Drug Shortages and Discontinuations

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Drug shortages can occur for a variety of reasons.The factors currently affecting drug supply are shortages of raw materials, quality control issues which lead to voluntary withdrawal and longer production times for some products and competition among drug manufacturers. The problem is expected to ease somewhat with renewed production in some cases and takeover of supply by another company in others. For more details see the environmental scan on Drug Supply Disruptions posted on the CADTH website.

In the meantime, healthcare providers are responsible for ensuring patients continue to receive appropriate drug therapy. A general protocol to follow in handling drug shortages is offered below:

  1. 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.
  2. 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 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 doctor, start at appropriate dose and titrate to desired effect (especially if 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 is available, check Health Canada Drug Product Database for other dosage forms 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 and titrate to desired effect (especially if 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.
    • As necessary, consult SPDP regarding coverage for substituted brand.
  3. 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.
    • Rx Files Charts - www.rxfiles.ca
    • e-therapeutics + (available at SHIRP)
    • Handbook of Clinical Drug Data , 2010, 11th edition - hardcopy text
  4. If there is not a therapeutic equivalent, check treatment guidelines and recommend a drug from another pharmacologic class. Monitor and titrate to desired effect.
  5. Compounding capsules or tablets in the desired doses when other strengths of drug are available or from bulk powders may be another option, especially in instances where there is not a readily available or acceptable substitute.

In order to provide greater information to health care practitioners and the general public, Canada’s Research Based Pharmaceutical Companies (Rx&D) and the Canadian Generic Pharmaceutical Association (CGPA) began collecting information on behalf of their individual member companies on current and impending drug shortages in the fall of 2011. Rx&D has now turned over its database architecture (i.e. the former Rx&D Drug Shortages Database) and opened its use to non-Rx&D members (i.e. all market authorization holders) who are authorized to sell medicines in Canada, and who may need to use the site to report a drug shortage.  Information is being provided on a voluntary basis.  It does not necessarily include all pharmaceutical companies in Canada, and therefore there may be gaps in the data. The new database is called  Drug Shortages Database Canada:

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.

medSask cannot accept phone, email, fax, or other inquiries about the content of this information.  Inquiries regarding specific drug shortages should be directed to the appropriate drug manufacturer as identified.  Questions about alternatives for shorted drugs and drug plan coverage for alternatives may be directed to the appropriate provincial drug information service.

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

To check current availability status of Sandoz parenteral drugs go to the Sandoz website.

 
Drug Availability / Alternatives
5-Aminosalicylic Acid (mesalamine)

Asacol® has been discontinued.

Teva 5-ASA 400mg tablet (DIN 02171929) is available.

For information on alternatives see:  https://www.rxfiles.ca/RxFiles/uploads/documents/members/Cht-IBD-UC-Crohns .pdf and eCPS - Inflammatory bowel disease. Both subscription only but available through SHIRP

Acenocoumarol

Sintrom® 1mg and 4mg tablets have been discontinued.

Acenocoumarol is approximately twice as potent as warfarin.  See eCPS  (subscription). Available through SHIRP             

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

Estimated availability: Aug 12/22

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

Beclomethasone Dipropionate inhaler

QVAR® 50mcg inhaler is NOW AVAILABLE.

Alternatives:

Beta-blocker Ophthalmic Drops

Timoptic® XE (timolol 0.5% - Elvium brand) available.

Timolol ophthalmic solution 0.5% currently available.

See DPEBB Bulletin #739: Effective July 22,2020 Health Canada has approved the import of Pharma-Stulln Timolol 0.5% ophthalmic solution. It will be temporarily listed as a full Formulary benefit and not interchangeable with other timolol ophthalmic solutions.

Betoptic® S (betaxolol) available.

Betagan® (levobunolol) and generics discontinued.

Combination products: timolol/dorzolamide, timolol/brimonidine,timolol brinzolamide, timolol latanoprost, timolol/travoprost currently available.

See eCPS (subscription) Glaucoma treatment algorithm for alternatives. eCPS is available through SHIRP.

Buprenorphine extended-release injection (Sublocade®)

Health Canada has approved importation of US-labelled product. See manufacturer's risk communication here

See Bulletin #745 (October 1, 2020) from DPEBB regarding temporary SK Formulary inclusion of Buprenorphine extended-release injection.

