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 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             

Acyclovir oral suspension

Zovirax® oral suspension is shorted. Estimated availability: Aug 26/22. 

Alternatives:

  • acyclovir tablets can be dispersed in 20-50 ml of water
  • an oral suspension can be compounded by compounding pharmacies
Last updated: Aug 5/22
Alfacalcidol

One-Alpha® capsules are shorted. No restock date given.

Alternatives:

  • One-Alpha® oral liquid and injection are available although the liquid is expected to be shorted in the near future.
  • see eCPS Vitamin D: CPhA Monograph for other Vit D analogues, eCPS is available through SHIRP
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

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.

betamethasone sodium phosphate enema

Betnesol® enema has been discontinued.

Alternative:

  • Entocort®  (budesonide) enema
Bupropion

XL formulations shorted - some brands sporatically 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.

Cefuroxime Oral Suspension

Ceftin® 125mg/5ml suspension is shorted. Estimated availability: Aug 26/22

No other brands of the suspension are manufactured.

Alternatives:

  • 250mg & 500mg tablets and the injectable remain available
  • other 2nd generation cephalosporin oral liquids (eg cefprozil) are available
  • See Bugs & Drugs for alternative antibiotic choices
Last updated: Jul 27/22
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
Last updated: Aug 5/22
Colestipol

Colestid® granules and tablets are shorted. No date for availability given for granules. Tablets may be back in stock Aug 14/22

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

Last updated: Aug 5/22

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 tablets are available
Suspension - no date for availability. 
See PDF for management options 

Drug Availability
Dapsone, topical

Aczone® topical gel is shorting. Estimated availability: Aug 14/22. There are no other brands of topical dapsone.

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

Last updated: Aug 5/22

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.

Last updated: Aug 5/22

Dorzolamide/
Timolol, Ophthalmic Solution

Cosopt® Preservative Free drops are shorted - estimated availability: Aug 10/22

For alternatives see "Glaucoma Agents, Topical" below.

Last updated: Aug 5/22

Drug Availability
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

Last updated Aug 5/22

Estradiol transdermal patch (Climara®)

Climara® 25 patches are shorted. Estimated availability: Oct 10/22

Alternatives

  • Oesclim® and Estradot® and generic transdermal patches are available in the 25 mcg/24 hr strength, however, they are NOT considered interchangeable with Climara®
  • the other strengths of Climara® are still in stock
Last updated: Aug 5/22
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 eCPS (subscription): Diabetes Mellitus. eCPS is available through SHIRP.

Fludrocortisone oral tablets

Back in stock!

Fludrocortisone (Florinef®) 0.1 mg tablets are shorted due to shipping delays. The estimated end date has been extended. Consider giving priority of existing inventory to infants and children until stable supply is re-established.

  • some pharmacies are compounding

 See PDFs for management strategies. (English, French)

Last updated Aug 5/22

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 inhaler

Flovent® 50 mcg inhaler is shorted - estimated availability Sep 10/22

Alternatives:

  • other strengths of Flovent® continue to be available
  • for other alternatives see PDF
Last updated: Aug 5/22

Formula, Infant

Some specialty infant formulas are short due to temporary closure of Abbott Nutrition’s U.S. based facility earlier this year. Activities resumed July 1, 2022, and production will ramp up slowly, initially focusing on amino acid-based formula. However, it could take several months for the supply to stabilize.

Types of Formulas
  • Regular infant formulas contain intact proteins or partially hydrolyzed proteins for babies with intolerances and  gastrointestinal discomfort. There is currently no shortage of regular infant formula in Canada. These types of formula  are still found on shelves in retail stores and pharmacies.
  • Hypoallergenic infant formulas contain extensively hydrolyzed proteins (for mild allergies) or are amino acid based (for severe or multiple allergies). There is a shortage of these formulas.
Health Canada Recommendations for Management of the Shortage
  • Health Canada has issued an interim policy which allows for importation and sale of infant formula from other countries. 
  • Pharmacists should be prepared to answer questions and know how to access hypoallergenic formula so that parents are not turned away.
  • To help manage the limited supply, specialty formulas should be kept behind the pharmacy counter, reserved for infants with a clear medical indication, and ordered only upon request. Pharmacies can consider including signage on the shelves to redirect families to the pharmacy counter for ordering hypoallergenic formula. Hospital stocks should not be used as they need to be protected for babies that were hospitalized because they found no other options.
  • Health Canada has provided a list of distributors as well as information for pharmacists, which includes details about specific formulas.
  • Pharmacies will need to provide additional labelling information when the imported products are sold. This labelling information is available in Appendix A of the Health Canada interim policy or in some of the product information sheets below.
Product Information

NOTE: Formula should be released in quantities of 7 to 10 day supply; use Typical Formula Consumption Amounts: Healthy Term Infants for guidance. 

