Clomiphene	Clomid® and Serophene® - discontinued      Alternatives:       Compounded by compounding pharmacy or pharmacological alternatives - see  document
Codeine multi-agent cough and cold syrups	Intermittent shortages of some codeine-containing cough and cold syrups. Breakdown of medications in the marketed products listed at McKesson : 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
Colesevelam	Apo-colesevelam 625mg tablets: Indeterminate availability. Lodalis 625mg tablets: estimated availability of early Aug/24 Health Canada has approved importation of Glenmark Pharmaceuticals US-labelled Colesevelam 625 mg tablets and these are now available. For product differences and other considerations, see their risk communication.  Formulary status of the imported Glenmark Pharmaceuticals product:  Temporarily listed as a non-interchangeable full Formulary benefit of SK DPEBB. See bulletin here.  Temporarily added to the Non-Insured Health Benefits formulary for the duration of the importation and sale approval from Health Canada.  At this time there are supply challenges with all bile acid sequestrants. A CPhA comparison of bile acid sequestrants is available here.  Last updated: Jul 12/24
Colestipol	Colestid® granules and tablets are shorted. No date given for availability.  Alternatives: There are supply challenges with all bile acid sequestrants, however, Glenmark Pharmaceuticals US-labelled Colesevelam 625 mg tablets are now available. See details in the colesevelam listing. A CPhA comparison of bile acid sequestrants is available here.  Diarrhea: see CPS (subscription) Diarrhea. Dyslipidemia: see CPS (subscription) Dyslipidemias or RxFiles (subscription) Lipid Lowering Therapy.  CPS and RxFiles are available through SHIRP. Last updated: Jul 12/24
Contraceptives, Hormonal (Oral)	For discontinued or shorted products refer, to SK Formulary for similar ingredients or RxFiles Combined Oral Contraceptives for similar hormonal activity. RxFiles is available through SHIRP.
Co-trimoxazole (sulfa- methoxazole /trimethoprim) Oral Suspension	Suspension is shorted with indeterminate availability date.  The regular, DS, and pediatric tablets are available. See document for management options. Last updated: Feb 15/24

D

Drug	Availability
Dapsone topical	Aczone® topical gel is shorting with estimated availability of late-Aug/24.  There are no other brands of topical dapsone. For alternatives see medSask Minor Ailment Acne guideline or CPS Acne. Both are available through SHIRP. Last updated: Jul 12/24
Desonide ointment	Estimated availability: May 2025 Alternatives: Desonide topical cream remains available. For topical corticosteroids of similar potency, see RxFiles Topical Corticosteroids. RxFiles is available through SHIRP.  Last updated: Jul 15/24
Diclofenac/misoprostol tablets	All brands of diclofenac/misoprostol 50 & 75 mg are shorting. Earliest availability: late July/24 Alternatives: Diclofenac 25 mg & 50 mg tablets and diclofenac SR 75 mg tablets are available. Misoprostol 100mg & 200 mcg tablets are available. See RxFiles (subscription) NSAIDS & Other Analgesics for other alternatives. RxFiles is available through SHIRP. Last updated: Jul 12/24
Dipyridamole/ASA 200/25 mg capsule	Estimated availability: January 2025 See document for alternatives. Last updated: Jul 12/24

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
Estradiol vaginal ring	Estring® - estimated availability: late August/24 Alternative vaginal estrogens include: Vagifem® vaginal tablet Imvexxy® vaginal insert Estragyn® and Premarin® vaginal creams See RxFiles: Menopause Hormone Therapy for details. RxFiles is available through SHIRP. Last updated: Jul 12/24
Estradiol transdermal patch	Several brands/strengths of estradiol patches are shorting. Estradot®  and Sandoz-estradiol patches are interchangeable. Oesclim® , Estradot®  and Climara® patches are NOT considered interchangeable by the SK drug plan.  Climara® patches are changed once weekly; Oesclim® & Estradot® are changed twice weekly. While cutting transdermal patches is not ideal, it is acceptable for matrix patches of medications with wide therapeutic indices (all of the estradiol patches are matrix). There are limited data regarding stability of cut patches, but some data of estrogen patches (not necessarily the same products available here) suggests cut patches maintain concentrations when returned to the original pouch and stored at labeled storage conditions for up to 1 month after cutting. It seems reasonable to apply this data to all estrogen matrix patches. Cutting square and rectangular-shaped patches on the diagonal may result in more even doses. Considering many people use estrogen patches for symptomatic treatment, dosage accuracy may not be critical, but something to keep in mind if symptoms are not controlled as well using cut patches.  Estradiol gel is another transdermal option. See RxFiles Postmenopausal Therapy for more information. RxFiles is available through SHIRP. Last updated: Apr 25/24
Evusheld™	Evusheld™ has been discontinued by the manufacturer. See medSask's COVID-19 treatments for alternate treatment options (specific to Saskatchewan only). Last updated: Apr 5/24
Exenatide Injection	Byetta® 1.2 & 2.4 ml prefilled pens and Bydureon® injection have been discontinued by the manufacturer. No other forms or brands of exenatide are available. For GLP-1 receptor agonist alternatives see CPS (subscription): Diabetes Mellitus. CPS is available through SHIRP.