Bupropion

XL formulations shorted .  ACT 300mg and Wellbutrin 150mg & 300mg now available

Convert to different formulations using same total daily dose (up to the maximum recommended dose for a given dosage form), but adjust frequency as indicated:

12-hour sustained release (SR) = once or twice daily depending on dose; twice daily for doses >150mg/day 

24-hour extended release (XL) = once daily

  • For patients taking 150 mg daily, consider reducing the daily dose to 100 mg SR once daily, switching to 150 mg SR once daily, or switching to 150 mg XL once daily, depending on product availability.

See PDF for more details of switching and potential therapeutic alternatives. 

Drug Availability
Calcitonin, Salmon, synthetic

Calcimar® 200U/ml (2ml) INJECTION available

Calcitonin (salmon synthetic) injectable remains on the market but is indicated only for Paget’s Disease and hypercalcemia. Due to the increased cancer risk the duration of treatment should be limited to the shortest period of time possible and the minimum effective dose.

All nasal spray calcitonin products have been withdrawn and discontinued from the market due to a small increased rate of cancer (up to 2.4 %). DINs became inactive October 1st, 2013.

Ciprofloxacin XL

Cipro® XL 500mg & 1000mg have been discontinued

Alternative:

  • PMS - ciprofloxacin XL 500mg tablet is available
Clomiphene

Clomid® and Serophene® - discontinued

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

Codeine 10mg/5ml; pseudoephedrine 30mg/5ml; triprolidine 2mg/5ml

Cotridin Syrup is shorted with indeterminate availability.

Alternatives:

  • Calmyin ACE Syrup has the same strength of codeine but also contains guaifenesin 100mg/5ml and pheniramine 7.5mg/5ml
Colestipol

Colestid® granules and tablets are shorted. The tablets are estimated to be available May 25/22. No date given for the granules. 

Alternatives:  The bile acid sequestrants cholestyramine and colesevelam are available in both powder and tablet form.  See RxFiles Lipid Lowering Therapy: Drug Comparison Chart (subscription) for dosing details.  RxFiles is available through SHIRP

Contraceptives (Oral)

For discontinued products refer to SK Formulary, for similar ingredients or RxFiles Oral Hormonal Contraception: Supplementary Tables, for similar hormonal activity.

Co-trimoxazole (sulfamethoxazole/trimethoprim) oral 

The AA brand of the DS, regular and pediatric strengths are available
Suspension - no date for availability. 
See PDF for management options 

Drug Availability
Difluprednate

Durezol® ophthalmic drops are shorted - indeterminate availability. No other brands are available.

For alternatives see eCPS (subscription): Dry Eye Table 7: Ophthalmic Anti-inflammatories for Red Eye. eCPS is available through SHIRP.

Dipyridamole/ASA

Aggrenox® has been discontinued.

Taro Dipyridamole/ASA 200mg/25mg available 

See PDF for alternatives.       

Disopyramide

Rythmodan® shortage has been resolved.

Drug Availability
Enoxaparin

Lovenox® products have been sporadically available or on allocation.  For more information contact Sanofi Customer Service: 1-800-265-7927

Alternatives: Most strengths can be found in the biosimilar enoxaparin products: Inclunox®, Noromby™ or Redesca® . Please note that the SK Drug Plan does not consider the biosimilar products interchangeable with Lovenox®. See DPEBB bulletin

Erythromycin Base

AA-Erythro 250mg has been discontinued

Alternatives:

  • Eryc® 333mg
  • compounded product
Estrogens (conjugated) /bazedoxifene acetate

Duavive® - Currently on backorder. Indeterminate availability.

Indication: Treatment of vasomotor symptoms associated with menopause.

Alternatives: Estrogen + progestin

Ethosuximide oral solution

Zarontin 250 mg/5 mL oral solution shorted - no availability date 

Alternative:

  • Zarontin 250 mg capsules  
Fludrocortisone oral tablets

Fludrocortisone (Florinef®) 0.1 mg tablets may become shorted due to shipping delays. The estimated end date is mid-May 2022. While there may be existing inventory, consider giving priority of existing inventory to infants and children until stable supply is re-established.

 See PDF for management strategies.

Fluphenazine decanoate injection

Oral dosage forms available.

