Specific Drug Shortages & Discontinuations

A-B

Drug	Availability / Alternatives
Acenocoumarol	Sintrom® 1mg and 4mg tablets have been discontinued. Acenocoumarol is approximately twice as potent as warfarin.  See CPS (subscription). Available through SHIRP
Acyclovir oral suspension	Zovirax® oral suspension is shorting. Estimated availability: mid-Dec/23  Alternatives: acyclovir tablets can be dispersed in 20-50 ml of water an oral suspension can be compounded. Medisca supplies a formula Last updated: Aug 30/23
Adefovir	Adefovir 10mg tablets. Estimated availability: July/24 For therapeutic alternatives see RxFiles Hepatitis B Drug Therapy. RxFiles is available through SHIRP  Last updated: Sep 1/23
Antibiotics - pediatric formulations	Pediatric formulations of many commonly used antibiotics are undergoing shortages -  For specifics, see listing under individual medication. Pharmacists may help minimize the shortages: ensure that liquid preparations or chewable tablets are needed.  Could the child swallow a tablet/capsule or could the adult product be split/crushed/opened? We have compiled some helpful tips on how to administer adult formulations (whole/opened/split/crushed) to children ensure duration of therapy is appropriate. See CPhA's  Optimizing Duration of Therapy: Is Shorter Smarter? promote proper use of antibiotics and discourage use for viral infections. Some useful resources for patient education: Choosing Wisely Canada Canadian Pediatric Society's  How to make sure antibiotics are the right choice Last updated Jun 14/23
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
Beclomethasone Aqueous nasal spray	Apotex estimating availability for late Oct/23.  Mylan is indeterminate. For therapeutic alternatives, see RxFiles Intranasal corticosteroids. RxFiles is available through SHIRP. Last updated: Sep 14/23
Betamethasone sodium phosphate - betamethasone  acetate injection	Celestone® Soluspan®  is shorting. Estimated availability: mid-Nov/23 For therapeutic alternatives, see CPS (subscription) - Corticosteroids: Systemic. CPS is available through SHIRP Last updated: Sep 11/23
Betamethasone valerate topical lotion	Ectosone regular lotions are shorting. Estimated availability:  0.05% - Jan/24 0.1% - Feb/24.  No other brands are marketed Alternatives : for topical corticosteroids of similar potency see RxFiles Topical Corticosteroids. RxFiles is available through SHIRP  Last updated: Sep 21/23
Budesonide nasal spray	The 100 mcg nasal spray is shorting with indeterminate availability. Alternatives: Rhinocort ®  Aqua 64 mcg nasal spray is in stock For alternative corticosteroid nasal sprays see CPS (subscription) - Allergic Rhinitis. CPS is available through SHIRP Last updated: May 1/23
Budesonide nebules	McKesson has Pulmicort 0.125mg & 0.25mg/ml nebules in stock! All brands and strengths of budesonide for nebulization are shorting. Teva is estimating availability - mid-Oct/23.  Alternatives: Pulmicort Turbuhalers are available in all strengths contact compounding pharmacies re compounding  see RxFiles (subscription)  Asthma Overview & Drug Comparison Chart. RxFiles is available through SHIRP  Last updated: Sep 21/23
Buprenorphine Implant	Probuphine®  80mg implant has been discontinued. Information from manufacturer: The reason for discontinuation is due to the inability to successfully acquire continued supply and is unrelated to any safety concerns. Last updated: Jul 5/23