Ferrous Fumarate Oral Suspension	JAMP 60 mg/mL suspension is shorted with estimated availability of December/24. Palafer 20mg/ml suspension is back in stock Ferrous fumarate 300 mg capsules and tablets are available.  Ferrous sulfate liquids in various concentrations available.  Elemental iron content of salts:  Ferrous fumarate: 33% Ferrous sulfate: 20% Ferrous gluconate: 12%  Last updated: Jul 12/24
Fluphenazine decanoate injection	Both brand name (Modecate®) and generic products have been discontinued.    See document for alternative antipsychotic depot injectables. Oral dosage forms are available.
Formula, Infant	A temporary closure of Abbott Nutrition’s U.S. based facility in 2022 resulted in limited supply of infant formula. Specialty formulas were first affected, though the supply of these has largely stabilized. However, strain shifted to supply of regular infant formula in the autumn of 2022 and is expected to continue into the summer of 2023. Supply of liquid formulations has been stable, but the more popular powder formulations are often unavailable. Health Canada continues to import formulas through the interim policy. See CPhA’s Infant Formula Shortage: Information for Pharmacy Professionals, which has comprehensive information, including Health Canada websites and documents. Last updated: 09 May 2023
Gemfibrozil tablets	Indeterminate availability Considerations: Consider if a fibrate is warranted. Dyslipidemia/CV Risk Reduction Primary prevention: fibrates play no role. Secondary prevention: fibrates may be considered if statin intolerance, although ezetimibe and PCSK9 inhibitors are preferred. Hypertriglyceridemia Fibrates are first-line if fasting TG > 10.0 mmol/L despite weight loss, glycemic control, and diet modification. Alternatives: 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.
Gliclazide MR 60 mg  tablets	All brands shorting with earliest availability: late August/24 Gliclazide MR 30mg tablets are now available 2x MR 30 mg tablets are equivalent to 1x MR 60 mg tablet. Last updated: Jul 12/24
Glucagon for Injection 1 mg/mL	Eli Lilly and Novo Nordisk have discontinued their injectable glucagon products; currently there are no Canadian products available.   Health Canada has imported a US-labelled glucagon 1 mg/mL (Amphastar). Note that this product is very similar to the Canadian emergency kit products in terms of how supplied and dose. However, the products are not considered equivalent and US labelling needs to be followed. Monitor closely for effect. See DPEB Bulletin (including PseudoDIN) and risk communication. Baqsimi™ (glucagon nasal spray) remains in stock. Please note that Baqsimi™ is not indicated for use in children < 4 years of age. Last updated:  Jan 22/24

H-K

Drug	Availability
Hepatitis A vaccine	Some adult hepatitis A vaccines are shorted. Pediatric hepatitis A vaccine and combination hepatitis A/hepatitis B vaccine (adult and pediatric) are available. See document for strategies. Last updated: Jul 12/24
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) - estimated availability: mid-Aug/24 Proctol (hydrocortisone, dibucaine, esculin, framycetin) -  estimated availability: early-mid Aug/24 Available: Anusol-HC, Anodan-HC (hydrocortisone, zinc sulfate)    Last updated: Jul 12/24
Indacaterol Breezhaler®	Onbrez® Breezhaler® has been discontinued by the manufacturer. There are no other products containing indacaterol alone. Alternatives: There are inhalation products containing indacaterol in combination: Atectura® Breezhaler® - indacaterol & mometasone Ultibro® Breezhaler® - indacaterol & glycopyrronium Enerzair® Breezhaler® - indacaterol, mometasone & glycopyrronium For LABA alternatives, see RxFiles COPD Drug Comparison chart. RxFiles is available through SHIRP.