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

Fluticasone MDI

Flovent® 125 mcg MDI  - now available 

Alternatives:

  • Flovent® Diskus
  • See PDF for other therapeutic options and considerations.

Framycetin sulfate/​gramicidin/​dexamethasone ophthalmic drops

Sofracort® ophthalmic drops shorted until July 18/22.

For alternatives see eCPS (subscription): Red Eye. Table 7: Ophthalmic Anti-inflammatories for Red Eye. eCPS is available through SHIRP.

Gramicidin 0.025 mg/mL/polymyxin B sulfate 10 000 units/mL

Optimyxin eye and ear drops shorted. Estimated availability: Sep 11/22

Alternatives: Polysporin® drops 


Drug Availability
Hydrocortisone 10 mg tablets

Hydrocortisone (Cortef) 10mg tablets are shorted though there may be existing inventory. Estimated availability Sep  30, 2022.

Cortef 20 mg tablets are currently available; 5 mg tablets are accessible through the Special Access Programme.

See PDF (minor updates 2022) for conservation strategies and information related to use in adrenal insufficiency. French version here.

Hydrocortisone 2.5% cream

Sandoz Hydrocortisone 2.5% cream is shorted - estimated availability of Jul 9/22. No other brands are available.

Alternatives: Can be compounded

Hydrocortisone enema

Cortenema® has been discontinued.

Alternatives: Other corticosteroid enemas are available:

  • Betnesol® (betamethasone sodium phosphate) - (to be discontinued in Jun/22)
  • Entocort®  (budesonide) 
Insulin glargine (Lantus®)

All formats of Lantus® (vial, cartridge, pen) are on allocation by the manufacturer. Estimated end date May 13, 2022. For questions on allocated quantities, contact lavalcs@sanofi.com.

Alternative
Basaglar™ contains insulin glargine 100 units/mL and is considered a biosimilar to Lantus®. The two products have comparable pharmacokinetics and no clinically meaningful difference in efficacy and safety. Switch on a unit-to-unit basis and monitor. These products are not interchangeable on the SK Drug Plan Formulary.

Irbesartan

As of May, 2021, several manufacturers are recalling various lots of irbesartan and irbesartan-HCTZ. See Health Canada for more information and a list of affected products. 

Recalls of further lots/manufacturers may ensue. Should irbesartan become unavailable, refer to Angiotensin II Receptor Blocker Comparison. This document is being updated to reflect the current situation.

Iron dextran injection

Dexiron has been discontinued

For alternatives see PDF

Drug Availability
Losartan

As of May, 2021, some manufacturers have recalled various lots of losartan. See Health Canada for more information and a list of affected products. 

Recalls of further lots/manufacturers may ensue. Should all brands of losartan become unavailable, see Angiotensin Receptor Antagonist (ARB) comparison chart for information about switching to a different ARB. This document is being updated to reflect the current situation.

Maxitrol® ophthalmic drops

See neomycin/​polymyxin B/​dexamethasone ophthalmic drops

Medroxyprogesterone
acetate injectable suspension 150 mg/mL (Depo-Provera®)

Depo-Provera® 150mg/ml is shorted - estimated availability date: Jun 1, 2023

Health Canada has approved importation of US-labelled product. Note the US-labelled product is only indicated for contraception and is available in a prefilled syringe. See Pfizer information here.

Regarding interchangeability:
If the prescription authorizes the dispensing of a particular strength and dosage of medroxyprogesterone acetate without specifying a specific brand or product name, then a pharmacist may dispense the US-labelled medroxyprogesterone acetate (Depo-Provera CI) 150mg/mL pre-filled syringes.

If the prescription directs the dispensing of Depo Provera®, a new prescription would be required in order to dispense the US-labelled medroxyprogesterone acetate (Depo-Provera CI) 150mg/mL pre-filled syringes.

See the DPEBB Bulletin for more information.