C

Drug	Availability
Cefadroxil oral capsule	All brands are shorting. Estimated availability: mid-Oct/23 For alternative antibiotic options see indication in Bugs & Drugs Last updated: Sep 11/23
Cefuroxime oral suspension	Ceftin® suspension is shorting. Estimated availability: mid-Oct/23. No other brands are marketed. Alternatives: 250mg & 500mg tablets are still available crushing not recommended due to extremely bitter taste, however, crushed tablets have been found to be compatible with apple, grape & orange juice as well as chocolate milk see our tips for administration of adult tablets (whole & crushed) to children for alternative antibiotic options see indication in Bugs & Drugs Last updated: Jul 13/23
Ciprofloxacin XL tablets	PMS-Ciprofloxacin XL 500mg oral tablets are shorting with indeterminate availability. No other brands are marketed. The XL tablets are indicated solely for urinary tract infections Ciprofloxacin regular 250mg & 500mg tablets remain available. For alternative UTI treatments, see Bugs & Drugs Last updated: Sep 23/23
Clindamycin 1%/benzoyl peroxide 3% & 5% gels	All formulations/brands shorting. Availability: Clindoxyl™ ADV, and Taro-Clindamycin 1%/Benzoyl peroxide 5% gel (DIN 02440180) - Oct/23 Clindoxyl™ - Jan/24 Benzaclin® and Taro-Clindamycin 1%/Benzoyl peroxide 5% gel kit (DIN 02464519) - indeterminate Benzaclin® and Taro-Clindamycin 1%/Benzoyl peroxide 5% gel kit (DIN 02464519) are interchangeable Clindoxyl™ and Taro-Clindamycin 1%/Benzoyl peroxide 5% gel  (DIN 02440180) are interchangeable. Although the medicinal ingredients are identical, Clindoxyl™ and it's generic are not interchangeable with Benzaclin® and it's generic. This is due to the difference in base formulations. They also differ in cost, pack size and storage requirements. Alternatives: For therapeutic alternatives, see RxFiles: Acne Treatment . RxFiles is available through SHIRP Last updated: Sep 13/23
Clomiphene	Clomid® and Serophene® - discontinued                           Alternatives:                           Compounded by compounding pharmacy or pharmacological alternatives - see  PDF
Cloxacillin oral suspension	Estimated availability: end of Sep/23 Alternatives: The oral capsules are available, however, the manufacturer - Teva Canada - has no data supporting absorption, safety & efficacy if the capsule is opened. Compounding pharmacies do have a formula for cloxacillin liquid, however, the BUD is only 36 hours. See Bugs & Drugs for alternative antibiotic options Last updated: Aug 28/23
Colestipol	Colestid® granules and tablets are shorted. No date given for availability.  Alternatives:  The bile acid sequestrant cholestyramine is 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: May 22/23
Collagenase topical ointment	Santyl ointment - indeterminate availability. No other brands marketed. Santyl ointment is a topical enzymatic debriding agent used in dermal ulcers and severe burns. Consult wound care specialist for alternatives. Last updated: Aug 21/23
Contraceptives (Oral)	For discontinued or shorted products refer, to SK Formulary for similar ingredients or RxFiles Oral Hormonal Contraception: Supplementary Tables, for similar hormonal activity.
Co-trimoxazole (sulfamethoxazole /trimethoprim) oral	Suspension - no date for availability.  The regular, DS and pediatric tablets are available. See PDF for management options. Last updated: May 5/23

D

Drug	Availability
Diazepam gel - rectal	Diastat® rectal gel is shorting with estimated availability of Oct 30/23. No other brands are marketed. Alternatives: Medisca lists a compounding formula for a rectal gel. Compounding pharmacies are able to supply. Pharmacist's Letter (subscription) - Giving Meds by Alternative Routes has information on rectal administration of diazepam and lorazepam injection and on intranasal use of midazolam injection for seizure control. Last updated: Aug 25/23
Diphenoxylate tablet	Lomotil® 2.5mg tablets are on short. Estimated availability: late Oct/23 For therapeutic alternatives see CPS (subscription) - Diarrhea. CPS is available through SHIRP. Last updated: Aug 25/23