Infant Formula	See "Formula, Infant"
Insulin - premixed	Novolin® GE 40/60 and 50/50 penfills have been discontinued by the manufacturer.  See RxFiles Insulin Comparison Chart for alternate insulin choices. RxFiles is available through SHIRP. Last updated: April 6/23
Iron dextran injection	Dexiron has been discontinued For alternatives see document
Isosorbide mononitrate 60 mg oral tablet	McKesson has Apotex in stock All brands shorting with estimated availability of Sep/24 For alternatives see document. Last updated: Jul 12/24

L-O

Drug
Lithium 300 mg sustained-release tablet	Lithmax® is the only sustained-released (SR) lithium product marketed. Expected availability of early Aug/24. Lithium immediate-release (IR) capsules remain available.  At the beginning of therapy, IR is typically administered in 2 to 3 daily doses and SR in 2 daily doses. For both formulations, after several weeks at an established dose, the dose can be consolidated to one dose at bedtime. For patients who have been on a once daily dose of SR and have tolerated it well, it is possible to convert to IR at the same once daily dose; however, this may increase the risk of adverse effects. If adverse effects are of concern, consider dividing the same daily dose into 2 doses at initial switch to IR. This can then be consolidated to a once daily dose at bedtime after a few weeks if tolerated.  For patients who have been on 2 daily doses of SR, convert to IR at the same dose and frequency, though if not tolerated, the daily dose can be administered in 3 divided doses. Monitor: Adverse effects: fatigue, fine tremor in hands, nausea, loose stools Symptom control Lithium levels 5 days after a change in formulation. Drawing 12 hours after the last dose is preferred, but if this is not possible, draw at least 8 hours after the last dose.   Last updated: Jul 12/24
Locacorten® Vioform®   topical cream	See clioquinol/flumethasone.
Loxapine oral tablet	The 10 mg tablets are on short.  Earliest availability:  early-mid August/24 The 2.5 and 25mg tablets are available. For information on alternative antipsychotics, see RxFiles: Antipsychotics. RxFiles is available through SHIRP. Last updated: Jul 15/24
Loxapine 50mg/ml injection	On allocation - for more information contact Sandoz at 1-800-361-3062 or info.clients@sandoz.com  For alternative antipsychotic injections, see RxFiles: Antipsychotics. RxFiles is available through SHIRP. Last updated: Jun 5/24
Megestrol 160 mg tablet	Estimated availability - Sept/24.  Only the AA brand is marketed. The 40 mg tablets are now available. Last updated: Jun 14/24
Methadone, Metadol®-D liquid (OAT)	There have been intermittent periods in which Metadol®-D is not available.  The only other methadone products that can be used for opioid agonist therapy (OAT) are:  Methadose™ Sugar Free (and generics, Jamp, Odan)  Methadose™ Cherry Flavoured (and generic, Odan) Methadose™ Sugar Free (or generics) is preferred because there have been reports of destabilization following switches to the Cherry Flavoured (and generic) product.  A new prescription is required when switching to a different methadone product as they are not interchangeable.  See Commercially Available Methadone for Opioid Agonist Therapy. Notes:  Metadol® cannot be used for opioid agonist therapy because it holds Exceptional Drug Status (SK Drug Plan) and Limited Use Benefit (NIHB) status for pain only.  Methadone solutions cannot be compounded while commercial product is available as per Health Canada policy. Last updated: Feb 15/24
Methazolamide tablets	AA-methazolamide 50mg tablets are shorted with expected availability of Oct/24 No other strengths or brands are manufactured. Alternatives: Acetazolamide is the only other oral carbonic anhydrate inhibitor available. See CPS Glaucoma for acetazolamide dosing & alternative treatments. CPS is available through SHIRP. Last updated: Jun 5/24
Methylphenidate, Long Acting	Biphentin®, Foquest®, generic methylphenidate ER-intermittent shortages of some strengths. Alternatives: Some strengths of the formulations may be available. Concerta® is available but is NOT interchangeable with the generic methylphenidate ER. Note that Biphentin®, Foquest® and Concerta® are not interchangeable. Ritalin® SR and Sandoz-methylphenidate SR tablets have been discontinued.  Apo-methylphenidate SR 20 mg is still marketed. Last updated: Oct 14/22