Methocarbamol

A number of "Robax" products are shorted:

Robaxin® 750mg - estimated availability June 28/22 

Robaxisal® Extra Strength - no availability date

Robaxacet® 8  - estimated availability Aug 15/22

Robaxisal® C 1/4 - estimated availability of Jun 29/22

Alternatives:

  • Other Robax products are available e.g., Robaxin® 500mg ; Robaxacet®; Robax® Platinum;  Robaxisal® C 1/2 
  • Tylenol Back Pain Regular & Extra 
    Strength and Tylenol Body Pain contain methocarbamol
  • For other muscle relaxants see RxFiles (subscription) LOW BACK PAIN – PHARMACOLOGICAL TREATMENT. RxFiles is available through SHIRP.
Methotrimeprazine injection

Nozinan® injection is shorted - estimated availability: May 31/22

Alternatives:

  • methotrimeprazine tablets are available in 2, 5, 25 & 50mg
  • for injectable alternatives see eCPS (subscription) - Phenothiazines CPhA monograph. eCPS is available through SHIRP
Methylphenidate, Long Acting

Biphentin®, Foquest® - intermittent shortages of some strengths.

Alternatives:

  • Some strengths of the formulations may be available.
  • Concerta® is available.
  • Note that Biphentin®, Foquest® and Concerta® are not interchangeable.
Morphine  - Slow Release

All strengths of Kadian® are now available  

Alternatives:

Pain management: See Opioid Manager

OAT: See the British Columbia Centre on Substance Abuse directive

Morphine suppositories

Statex suppositories have been discontinued.  Some stock may still be available.

Alternatives:

  • morphine suppositories can be compounded
  • morphine SR tablets have been used rectally: off-label use
Naloxone Omega, Sandoz and Teligent brands 0.4mg/ml 10 x 1ml available

NALOXONE KIT WITH 2 VIALS - available through McKesson

Contact Poison Control for emergency information in the event naloxone is unavailable.

Naloxone Kits are available to Saskatchewan residents without a prescription. Residents may access free health region funded naloxone kits at the following locations. 

Neomycin/methylprednisolone acne lotion

Neo-Medrol® acne lotion has been discontinued

Alternatives:

neomycin/​polymyxin B/​dexamethasone ophthalmic drops

Maxitrol® eye drops are shorted - no availability date

Alternatives:

  • Maxitrol ophthalmic ointment is still available
  • For other alternatives see eCPS (subscription): Red Eye. Table 7: Ophthalmic Anti-inflammatories for Red Eye. eCPS is available through SHIRP.
Nifedipine extended-release

XR 30mg and XR 60mg Mylan brand currently available. 

Adalat® XL 30mg available.

XL 20mg indeterminate availability. 

See PDF for information regarding switching to a different calcium channel blocker.

Ofloxacin

Ocuflox® 0.3% ophthalmic drops are shorted. No date given

Alternatives: See RxFiles (subscription):  Anti-Infectives for Common Infections: Conjunctivitis. Available through SHIRP

Opium and Belladonna Rectal Suppositories Discontinued by manufacturer. For information:1-800-361-3062 
                                  
Therapeutic Alternatives:
Hyoscine (Buscopan) injectable, morphine suppositories, NSAID suppositories - See PDF for more details.
Oxcarbazepine Trileptal® 60mg/ml suspension is now in stock

Alternatives:

  • 150, 300 & 600mg tablets are available

Drug Availability
Phenelzine

23 Nov 2020
US-labelled product is no longer available. See ERFA's communication.

01 Oct 2020
See Bulletin #745 from DPEBB regarding temporary SK Formulary inclusion of Phenelzine.

23 Sep 2020
Health Canada has approved importation of US-labelled product. See manufacturer's risk communication here

24 Jun 2020
As per Health Canada, “due to a global shortage of Nardil (phenelzine sulfate), a potent monoamine oxidase inhibitor (MAOI) indicated for the treatment of certain types of depressed patients, intermittent shortages of the product will be experienced in Canada. Healthcare professionals are advised to ensure no new patients are started on Nardil, consider switching patients taking Nardil to an alternative treatment and avoid abrupt discontinuation of Nardil treatment to prevent withdrawal syndrome.“

Pirfenidone

Sandoz-Pirfenidone is on allocation. Contact Sandoz at: 1-800-361-3062 for details.

All other brands of pirfenidone are shorted.