 Other Resources
Last Updated

03 Aug 2022

Framycetin sulfate/​gramicidin/​dexamethasone ophthalmic drops (Sofracort®)

Sofracort® ophthalmic drops shorted - predicted availability: Sep 22/22.

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

Last updated: Aug 5/22

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.

Gramicidin 0.025 mg/mL/polymyxin B sulfate 10 000 units/mL (Optimyxin)

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

Alternatives: Polysporin® drops 

Last updated Aug 5/22


Drug Availability
Haloperidol LA injection

Haloperidol LA Inj 100mg/ml is on allocation.  

Contact Sandoz at 1-800-361-3062 or info.clients@sandoz.com for more information.

See PDF for alternative antipsychotic depot injectables.

Hydrocortisone 10 mg tablets

Hydrocortisone (Cortef) 10mg tablets are shorted though there may be existing inventory. Estimated availability Sep 30, 2022. Health Canada has approved importation of US-labelled Cortef 10 mg tablets (NDC 0009-0031-01) to mitigate the shortage. See Pfizer Canada's letter in English and French.   

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 enema

Cortenema® has been discontinued.

Alternative: 

  • Entocort®  (budesonide) enema
Hydrocortisone 1%/ Pramoxine 1% rectal foam (Proctofoam-HC®)

Proctofoam-HC® is being shorted - no availability date given.

Alternatives:

Last updated: Aug 5/22
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
Hydromorphone long-acting capsules

Hydromorph Contin®  - all strengths have been shorting. Some strengths currently available.

Alternatives:

  • other long-acting opioids are available. See Opioid Manager for opioid equivalencies and Switching Opioids form
Infant Formula

See "Formula, Infant"

Insulin glargine (Lantus®)

All formats of Lantus® (vial, cartridge, pen) are on allocation by the manufacturer.  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.

SCPP has published a guidance document on managing this shortage

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.

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® 500mg - no date given

Robaxin® 750mg - estimated availability Feb 28/23

Robaxacet® 8  - estimated availability Dec 29/22

Robaxisal® C 1/4 - estimated availability of Aug 11/22

Alternatives:

  • Other Robax products are available e.g., Robaxacet®; Robaxacet® Extra Strength; 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.
Last updated: Jul 27/22
Methylphenidate, Long Acting

Biphentin®, Foquest®, Apo-methylphenidate ER - 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.
Ritalin® SR and Sandoz-methylphenidate SR tablets have been discontinued.  Apo-methylphenidate SR 20mg is still marketed. 
Minoxidil tablets

Loniten® 2.5mg & 10 mg tablets are shorted. Earliest availability date: Sep 10/22

No other brands manufactured.

Alternative:

  • minoxidil powder is stocked by McKesson therefore potential for compounding
Last updated: Aug 5/22

Drug Availability
Phenelzine

Now available!

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.“

Last updated: Jul 22/22

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. No restock date given.
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)

Last updated: Jul 22/22

Prednicarbate 0.1% ointment

Dermatop® 0.1% ointment is shorted - estimated availability: Oct 7/22

Alternatives: the 0.1% cream is still available

Last updated Aug 5/22

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.
Proctofoam-HC® see Hydrocortisone 1%/ Pramoxine 1% rectal foam
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 have been discontinued by the manufacturer. 

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.

Last updated: Jul 22/22

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: Oct 7/22
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).
Last updated Aug 5/22
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

*Jul 4- all strengths of Ran-ropinirole are available*

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

Some supply of 1 mg, 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.

Scopolamine transdermal patch

Transderm V transdermal patches have been discontinued by the manufacturer. An alternative options PDF will follow.

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

Last updated: Aug 5/22

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 Mar 13/23. 

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).
Last updated: Jul 22/22
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.

Vigabatrin 500mg Sachet

Sabril® 500mg Sachet is shorting with no availability date

Alternatives:

  • Sabril® 500mg tablets are available
  • No formula for an oral liquid was found. Contact a compounding pharmacy regarding possible compounding using the tablets.
  • For alternative antiepileptics see RxFiles: Seizures: Antiepileptics. RxFiles is available through SHIRP
Last updated: Aug 5/22