Methylprednisolone  4 mg tablet	Medrol 4 mg is shorted. Estimated availability: late Aug/24. No other brands are available.  16 mg tablets can be quartered (cross-scored).  These are immediate-release tablets and no safety/efficacy concerns regarding splitting have been identified. As a general rule, a pill-splitter should be used to split tablets to ensure less variation in size and tablets should not be split in advance to minimize exposure to light and moisture. Last updated: Jul 12/24
Mounjaro®	See Tirzepatide
Moxifloxacin 400 mg oral tablet	Moxifloxacin 400 mg oral tablets are shorted with earliest availability: end of Sept/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   RxFiles (available through SHIRP) CPS (available through SHIRP) Last updated: Jul 5/24
Mumps, Measles, Rubella (MMR) Vaccine	Inventory of MMR vaccine is limited due to increased demand. Currently, it is not available for private purchase. Refer to Public Health, which has some supply.  Last updated: Mar 27/24
Nevirapine 200mg tablet	Estimated availability: September/24 For alternatives, see RxFiles HIV Drug Comparison chart.  RxFiles is available through SHIRP. Last updated: Jul 12/24
Nitrofurantoin	Intermittent availability of PMS-nitrofurantoin BID 100 mg capsules (macrocrystal/monohydrate). Nitrofurantoin 100 mg capsules (macrocrystal) are on short. Expected availability: mid-Aug/24 Nitrofurantoin 50 capsules (macrocrystal) and nitrofurantoin 50 mg & 100 mg tablets are available. Note the differences in dosing frequency among the different nitrofurantoin forms: BID nitrofurantoin products (original brand MacroBID®), including PMS-Nitrofurantoin BID, contain nitrofurantoin as macrocrystals (25%) and monohydrate (75%). Nitrofurantoin monohydrate (but not macrocrystals) forms a gel matrix when exposed to intestinal fluids. This matrix releases nitrofurantoin over time, which allows for twice daily dosing. AA Pharma Nitrofurantoin tablets and Teva-Nitrofurantoin capsules do not contain monohydrate and need to be administered four times daily. Dosing of these products for treatment of cystitis is 50 mg to 100 mg, four times daily. 50 mg four times daily has been found to be as effective as 100 mg twice daily of the BID product and is appropriate in most situations. If the only product on hand is 100 mg, go with that (QID).  See CPS - Nitrofurantoin (CPhA Monograph) for dosing of all nitrofurantoin products. CPS is available through SHIRP.  See Bugs & Drugs: Urinary Tract Infections for therapeutic alternatives.  Last Updated: Jul 12/24
Nitroglycerin spray	RHO Nitro and Nitrolingual pump sprays are back in stock! Health Canada has approved importation of a UK-authorized nitroglycerin spray. This product has been temporarily listed on the Saskatchewan Drug Plan formulary and is not interchangeable with the currently listed products. See the Drug Plan bulletin for pseudoDIN, product differences, and FAQs. The risk communication is here. Last updated: Jul 12/24
Nystatin cream, topical	Nyaderm is the only marketed brand and is shorted until early Aug/24. For treatment of cutaneous or mucocutaneous infections caused by C albicans (e.g., diaper dermatitis), alternative topical antifungals include imidazoles (clotrimazole, miconazole) (preferred), ciclopirox, and ketoconazole. See CPS Diaper Dermatitis or RxFiles OTC Products. Both are available through SHIRP.  Last updated: Jul 12/24
Nystatin cream, vaginal	Nyaderm is the only marketed brand and is shorted until mid-July/24. For treatment of vulvovaginal candidiasis, alternative options are preferred, including vaginal imidazoles (clotrimazole, miconazole) or oral fluconazole. See RxFiles Antifungals, available through SHIRP.  Last updated: Jul 12/24
Nystatin oral suspension	All brands shorting - estimated availability: mid-Aug/24 Bulk powder is available for compounding. Medisca provides several compounding formulae . Contact DPEB regarding coverage for compounded suspensions. Last updated: Jul 12/24
Olsalazine 250 mg capsule	Dipentum®  250 mg capsules shorting. Estimated availability: late-Sep/24. 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: Jul 12/24