E-G

Drug	Availability
Eprosartan and Eprosartan/HCTZ oral tablets	Teveten®  and Teveten® Plus have been discontinued by the manufacturer. No other brands of eprosartan are marketed. See medSask's ARB comparison table for suitable alternatives. Last updated: Sep 7/23
Erythromycin base oral tab/cap	AA-Erythro 250mg and Eryc® 333mg have been discontinued. No other oral erythromycin products are marketed. Alternatives: bulk powder is available for compounding see Bugs & Drugs for therapeutic alternatives Last updated: Apr 28/23
Estradiol transdermal patch	Several brands/strengths of estradiol patches are currently shorting. Estradot®  and Sandoz-estradiol patches are interchangeable Oesclim® , Estradot®  and Climara® patches are NOT considered interchangeable by the SK drug plan.  Climara® patches are changed once weekly; Oesclim® & Estradot® are changed twice weekly. cutting transdermal patches is not recommended.  However, if NO OTHER OPTIONS,  limited data indicates cutting matrix patches in half is safe Estradiol gel is another transdermal option See RxFiles Postmenopausal Therapy for more information. RxFiles is available through SHIRP. Last updated: Aug 21/23
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 CPS (subscription): Diabetes Mellitus. CPS is available through SHIRP.
Fluphenazine decanoate injection	Both brand name (Modecate®) and generic products have been discontinued.                See PDF for alternative antipsychotic depot injectables. Oral dosage forms are available.
Folic acid 5mg tablet	All brands are shorting. AA estimated availability: Dec/23 The 1mg tablets are in stock and DPEB has added the WNP, VTH, WAM, JAM brands to the Formulary for a period of six (6) months from June 7, 2023 to December 31, 2023.  NOTE: The listing of folic acid 1mg tablets is intended to replace folic acid 5mg tablets for those individuals requiring a therapeutic dose of folic acid. If supplies of folic acid 5mg tablets become available during this six-month period, pharmacies should resume dispensing the 5mg dosage form, and the 1mg tablet listing will be discontinued. If the shortage continues to exist at the end of the six-month period, 1mg tablets will continue to be listed. Last updated: Sep 1/23
Formula, Infant	A temporary closure of Abbott Nutrition’s U.S. based facility in 2022 resulted in limited supply of infant formula. Specialty formulas were first affected, though the supply of these has largely stabilized. However, strain shifted to supply of regular infant formula in the autumn of 2022 and is expected to continue into the summer of 2023. Supply of liquid formulations has been stable, but the more popular powder formulations are often unavailable. Health Canada continues to import formulas through the interim policy. See CPhA’s Infant Formula Shortage: Information for Pharmacy Professionals, which has comprehensive information, including Health Canada websites and documents.  LAST UPDATED 09 May 2023
Framycetin, gramicidin,​dexamethasone eye/ear drops	See Sofracort® eye/ear drops
Framycetin, gramicidin, phenylephrine nasal spray	See Soframycin®  Nasal spray
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 0.025mg/mL /polymyxin B sulfate 10,000 units/mL (Optimyxin)	Optimyxin eye and ear drops shorted. Estimated availability: Dec/24 Alternatives: Polysporin® drops Last updated: Apr 10/23

H-K

Drug	Availability
Hydrocortisone sodium succinate (Solu-Cortef®)	This has been deemed a Tier 3 drug shortage. Tier 3 drug shortages are those that have the greatest potential impact on Canada's drug supply and health care system.  Various vial sizes are reported as shorted with resupply dates in July, 2023. Some formats may be available by allocation. Contact Pfizer 1-888-999-8750; ALLOCATION@PFIZER.COM  Until further notice, the SK Drug Plan & Extended Benefits Branch has temporarily added Solu-Cortef®, 500 mg vials to Full Formulary status. See English or French documents for conservation strategies and alternatives. Last updated: July 27, 2023
Hydrocortisone 1%/ Pramoxine 1% rectal foam (Proctofoam-HC®)	Proctofoam-HC® is being shorted - no availability date given. Alternatives: Proctodan HC rectal ointment and suppositories contain 0.5% hydrocortisone and 1% pramoxine (as well as zinc sulfate) see CPS Hemorrhoids and Pharmacologic Therapy for Prevention and Management of Side Effects of Cancer Therapies and Radiation Therapy for therapeutic alternatives. CPS is available through SHIRP 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
Infant Formula	See "Formula, Infant"
Insulin - premixed	Novolin® GE 40/60 and 50/50 penfills have been discontinued by the manufacturer.  See RxFiles Insulin Comparison Chart for alternate insulin choices. RxFiles is available through SHIRP. Last updated: April 6/23
Ipratropium nasal spray	PMS-Ipratropium 0.03% nasal spray is shorting. Estimated availability: mid-Nov/23.  AA ipratropium 0.06% (Ipravent) nasal spray is available.  It is not a benefit under the SK drug plan, however, it is a benefit under NIHB. See CPS - Allergic Rhinitis for therapeutic alternatives. CPS is available through SHIRP. Last updated: Sep 21/23
Iron dextran injection	Dexiron has been discontinued For alternatives see PDF

