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:
- Ensure there is a valid indication for the drug. Review the patient’s drug and medical history. For a checklist of criteria to consider, check the CPhA Drug Shortages Guide pg 4 - 6.
- Substitution of a different brand of the same drug (molecule):
- Check the Saskatchewan Prescription Drug Plan (SPDP) Formulary for interchangeable brands of the same drug; then check for availability of these brands. (Call wholesalers, manufacturers)
- If none are available, is there a non-interchangeable brand of the same drug in the same dosage form? Obtain authorization for substitution from prescriber, start at same dose or a reduced dose and titrate to desired effect (especially important if drug has a narrow therapeutic index) and monitor for beneficial and adverse effects. Follow-up with the patient in 24 – 48 hours, as indicated by kinetic and pharmacologic characteristics of the drug.
- If no Formulary drug in the same dosage form is available, check 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.
- 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
- If there is not a therapeutic equivalent, check treatment guidelines and recommend a drug from another pharmacologic class. Monitor and titrate to desired effect.
- e-therapeutics+
- RxFiles
- Others, e.g. Healthcare Network Clinical Guidelines, National Guideline Clearinghouse, etc.
- 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.
Fluticasone propionate oral inhaler
Salbutamol oral inhaler
Amoxicillin oral suspension
Dipyridamole/ASA oral capsule
Hydrocortisone 10 mg tablet; French version
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
See PDF for more details of switching and potential therapeutic alternatives. |
| Drug | Availability |
| Calcitonin, Salmon, synthetic |
Calcimar® 200U/ml (2ml) INJECTION available |
| Ciprofloxacin XL |
Cipro® XL 500mg & 1000mg have been discontinued Alternative:
|
| Clomiphene |
Clomid® and Serophene® - discontinued |
|
Codeine 10mg/5ml; pseudoephedrine 30mg/5ml; triprolidine 2mg/5ml |
Cotridin Syrup is shorted with indeterminate availability. Alternatives:
|
| 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 |
| 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:
|
| 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:
|
| 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. |
|
Fluticasone MDI |
Flovent® 125 mcg MDI - now available Alternatives:
|
|
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:
|
| 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. |
| 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 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:
|
| Methotrimeprazine injection |
Nozinan® injection is shorted - estimated availability: May 31/22 Alternatives:
|
| Methylphenidate, Long Acting |
Biphentin®, Foquest® - intermittent shortages of some strengths. Alternatives:
|
| 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:
|
| 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:
|
| 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:
|
| Drug | Availability |
| Phenelzine |
23 Nov 2020 01 Oct 2020 23 Sep 2020 24 Jun 2020 |
| 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.
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+:
|
| Potassium citrate effervescent tablet (K-Lyte®) |
K-Lyte® effervescent tablets shorted. Approximate availability Jun 2/22. |
| 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. |
| Pyrantel pamoate suspension |
Jamp Pharma Pyrantel Pamoate suspension 50mg/ml is shorted.Estimated availability: Jan 7/23
|
| 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. |
| 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:
|
| 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 Eye. eCPS 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:
|
| 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. |