Orencia® subcutaneous injection	see abatacept
Oxybutynin: long-acting formulations and topical gel	Ditropan XL® tablets, Oxytrol® transdermal patches and Gelnique®  topical gel have been discontinued by the manufacturers. Alternatives: Generic oxybutynin 2.5 mg & 5 mg immediate release tablets and 1 mg/ml syrup are available. For therapeutic alternatives, see RxFiles: Urinary Incontinence. RxFiles is available through SHIRP. Last updated: May 5/22

P-R

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
Penicillin G - benzathine	Bicillin® L-A is on allocation.  If you have questions or need to increase your allocation, contact Pfizer at 1-888-999-8750 or allocation@Pfizer.com  Last updated: Feb 15/24
Periciazine oral capsule	Neuleptil® capsules are shorting with indeterminate availability. Neuleptil® oral solution 10 mg/ml is available. For therapeutic alternatives, see CPS (subscription): Phenothiazines: CPhA monograph. CPS is available through SHIRP Last updated: Jun 5/24
Pizotifen 1 mg tablet	Sandomigran DS - estimated availability: mid-August/24 For therapeutic alternatives, see RxFiles - Migraine: Acute & Prophylaxis. RxFiles is available through SHIRP. Last updated: Jul 12/24
Pneumococcal 13-Valent Conjugate Vaccine (Prevnar 13)	Prevnar 13 has been discontinued and is no longer available for purchase by pharmacies.  Last updated: Jun 17/24
Potassium chloride (Slow-K®)	Slow-K® (NPN 80040226) 600 mg KCl (8 mEq K+) slow release matrix tablets and Sandoz/Euro K8 (DIN 02246734) have been discontinued.                       Alternative long-acting tablets providing 8 mEq K+: Jamp K-8 (NPN 80013005) 600 mg long acting tablet M-K8 (NPN 80035346) 600 mg long acting tablet  Please note: both of these are currently on short with estimated availability of Sep/24. Note: These products contain the same strength of KCl in a similar dosage form to Slow-K® and Sandoz/Euro K8 and are the closest alternatives. However, the products are not interchangeable. If patient is near the high or low ends of the potassium reference range or if patient has a history of frequent fluctuations, closer monitoring after transition is prudent.                                         Note: Inventory of the above products seems to fluctuate frequently. Alternative solid dosage forms providing 8 mEq K+: Jamp Potassium Cl ER 600 mg capsules (NPN 80062704) Please note: this is on short with indeterminate availability. Note: These capsules contain the same strength of KCl in a different, yet still modified release, dosage form. If patient is near the high or low ends of the potassium reference range or if patient has a history of frequent fluctuations, closer monitoring after transition is prudent. Alternative liquid providing 1.33 mEq/ml KCl+: Odan-Potassium Chloride (NPN 80046782) Jamp KCl liquid (NPN 80024835) PMS KCl liquid (DIN 02238604) Note: Because the absorption pattern will be quite different between Slow-K®/ other long-acting oral KCl tablets and the liquid, closer monitoring of all patients after transition is prudent. Alternative long-acting tablets providing 20 mEq K+: Sandoz K-20 (NPN 02242261) Odan K-20 (NPN 80004415) JAMP K-20 (NPN 80013007) Note: K-Dur tablets are no longer available, but were scored, sustained-release tablets that could be broken in half or dispersed in water. Though Sandoz K-20 tablets (NPN: 02242261) are also scored, sustained-release tablets, Sandoz suggests that K-20 long-acting tablets should not be split and must be swallowed whole to retain their sustained-release properties. Jamp Pharma confirmed that dividing their K-20 tablets (NPN: 80013007) would compromise the sustained-release properties of the tablets. This could be clinically significant as modified release formulations slow the release of potassium to avoid high local concentrations which may lead to gastric irritation. (Note: modified release solid dosage forms have been associated with a low risk of GI ulceration/bleeding in some circumstances and caution is necessary in people with delayed GI transit or impaired GI motility.) Splitting tablets may also lead to dose inaccuracy. Last updated: Jul 12/24