May/22 - Jamp & Sandoz 267mg & 801mg capsules are available at McKesson

Potassium chloride (Slow-K®)

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

Alternative long acting tablets providing 8 mEq K+:

  •    Jamp K-8 (NPN 80013005) 600 mg long acting tablet;
  •    Sandoz K-8 (NPN 02247834) 600mg long acting tablet
    Note: These products contain the same strength of KCl in a similar dosage form to Slow-K® and are the closest alternatives. However, the products are not interchangeable. If patient is near the high or low ends of the potassium reference range or if patient has a history of frequent fluctuations, closer monitoring after transition is prudent.
    Note: Inventory of the above products seems to fluctuate frequently.
Alternative solid dosage forms providing 8 mEq K+:
  • Jamp Potassium Cl ER 600mg capsules (NPN 80062704)
  • Micro-K® Extencaps (NPN 02042304)

       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 1.33mEq/ml KCl+:

  • Odan-Potassium Chloride (NPN 80046782 )
  • Jamp KCl liquid (NPN 80024835)
    Note: Because the absorption pattern will be quite different between Slow-K® and the liquid, closer monitoring of all patients after transition is prudent.
Alternative long acting tablets providing 20 mEq K+:
  • Sandoz K-20 (NPN 02242261)
  • Odan K-20 (NPN 80004415)
  • JAMP K-20 (NPN 80013007)
Potassium citrate effervescent tablet
(K-Lyte®)

K-Lyte® effervescent tablets shorted. Approximate availability Jun 2/22.
JAMP K-Effervescent tablets shorted. Approx avail Jan 7/23
These products provide 25 mEq potassium per tablet in the form of potassium citrate.

No other effervescent tablets available.

Alternative sources of potassium citrate:
Modified release tablets: Urocit®-K 5 and 10 mEq, K-Citrate 10 mEq (JAMP), K-Citra 10 mEq (Seaford)
Oral solution: K-Citra 10 mEq/5mL (Seaford)

Prednicarbate 0.1% ointment

Dermatop® 0.1% ointment is shorted - estimated availability: May 22/22

Alternatives: the 0.1% cream is still available

Prochlorperazine injectable Injectable formulation discontinued by manufacturer.
Alternate forms: 5mg and 10 mg oral tablets available
10 mg rectal suppository Available
Therapeutic alternatives: See PDF.
Promethazine oral Histantil 50mg tablets available.
See PDF for injectable promethazine for alternatives
Promethazine injectable Injectable formulation has been discontinued by manufacturer
Alternate forms: 50 mg oral tablets available. For information call 1-866-926-7653
Bulk chemical listed in Medisca catalogue.
Therapeutic alternatives: See PDF.
Propranolol long acting oral capsule

All strengths of Inderal®-LA are shorted with no estimated resupply date.

No alternative brands are available in Canada.

Consider switching to immediate release propranolol, another beta blocker, or another therapeutic option. See RxFiles or CPS for appropriate alternatives. Both subscription only but available through SHIRP.

See PDF for guidance on how to switch to immediate-release propranolol, other beta-blockers, or therapeutic alternatives.

Propylthiouracil 

Discontinued distribution in Canada by Paladin.

Australian product by Phebra has been authorized by Health Canada and is available at McKesson.

See Bulletin #738 (July 15, 2020) from DPEBB regarding temporary SK Formulary inclusion of Phebra brand PTU 50 mg.

Therapeutic alternative: methimazole is the only alternative antithyroid drug in Canada.
Dose conversion imprecise. Usual maintenance doses in Graves' disease: 
Propylthiouracil: 100-150 mg PO daily in 2-3 divided doses
Methimazole: 5-15 mg PO once daily

Pyrantel pamoate suspension

Jamp Pharma Pyrantel Pamoate suspension 50mg/ml is shorted.Estimated availability: Jan 7/23
Combantrin® suspension has been discontinued.

Alternatives:
  • Combantrin® 125 mg tablets available. Jamp brand 125mg tablets available.
  • For patients unable to swallow tablets, the tablet can be crushed and mixed with a soft food immediately before administering.
  • Vermox® (mebendazole) 100mg by prescription is available.
  • Albendazole is available only through Health Canada’s Special Access Program (SAP).
Drug Availability
Quinagolide

Quinagolide (Norprolac®) has been discontinued.

For alternatives see PDF

Ranitidine injectable Currently not available through McKesson. Under allocation. Contact Sandoz at 1-800-361-3062.

Change to alternative if required:
Alternative H2 antagonists:
-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: lansoprazole, esomeprazole.
Ranitidine oral solution

Indeterminate availabilty.
If dose corresponds to tablet strength (75, 150, 300 mg), tablet can be crushed and mixed with soft food such as applesauce immediately before administering.
Extemporaneous compounding: See PDF for details.
Alternatives: See PDF for details

Ranitidine tablets

Some generics intermittently available.

