Available through Medicis for active cases only. Will be sent overnight if needed. Call

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1 Drug Reason for Shortage Action Plan Merck has low inventory of Antivenin Latrodectus Mactans Black Widow Antivenin Calcium chloride and calcium gluconate Calcium Disodium Versenate Change in distribution of product Memo created and sent to ED staff and pharmacy on process on how to obtain emergency supply through Merck. Merck (medical team) If after normal business hours, contact the same number and follow prompts Following P&T approved action plan in adults. CPOE alerts active. Available through Medicis for active cases only. Will be sent overnight if needed. Call Compazine Unknown CPOE alert to use alternatives Cytarabine Manufacturing issues Some products are available. Alternatives: For AML, use Mitoxantrone+Etoposide. For ALL, use alternative regimens or omit Cytarabine. See Chemo action plan for plans on select critical chemo shortages-approved by P&T. D5W 1L bags Increased Encouraging practitioners to critically evaluate the need for IV fluids. D5W1/2NS Increased Encouraging practitioners to critically evaluate the need for IV fluids. This remains the preferred fluid for pharmacist therapeutic interchange for NS in adult patients.

2 D5WNS Increased Demand Encouraging practitioners to critically evaluate the need for IV fluids. Doxorubicin Manufacturing issues A communication letter has been sent to oncologists/hematologists to notify them of the shortage. Use alternative anthracycline or an alternative regimen for lymphomas, metastatic breast cancer, or sarcomas. Droperidol Manufacturing delays Anesthesia preference is for ondansetron to be available as alternative (stocked on OR Omnicell already) Excel Bags (NS and D5W) Unclear etiology, but may be due to production delays. Monitor. If PharMedium product is not available, pharmacy will prep amiodarone infusions in NS (non Excel) using a final concentration of 450 mg in 250 ml. If stock becomes critical, Excel bags will be removed from EH cart, with a note to contact pharmacy for amiodarone drip. Fosphenytoin Recalls and manufacturing delays CPOE shortage alert encouraging prescriber to use po phenytoin if possible, or injectable phenytoin. Heparin premix Unknown Admixing in pharmacy to same concentration Hydralazine inj Shortage due to increased and manufacturing delays CPOE alert asking prescriber to use alternative therapy Hydroxyzine inj Shortage is due to manufacturing issues. Promote alternatives such as diphenhydramine. CPOE shortage alert is active. Indigo carmine One company has discontinued product. Consider alternatives (e.g. methylene blue) Irrigation solutions Leucovorin inj Includes: LR, NS, Sterile Water, and Glycine The shortage is due to increased and manufacturing issues. Monitor and work with OR staff to ensure ordering allocation amounts P&T approved pharmacist interchange from leucovorin to levoleucovorin if needed. Leucovorin tablets are currently available and are not affected by the shortage. A communication letter has been sent to oncologists/hematologists to notify them of the shortage.

3 Lactated Ringers Increased Encouraging practitioners to critically evaluate the need for IV fluids. IV Levetiracetam Unknown CPOE alert asking prescriber to use alternative therapy. Magnesium 2 ml Stock has been moved from the EH cart trays to the EH bags Methylene Blue Unknown Maintaining stock per antidote policy and in GI areas where Topex is stocked. Utilize alternatives where possible. Moxifloxacin Multivitamin Oral Liquid Unknown Product currently not being produced. Utilize PO where possible, or consider IV levofloxacin. CPOE alert is active. There is no equivalent or comparable product currently available. Will continue to send the tablet to be crushed. NS and1/2 NS Fluids Pantoprazole Shortage is due to manufacturing delays. Increased Encouraging practitioners to critically evaluate the need for IV fluids. In adults, pharmacists may interchange orders to D51/2NS based on criteria. Supply depleted. Please utilize alternatives, which may include PO pantoprazole, IV famotidine push and/or IV famotidine infusion. Piperacillin/ Tazobactam Increased CPOE alert active in adults- consider cefepime or meropenem depending on the indication. Thiotepa s Manufacturing issues FDA has permitted importation of Italian product. This was taken to P&T and approved if needed in May (to be determined by drug shortage team).

4 Torsemide One of the manufacturers has discontinued product, and no one else is currently producing product. Encourage PO use when possible. Unasyn CPOE alert active to utilize alternatives. Vasopressin Moved from EH cart medication trays to EH medication bags Vasolex Ointment Unknown CPOE alert active to utilize alternatives. Vecuronium Manufacturing delays For use on the hypothermia protocol or NMB protocol, consider atracurium as an alternative. OR will use rocuronium as an alternative during the shortage. Reference: ASHP s national current drug shortages list. May Recently added to list: None Recently removed from list: Digoxin Where is information on drug shortages posted? On MOLLI>>drug information>>drug shortages. This includes a full report of all national shortages and the above abbreviated report

5 On Methodist MD>>Quality and Patient Safety>>Pharmacy and Therapeutics>>Drug Shortages and on Methodist MD under recent news This includes a full report of all national shortages and the above abbreviated report, and specific memos. Updated/new memos are posted under recent news. On System Pharmacy Sharepoint Page>> Shared documents>>drug shortages This includes the Excel tracking log used by the pharmacy drug shortage team of all shortages critical to Methodist. This also includes specific drug shortage memos