What’s Your Drug Shortage Plan: Part I

29 May
May 29, 2017

Many drugs critical to patient management are showing up on national shortages (most pertinent to the ED list below).  Is your institution feeling the effects?  Do you have a drug shortage plan?

In this post we will cover potential alternatives to combat drug shortages for the following medications:

  • Atropine
  • Calcium Chloride
  • Calcium Gluconate
  • Dextrose 50%
  • Epinephrine
  • Lidocaine

Atropine:

  • Alternate concentration of 0.4mg/mL appears to still be available
  • Depending on indication, alternate therapies (vasopressors)/interventions (i.e. Pacing) may need to be pursued

Calcium Products:

  • Both products have been on and off shortage
  • Minimal differences in products if equal amounts of calcium are given (All Calcium is Not Created Equal)
  • Calcium Chloride is most commonly used for cardiac arrest (ACLS); Also, used for Hyperkalemia with EKG changes, calcium channel blocker and beta blocker overdoses

Dextrose:

  • Oral agents are readily available, however if not appropriate given severe hypoglycemia or cardiac arrest situations alternate concentrations of dextrose solutions could be used

Epinephrine:

  • Alternate 1mg/mL 30mL vial is still available
    • Traditionally reserved for making drips but can be used for anaphylaxis and cardiac arrest situations
    • Be aware of concentration differences

Lidocaine:

  • An alternative antiarrhythmic is an option
  • Other concentrations and vial sizes of lidocaine are available

If you are not feeling the effects of the shortage yet, there is still time to strategize.  Understanding how your hospital is affected is important and dependent on your drug wholesaler.  Reach out to your pharmacist or pharmacy department and don’t forget to include your toxicologist and poison control center in instances of alternate treatment for overdoses.

Guest Post By:

Regan Baum, PharmD 
UK HealthCare
Lexington, KY
Twitter: @KYEMPharmDs

References:

  1. American Society of Hospital Pharmacists: Current Drug Shortages
  2. Calcium In: Micromedex Solutions. Ann Arbor (MI): Truven Health Analytics; Publication 2017. Available from micromedexsolutions.com
  3. Martin TG. Ionization and Hemodynamic Effects of Calcium Chloride and Calcium Gluconate in the Absence of Hepatic Function. Anesthesiology 1990; 73(1): 62 – 5. PMID: 2360741
  4. Society of Critical Care Medicine. Drug Shortage Alert on Electrolyte Medication.
  5. Society of Critical Care Medicine. Drug Shortages Alert September 2016.
  6. Society of Critical Care Medicine. Ethical Dilemmas Related to Drug Shortages April 2017.
  7. S. Food and Drug Administration (2013): Drug Safety and Availability. Current Drug Shortages Index.
  8. S Food and Drug Administration (2013): Drug Safety and Availability. Current Drug Shortages Index. Pfizer Injectables Notification of Emergency Syringe Supply Interruption.

Post Peer Reviewed By: Anand Swaminathan (Twitter: @EMSwami) and Salim Rezaie (Twitter: @srrezaie)

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Salim Rezaie

Emergency Physician at Greater San Antonio Emergency Physicians (GSEP)
Creator & Founder of R.E.B.E.L. EM
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