Prazosin tablets	All strengths/brands of prazosin tablets are shorting.  Earliest estimated availability: January 2025. US-labelled 1 mg, 2 mg, and 5 mg capsules have been imported and will be temporarily listed on the Saskatchewan Drug Plan Formulary. See DPEBB bulletin for details.  See document regarding use for hypertension and PTSD. Therapeutic alternatives for most other indications can be found in the CPS: Alpha1 Adrenergic Receptor Antagonists. CPS is available through SHIRP. Some compounding pharmacies are compounding capsules until commercial product is available or for strengths (e.g., 0.5 mg) not attainable with available product. Last updated: Jul 12/24
Prednicarbate 0.1% ointment	Dermatop® 0.1% ointment has been discontinued. The 0.1% cream is still available.  Last updated: Feb 14/23
Prevnar 13	See Pneumococcal 13-Valent Conjugate Vaccine
Prochlorperazine injectable	Injectable formulation discontinued by manufacturer.  Alternate forms: 5 mg and 10 mg oral tablets Therapeutic alternatives: See document Last updated: Sep 21/22
Prochlorperazine 10 mg rectal suppository	Sandoz has discontinued this product.  Odan may take over production in the future, but no suppositories are available at this time. For therapeutic alternatives see RxFiles (subscription) Migraine: Acute Therapy; Nausea & Vomiting Comparison. RxFiles is available through SHIRP. Last updated: Apr 6/23
Proctofoam-HC®	See Hydrocortisone 1%/Pramoxine 1% rectal foam.
Procyclidine oral tablets and elixir	All strengths and formulations of procyclidine have been discontinued. Procyclidine is an anticholinergic that has been used to treat: motor symptoms (tremor) of Parkinson's disease not first line; consider if anticholinergic therapy is still appropriate drug-induced parkinsonian symptoms (e.g., from antipsychotic agents)    For information about alternative anticholinergic agents or alternative treatment agents, See CPS Parkinson Disease, Schizophrenia and Related Psychotic Disorders; RxFiles Parkinson's Disease. CPS and RxFiles are available through SHIRP. Last updated: Jun 4/24
Progesterone effervescent vaginal tablet	Endometrin®  is shorting. Estimated availability: January 2025 Crinone® vaginal gel or micronized progesterone capsules inserted vaginally may be suitable alternatives. Consult with fertility specialist. Last updated: Jun 5/24
Promethazine injectable	Injectable formulation has been discontinued by the manufacturer. For information call 1-866-926-7653. Alternate forms: 50 mg oral tablets Therapeutic alternatives: see document Last updated: May 5/23
Quinagolide	Quinagolide (Norprolac®) has been discontinued. For alternatives see document
Quinapril tablets	Quinapril 5 mg and all strengths of quinapril/HCTZ are shorting. Availability is indeterminate. Quinapril 10 mg, 20 mg & 40 mg tablets, as well as HCTZ tablets, are in stock. Quinapril 10 mg tablets may be halved.  These are immediate-release tablets and no safety/efficacy concerns regarding splitting have been identified. As a general rule, a pill-splitter should be used to split tablets to ensure less variation in size and tablets should not be split in advance to minimize exposure to light and moisture. For alternatives see RxFiles - ACEI Comparison Chart and CPS - ACE Inhibitors. Both are subscription only but available through SHIRP. Last updated: Jun 6/24
Rabeprazole oral tablets	All strengths and brands are shorting - intermittent availability Use alternative oral PPIs:        Rabeprazole 20 mg ~ Pantoprazole 40 mg ~ Lansoprazole 30 mg ~ Omeprazole 20 mg ~ Esomeprazole 40 mg        Last updated: Jun 12/24
Ranitidine injectable	Product has been discontinued.  Change to alternative H2RA if required: IV: famotidine (APX, Omega) – in short supply Oral: famotidine 40 mg ~ nizatidine 300 mg ~ ranitidine 150 mg BID or 300 mg HS      Alternative PPIs: IV: pantoprazole             Oral: pantoprazole 40 mg ~ lansoprazole 30 mg ~ omeprazole 20 mg ~ esomeprazole 40 mg ~ rabeprazole 20 mg Nasogastric administration: esomeprazole, lansoprazole
Ranitidine oral solution	Indeterminate availability.              If dose corresponds to tablet strength (75, 150, 300 mg), tablet can be crushed and mixed with soft food such as applesauce immediately before administering.                         See documents for extemporaneous compounding and therapeutic alternatives. Last updated: Feb 15/24
