Drug shortage thread

[IlDestriero]

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We have been battling with our pharmacy over several drug shortages over the last 6 months. What drugs have you experienced to be in short supply recently. If you want, you can also post your region (NE, NW, SW, CA, etc).
We have had shortages of Propofol (which I think nearly everyone had), Pentothal, Methohexital, Succs, Remi, and cisatracurium. Right now Pentothal and succs are reported to be in short supply.
I speak with friends at other places and they almost always say they have no shortage. Strange. We're usually a much bigger facility, but I would think that that would mean that we could get a better supply chain.
Thanks.

 

[scoobydum]

We've had minor propofol, stp, and sch shortages. Unfortunately, they all occurred around the same time. Fortunately, the issue seems to be resolved now. Midwest.

 

[sevoflurane]

About 3 months ago we had to bust out the 50ml vials of propofol to share btw/ 3 patients for about 1.5 weeks. That's about it. Midwest.

 

[pgg]

California -

Navy joint ran out of 20 mL propofol 1-2 weeks ago so we're using the 50 mL bottles. Civilian hospitals I work at have no shortages of anything.

 

[proman]

Mid-Atlantic:

Propofol, thiopental, ketamine, cisatracurium, vecuronium, remifentanil, IV Bactrim (hospital problem not OR), ephedrine

Plus the re-recall of Hospira generic propofol for metal shavings, still.

 

[proman]

About 3 months ago we had to bust out the 50ml vials of propofol to share btw/ 3 patients for about 1.5 weeks. That's about it. Midwest.

Did the pharmacy do the splitting? In case The Joint comes by, splitting vials is one thing they look for. Also, using multi-dose vials for multiple patients is another. Just FYI.

 

[sevoflurane]

Is a 50ml propofol vial considered multi dose vial? I honestly don't know. I remember drawing up 5 20ml syringes from 100ml vial for endo routinely during residency. It didn't seem to be a problem.

I did the splitting, not pharmacy. Seems wasteful to use 150mg on one case and waste 350mg, especially during a shortage. We were encouraged not to waste so long as sterile technique was applied and the vial was not sitting around for more than 6 hrs. Is this a violation?

 

[proman]

Is a 50ml propofol vial considered multi dose vial? I honestly don't know. I remember drawing up 5 20ml syringes from 100ml vial for endo routinely during residency. It didn't seem to be a problem.

I did the splitting, not pharmacy. Seems wasteful to use 150mg on one case and waste 350mg, especially during a shortage. We were encouraged not to waste so long as sterile technique was applied and the vial was not sitting around for more than 6 hrs. Is this a violation?

All the propofol vials are FDA labeled as single-patient vials. This article might be interesting:

Although it is possible to break 50-mL and 100-mL vials of propofol, which are intended for infusions, into smaller doses for injections, the FDA strongly discouraged such practice even under sterile conditions. "No vial of propofol is meant as a multidose vial," said Arthur Simone, MD, an FDA medical officer who participated in the conference call. Splitting doses of propofol has been linked to serious, and in some cases deadly infections, officials said.

Dr. Hannenberg agreed: "What may be sterile technique to you may be inconceivable to someone else."

The FDA also maintains a page of current and resolved drug shortages here

I agree it's wasteful, but while you might be very careful with your technique, these policies are designed around the lowest common denominator and The Joint loves to be the enforcer.

 

[sevoflurane]

I wonder how many institutions are following these guidelines? My training program, which has an excellent reputation, certainly is not. I used to bang out 15 endo's in one day and would use 3 100ml vials. The key to sterile technique is to draw all your drugs up at one time rather than double dipping. It really isn't rocket science, but I guess some people can even mess that up.

Reminds me of this:

http://thelede.blogs.nytimes.com/2008/03/06/nevada-health-threat-a-clinics-re-used-needles/

I will have to look into this and bring it up at our next group meeting in case we have a shortage again.

Thanks for the info proman.

 

[inmyslumber]

Only shortage we had was of propofol (like everyone else). Also, remifentanil was in short supply for a while.

Currently we are told to expect another shortage of propofol in the next month or so due to Teva stopping production. Not aware of any other shortages.

Northeast.

 

[drccw]

No shortage of anything..
well I take that back...
I havent seen any remifentanil around recently but nobody in my group uses it... I've heard rumors that it's possible to get from pharmacy...

STP is available primarily because it's rarely used....

Mid atlantic

drcw

 

[Jay K]

Shortages of propofol, ephedrine and ketamine. Vec has been long gone.

Fresenius propoven is a substitute option showing up in the U.S., and the makers of Lusedra (fospropofol) are hitting people up to sub for drips/sedation. Anybody use fospropofol?

About 3 months ago we had to bust out the 50ml vials of propofol to share btw/ 3 patients for about 1.5 weeks. That's about it. Midwest.

50's? Some of our places recently busted out the 100's (out of 20's and 50's). Despite JCAHO, it's been "don't ask don't tell" with the hospitals and clinics re: the use of 100's (how you gonna draw 1 induction dose out of the single 100 in your cart and chuck it?).

 

[proman]

We were just informed of a new sux shortage.