L-O

Drug	Availability
Locacorten® Vioform®  (clioquinol 3%/flumethasone pivalate 0.02%) topical cream	Estimated availability: late-October/23 Other antifungal/corticosteroid creams include Vioform® HC and Lotriderm®  cream. Last updated: Sep 23/23
Medroxyprogesterone oral tablets	McKesson has Apotex 2.5 and 5 mg tablets in stock All strengths/brands of medroxyprogesterone (with the exception of the 100mg) tablets are on short. See PDF for therapeutic alternatives. Until further notice, the SK Drug Plan & Extended Benefits Branch has temporarily opened micronized progesterone (Prometrium® and listed generics) to Full Formulary status. Last updated: Sep 22/23
Metadol®-D liquid	There have been intermittent periods in which Metadol®-D is not available. The manufacturer states it is not in a shortage situation; however, it is experiencing a higher than normal demand. Stakeholders are working with the manufacture to ensure available product is distributed equitably. The only other methadone products that can be used for opioid agonist therapy (OAT) are Methadose™ Sugar Free and Methadose™ Cherry Flavoured.  Methadose™ Sugar Free is preferred because there have been reports of destabilization following switches to the Cherry Flavoured product.  A new prescription is required when switching to a different methadone product as they are not interchangeable.  See Commercially Available Methadone for Opioid Agonist Therapy: Pharmacist Information (especially Product Availability, page 2, and Tips for Communication, page 13). Notes:  Metadol® cannot be used for opioid agonist therapy because it holds Exceptional Drug Status (SK Drug Plan) and Limited Use Benefit (NIHB) status for pain only.  Methadone solutions cannot be compounded while commercial product is available as per Health Canada policy. Last updated: May 31/23
Methotrimeprazine Injection	Nozinan 25mg/ml Injection is on allocation: CONTACT SANOFI CUSTOMER SERVICE LAVALCS@SANOFI.COM Alternatives: tablets are available in all strengths injectable alternatives: See PDF Last updated: Dec 28/22
Methylphenidate, Long Acting	Biphentin®, Foquest®, generic methylphenidate ER-intermittent shortages of some strengths. Alternatives: Some strengths of the formulations may be available. Concerta® is available but is NOT interchangeable with the generic methylphenidate ER. 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.  Last updated: Oct 14/22
Mexiletine oral capsules	Mexiletine 100mg capsules are shorting. Estimated availability: late Oct/23 the 200mg capsules are in stock mexiletine is indicated for specific types of ventricular arrhythmias and is used off-label for neuropathic pain. Consult with specialist regarding a suitable substitute. Last updated: Sep 13/23
Minoxidil tablets	Loniten® 2.5mg & 10 mg tablets are shorted with indeterminate availability. No other brands manufactured. Alternative: minoxidil powder is stocked by McKesson therefore potential for compounding Last updated: Oct 7/22
Nitrofurantoin oral	Shortages of all brands/formulations. Estimated availability: Teva-nitrofurantoin 50mg capsules: early Oct/23 PMS-nitrofurantoin 100 mg BID capsules: late-Oct/23 Teva-nitrofurantoin 100 mg capsules: early Dec/23 AA nitrofurantoin 50 & 100mg tablets: indeterminate See Bugs & Drugs: Urinary Tract Infections for therapeutic alternatives.  Last Updated: Sep 21/23
Nitroglycerin sublingual	All brands of the sublingual spray are shorting.  Nitrolingual® spray is now on allocation. Contact Sanofi for questions on this: lavalcs@sanofi.com  The shortage of the spray is leading to increased demand for and sporadic availability of the sublingual tablets.  Health Canada has been in contact with the manufacturers of the sublingual spray regarding extensions of expiry dates. Certain extensions have already been granted and Health Canada is asking consumers to: only obtain what they need from their pharmacy keep expired product and check this chart to confirm which products can be used beyond the original expiry date Other Management Strategies: A guidance tool has been developed (in partnership with CCS, CCPN, and supported by CPhA). Q&A for Pharmacy Professionals by CPhA. Optimize angina prophylaxis (nitroglycerin patches remain available). For details see RxFiles - Angina Treatment. RxFiles is available through SHIRP. Isosorbide dinitrate 5-10 mg sublingually prn is an option for pre-emptive treatment (prior to activity expected to cause angina). For details see RxFiles - Angina Treatment. RxFiles is available through SHIRP. Last updated: Jul 13/23
Ofloxacin ophthalmic drops	Ocuflox® ophthalmic drops are shorting - estimated availability: mid-Oct/23 Alternatives: See CPS (subscription) Conjunctivitis for ophthalmic antibiotics. CPS is available through SHIRP. Last updated: Sep 21/23
Olsalazine 250 mg capsule	Dipentum®  250 mg capsules shorting with indeterminate availability. No other strengths or brands are marketed. Alternatives: Sulfasalazine See RxFiles (subscription) IBD: Ulcerative Colitis vs. Crohn's Disease. RxFiles is available through SHIRP. Last updated: Apr 18/23
Oxybutynin: long-acting formulations and topical gel	Ditropan XL® tablets, Oxytrol® transdermal patches and Gelnique®  topical gel have been discontinued by the manufacturers. Alternatives: generic oxybutynin 2.5mg & 5mg immediate release tablets and 1mg/ml syrup are available for therapeutic alternatives, see RxFiles: Urinary Incontinence. RxFiles is available through SHIRP. Last updated: May 5/22