Ranitidine, histamine H2-receptor antagonist (H2RA), contamination with N-nitrosodimethylamine (NDMA) has prompted a recall of both the 150mg and 300mg tablets.

Testing methodology is being developed by Health Canada with ranitidine manufacturers to determine the extent of the problem, and whether additional H2RA products may be recalled.

See PDF for alternatives.

Ropinirole 0.25 mg, 1 mg tablets

No brands of ropinirole 0.25 mg or 1 mg tablets are currently available. Estimated end dates range from indeterminate to mid-July 2022.

May 16 - All strengths of Ran-ropinirole are available at McKesson

Some supply of 2 mg and 5 mg tablets are available, though the shape of the tablets makes them unsuitable for splitting. 

See PDF (last updated Jan 2020) for therapeutic alternatives.

Silodosin

Rapaflo® capsules have been discontinued.  No other brand is available.

Alternatives: Other medications in the alpha1-adrenergic receptor antagonist family are available - alfuzosin, doxazosin, tamsulosin and terazosin.  See eCPS (subscription) Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia for details. eCPS is available through SHIRP.

Sodium phosphate effervescent tablets Phosphate-Novartis - discontinued
Jamp-Sodium Phosphate 500mg - available
See PDF for alternatives.

sodium citrate/​sodium lauryl sulfoacetate/​sorbitol/​glycerin/​sorbic acid enema

Microlax® enemas (12 pack) are discontinued. The manufacturer has a 4 pack available for hospital orders. There is no micro enema alternative. 

Fleet® (regular,kids and mineral oil) and Lax-a-Nema® enemas are available. 

Sofracort® ophthalmic drops

see: Framycetin sulfate/​gramicidin/​dexamethasone

sulfacetamide/prednisolone ophthalmic

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

For alternatives see eCPS (subscription): Red Eye.  eCPS is available through SHIRP.

Sulfamethoxazole/trimethoprim

See Co-trimoxazole

Tazarotene

Tazorac® 0.05% Gel has been discontinued

Alternatives:

  • Tazorac® 0.1% Gel and Tazorac® 0.05% Cream still available
Testosterone

Delatestryl® (Testosterone Enanthate) - available

Taro Testosterone Cypionate 100mg/ml - available

Depo Testosterone 100mg/ml - Apr 8/23 estimated 

Oral and topical dosage forms currently available.

For alternatives: see PDF

Timolol ophthalmic

Timoptic® XE (timolol 0.5% - Elvium brand) available.

Timolol ophthalmic solution 0.5% 10ml currently available.

See DPEBB Bulletin #739: Effective July 22,2020 Health Canada has approved the import of Pharma-Stulln Timolol 0.5% ophthalmic solution. It will be temporarily listed as a full Formulary benefit and not interchangeable with other timolol ophthalmic solutions.

Combination products: timolol/dorzolamide, timolol/brimonidine,timolol brinzolamide, timolol latanoprost, timolol/travoprost currently available.

See eCPS (subscription) Glaucoma treatment algorithm for alternatives. RxTx is available through SHIRP.

Tirofiban 0.05mg/ml Aggrastat® - MANUFACTURER CANNOT SUPPLY FOR INFORMATION CALL 610-833-6050.
Trifluoperazine

AA-trifluoperazine 1mg & 2mg tablets are shorted. Estimated availability: Oct 25/22

AA-trifluoperazine 5, 10 & 20mg tablets are available

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.

Reference: eCPS (subscription) - Red EyeeCPS is available through SHIRP.
Ulipristal 

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

See: https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/74063a-eng.php

Valproic Acid EC Capsules

PMS-Valproic Acid EC Capsules 500 mg are shorted. Estimated availability May 28/22. 

Alternatives:

  • Valproic acid 250 mg capsules - these are not enteric coated.
  • 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).
Valsartan

As of May, 2021, some manufacturers have recalled various lots of valsartan. See Health Canada for more information and a list of affected products. 

Recalls of further lots/manufacturers may ensue. Should all brands of valsartan become unavailable, see ARB comparison chart for information about switching to a different ARB. This document is being updated to reflect the current situation.