Risperidone ODT	Mylan risperidone 0.5 mg ODT has been discontinued by the manufacturer. No other brands or strengths of ODTs are available. Alternatives: An oral liquid is available although this is currently on short (see listing below). The regular tablets can be dispersed in 10 to 20 mL water (may take 5 mins). If unable to swallow, Risperdal® Consta injections could be an option. For oral equivalent dosing and information on alternative antipsychotics, see RxFiles: Antipsychotics. RxFiles is available through SHIRP. Last updated: Dec 8/23

S-Z

Drug	Availability
Salbutamol solution for inhalation	Ventolin® 5 mg/ml respirator solution - indeterminate availability Salbutamol 2mg/ml 2.5 ml nebules - estimated availability: late Jul/24 Alternatives: Salbutamol 0.5 mg/ml and 1 mg/ml 2.5 ml nebules are in stock Last updated: Jul 12/24
Scopolamine transdermal patch	Transderm V transdermal patches have been discontinued by the manufacturer.  See therapeutic alternatives for select indications.
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.
Tamsulosin CR tablets	All brands are shorting. Earliest availability: late Jul/24. Alternatives: Jalyn® (tamsulosin/dutasteride 0.4/0.5 mg) capsules are available. Silodosin and alfuzosin are uroselective alpha1- blockers, though are also suffering supply constraints. These can be initiated at the full maintenance dose. The non-selective alpha1-blockers doxazosin and terazosin are equally effective for BPH but have a higher incidence of side effects eg orthostatic hypotension. Start with low dosage and titrate to minimize these effects. For more detailed information, see CPS: Alpha1-Adrenergic Receptor Antagonists and Lower Urinary Tract Symptoms & Benign Prostatic Hyperplasia. CPS is available through SHIRP. Last updated: Jul 12/24
Tamsulosin SR capsules	Indeterminate availability Alternatives: Jalyn® (tamsulosin/dutasteride 0.4/0.5 mg) capsules are available. Tamsulosin, silodosin and alfuzosin are uroselective alpha1- blockers. Alfuzosin and silodosin can be initiated at the full maintenance dose. The non-selective alpha1-blockers doxazosin and terazosin are equally effective for BPH but have a higher incidence of side effects e.g., orthostatic hypotension. Start with low dosage and titrate to minimize these effects. Consider these if needing an agent that can be crushed.   For more detailed information, see CPS: Alpha1-Adrenergic Receptor Antagonists and Lower Urinary Tract Symptoms & Benign Prostatic Hyperplasia. CPS is available through SHIRP. Last updated: Jul 12/24
Tazarotene 0.05% & 0.1% cream and gel	All Tazorac® products have been discontinued for business reasons. Tazarotene is now only available as a 0.045% topical lotion: Arazlo™. This is only indicated for acne. For alternatives, see CPS (subscription): Acne or Psoriasis. CPS is available through SHIRP.  Last updated: Oct 4/23
Testosterone enanthate 200mg/ml injection	Delatestryl® has been discontinued by the manufacturer.  Hikma testosterone enanthate 200 mg/mL is shorted with indeterminate availability. Testosterone cypionate 100 mg/mL (Depo-Testosterone) is available. See medSask's Testosterone Products Available in Canada for information about dosing and other formulations. Last updated: Jul 5/24
Timolol  regular & EX 0.25%  ophthalmic solution	Sandoz timolol 0.25% regular ophthalmic solution is on short. No other brands are marketed. Estimated availability: late Jul/24 Sandoz timolol EX 0.25% gel-forming solution is on short. No other brands are marketed. Estimated availability: Oct/24 Alternatives: Timolol 0.5% regular and EX ophthalmic formulations remain available. See CPS - Glaucoma for details and other alternatives. CPS is available through SHIRP. Last updated: Jul 12/24
Tirzepatide (Mounjaro®)	Intermittent availability The mymounjaro™ Patient Support Program was designed to provide patients with a seamless and supportive experience and it is an option for Canadian patients. Enrollment into the PSP includes support to find product in a patient’s region, in addition to a number of other resources. Information that has been developed for the Ozempic® shortage may apply to tirzepatide:  A quick guide, more comprehensive guidance document, and resources pertaining to use in diabetes are available on our shortage page. Therapeutic alternatives for obesity are here. Last updated: Jul 15/24