P

Drug	Availability
Penicillin G - benzathine	Bicillin® L-A is on allocation.  This is a preventative allocation due to a shortage in the US - no current shortage in Canada.  If you have questions or need to increase your allocation, contact Pfizer at 1-888-999-8750 or allocation@Pfizer.com  Last updated: Jul 7/23
Periciazine oral	Neuleptil® capsules are shorting with indeterminate availability.  Neuleptil® oral solution 10mg/ml is now in stock For therapeutic alternatives, see CPS (subscription): Phenothiazines: CPhA monograph. CPS is available through SHIRP Last updated: Aug 28/23
Permethrin 5% topical	Availability for Nix® Dermal Cream: indeterminate Availability for Kwellada®-P lotion: mid-Nov/23 Therapeutic alternatives: Note: lower strengths of permethrin are not effective as scabicides. Primary use of permethrin is for the treatment of scabies.  Alternatives to permethrin are limited to oral ivermectin, topical ivermectin, topical sulfur ointment and crotamiton. oral and topical ivermectin have demonstrated efficacy and are used off-label for this indication.  Both are expensive.  oral ivermectin (Stromectol®) dosage: 200 mcg/kg orally as a single dose with a repeat dose two weeks later ivermectin (Rosiver®) 1% cream: apply to entire body and wash off after 2 hours; repeat in 1 week. topical sulfur ointment 5-10% needs to be compounded, has an unpleasant odor and is messy to apply. It is often used in pregnancy, chest/breastfeeding and in pediatrics because of its low risk of toxicity.   not as expensive as other treatments & is a benefit under NIHB apply once daily after a bath and leave on for 24 hours for five to seven days. crotamiton is an option, however, no preparations or bulk powder are available RxFiles and CPS have information on scabies treatment. Available for free through SHIRP for SK health care providers Last updated: Sep 21/23
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) 600 mg long acting tablet M-K8 (NPN 80035346) 600 mg 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) PMS KCl liquid (DIN 02238604) 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) Last updated: Jan 26/23
Prazosin tablets	All strengths/brands of prazosin tablets are shorting.   Earliest estimated availability: Jan/24 Although DPEB had delisted the Apotex brand of prazosin, it has temporarily added it to the formulary. Apo-prazosin can be considered interchangeable with the Teva brand during this shortage. See PDF regarding use for hypertension and PTSD. Therapeutic alternatives for most other indications can be found in the CPS: Alpha1 Adrenergic Receptor Antagonists. CPS is available through SHIRP. Some compounding pharmacies have been compounding capsules. Last updated: Jul 13/23
Prednicarbate 0.1% ointment	Dermatop® 0.1% ointment has been discontinued. The 0.1% cream is still available Last updated: Feb 14/23
Prochlorperazine injectable	Injectable formulation discontinued by manufacturer.                                  Alternate forms: 5mg and 10 mg oral tablets available                                  Therapeutic alternatives: See PDF. Last updated: Sep 21/22
Prochlorperazine 10mg rectal suppository	Sandoz has discontinued this product.  Odan may take over production in the future, but no suppositories are available at this time. For therapeutic alternatives see RxFiles (subscription) Migraine: Acute Therapy; Nausea & Vomiting Comparison. RxFiles is available through SHIRP. Last updated: Apr 6/23
Proctofoam-HC®	see Hydrocortisone 1%/ Pramoxine 1% rectal foam
Progesterone effervescent vaginal tablet	Endometrin®  is shorting with indeterminate availability Crinone® vaginal gel or micronized progesterone capsules inserted vaginally might be suitable alternatives. Consult with fertility specialist Last updated: Sep 7/23
Promethazine injectable	Injectable formulation has been discontinued by manufacturer. For information call 1-866-926-7653                                  Alternate forms: 50 mg oral tablets           Therapeutic alternatives: See PDF. Last updated: May 5/23
Propranolol long-acting capsule	All strengths of Inderal®-LA have been discontinued by the manufacturer.  Lupin-propranolol LA capsules are now marketed in Canada. McKesson has the 60, 80,120 & 160mg in stock! 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 the medSask/CPhA Inderal®-LA shortage document for guidance on how to switch to immediate-release propranolol, other beta-blockers, or therapeutic alternatives. Last updated: Jul 27/23