Tobramycin 60 mg/ml for inhalation	Both brands shorting. Earliest availability: mid-Aug/24. Alternatives: This formulation of tobramycin is indicated for the management of cystic fibrosis patients with chronic pulmonary (P. aeruginosa) infections. Any change in therapy should be directed by the CF team Tobi® podhaler is available Preservative-free IV tobramycin may be administered via inhalation. For details and information on alternative CF treatments, see RxFiles - Cystic Fibrosis. RxFiles is available through SHIRP. Last updated: Jul 5/24
Tramadol extended release tablets (Tridural®)	All strengths of Tridural® tablets are shorted. Estimated availability: late Sept/24 Taro-Tramadol ER has the same kinetics as Tridural® and is considered interchangeable by some formularies.  Durela®, Ralivia®, and Xytram XL® are long acting tramadol products ; these products have varying kinetics . Last updated: Jun 14/24
Travoprost Z 0.04% ophthalmic solution	All brands of travoprost Z 0.04% ophthalmic solution are shorted. Travatan® Z is expected late Jul/24. Travoprost Z is benzalkonium chloride-free, preserved instead with sofZia, an ionic buffered system. Alternatives Izba 0.03% is benzalkonium chloride-free, preserved instead with polyquaternium-1, and is available. Travoprost 0.04%, preserved with benzalkonium chloride, is available. All of these products are dosed one drop once daily in the evening. Last updated: Jul 12/24
Trifluoperazine	All strengths are shorting with indeterminate availability. For therapeutic alternatives, see CPS (subscription) - Phenothiazines (CPhA monograph). CPS is available through SHIRP. Last updated: Feb 15/24
Trifluridine	Viroptic® ophthalmic solution 1% has been discontinued.                         No other topical ophthalmic antivirals are currently available in Canada.                        Viral conjunctivitis does not usually require treatment, however, cold compresses and ocular lubricants may be used.                        If absolutely necessary - oral antiviral treatment.                        For more information, see CPS: Red Eye (available through SHIRP).
Trimeprazine tablets	Panectyl tablets have been discontinued by the manufacturer. No other brands are marketed. Last updated: May 10/24
Ulipristal	Ulipristal 5 mg (Fibristal) has been voluntarily withdrawn from the market in Canada due to risk of drug-induced liver injury. See Health Canada's risk communication.
Valproic Acid EC Capsules	Valproic Acid EC 500 mg capsules shorting with estimated availability of Sep/24 Alternatives: Valproic acid 250 mg capsules and 50 mg/ml syrup are available. Doses > 250 mg/day should be divided BID-TID. Divalproex sodium tablets – not interchangeable with valproic acid, but dosing is approximately the same. Switch to the same daily dosing schedule; once stabilized, it may be possible to reduce the frequency of doses (while maintaining the same total daily dose). Monitor for continued control of seizures / mood. Last updated: Jul 12/24
Verapamil sustained-release (SR) tablets	Verapamil SR 180 mg & 240 mg tablets are shorting with indeterminate availability. Alternatives: The 120mg SR tablets remain available - these should not be halved. Verapamil immediate release (IR) tablet strengths remain available. If converting from SR to IR tablets, use the same total daily dose (or closest possible) divided TID or QID. Monitor and adjust dose as required. SR capsules can be compounded. For therapeutic alternatives, see RxFiles - Calcium Channel Blocker (CCB). RxFiles is available through SHIRP. Last updated: May 13/24
Vitamin D 50,000 IU oral capsule	All brands shorting. Estimated availability: late Jul/24 The 10,000 IU oral formulations remain in stock. Please note that the 10,000 IU and most 50,000 IU products are Vitamin D3 (cholecalciferol). Some older 50,000 products were Vitamin D2 (ergocalciferol). Cholecalciferol and ergocalciferol are not considered interchangeable. See RxFiles Vitamin D: Q & A for more details. RxFiles is available through SHIRP. Last updated: Jul 12/24

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