Q-Z

Drug	Availability
Quinagolide	Quinagolide (Norprolac®) has been discontinued. For alternatives see PDF
Quinapril	McKesson has PMS-quinapril 20mg in stock All strengths/brands of quinapril and quinapril/HCTZ are shorting. Availability is indeterminate. For alternatives see RxFiles - ACEI Comparison Chart and CPS - ACE Inhibitors. Both are subscription only but available through SHIRP. Last updated: Jun 22/23
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 availability.                 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
Rivaroxaban oral suspension	Xarelto®  1mg/ml oral suspension - indeterminate availability. No other brands are marketed. The tablets can be crushed and mixed with applesauce. Last updated: Sep 14/23
Rivastigmine oral solution	Exelon ®  oral solution is shorting with indeterminate availability. Rivastigmine oral capsules and transdermal patches remain available. There is a case report of the use of capsule contents dispersed in water and administered via nasogastric tube. Contact medSask for more details. Last updated: Apr 18/23
Scopolamine transdermal patch	Transderm V transdermal patches have been discontinued by the manufacturer.  See therapeutic alternatives for select indications.
Semaglutide subcutaneous injection	Novo-Nordisk is advising of intermittent shortages lasting until early October of Ozempic® in the 1mg pen format. McKesson has developed specific instructions for ordering Ozempic® pens that deliver 0.25 mg/0.5 mg doses (item #166390) and Ozempic® pens that deliver 1 mg doses (item #165991) found here (make sure to be logged in to PharmaClik before opening). Alternative GLP-1RAs for diabetes and how to switch can be found here. Therapeutic alternatives for obesity are here. Last updated: Sep 14/23
Sitagliptin/metformin XR 50/1000mg	All brands of sitagliptin/metformin XR 50/1000mg tablets are shorting with estimated availability: mid-Oct/23.   All other strengths of XR tablets and all strengths of the immediate release (IR) tablets remain in stock.  See table below for equivalent regimens. Product Recommended dosage: eGFR > 45 ml/min                      Recommended dosage: eGFR 30-45 ml/min                        sitagliptin/ metformin XR 50/1000mg 2 tablets once daily 1 tablet once daily sitagliptin/ metformin IR 50/1000mg 1 tablet twice daily not recommended sitagliptin 50mg PLUS  metformin 1000mg ER 2 tablets once daily.  2 tablets once daily 1 tablet once daily.  1 tablet once daily sitagliptin 50mg PLUS  metformin IR 500mg 2 tablets once daily.  2 tablets twice daily 1 tablet once daily.  1 tablet twice daily Last updated: Aug 31/23
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®  eye/ear drops	Indeterminate availability For alternative antibiotic/steroid otic drops, see CPS - Otitis Externa. For alternative antibiotic/steroid ophthalmic drops, see CPS - Red Eye. Table 4: Anti-Infectives for Red Eye. CPS is available through SHIRP Note: Ophthalmic drops and ointments can be used in the ear, but otic products CANNOT be used in the eye. Last updated: Sep 1/23
Soframycin® Nasal Spray	Indeterminate availability Indications: local treatment of infections and/or congestion caused by susceptible organisms in acute rhino-sinusitis crusting rhinitis nasal conditions accompanying the common cold post-operative care of patients who have undergone intranasal or sinus surgery prophylactic use, for reduction of nasal carriage of staphylococci See CPS or RxFiles for therapeutic alternatives as per indication. CPS and RxFiles are available through SHIRP Last updated: Sep 11/23
Somatropin injection	Certain formats and sizes of somatropin are shorted. The Drug Plan and Extended Benefits Branch should be contacted regarding any patients affected by the Norditropin® NordiFlex® shortage who require an alternative product immediately.  Last updated: Aug 2/23
Sulfacetamide/ prednisolone ophthalmic	Blephamide® ophthalmic drops and ointment have been discontinued.  No other brands are available. For therapeutic alternatives see CPS (subscription): Eyelid conditions: Stye, Chalazion and Blepharitis.  CPS is available through SHIRP.
Sulfamethoxazole /trimethoprim	See Co-trimoxazole
Tamsulosin SR capsules	Tamsulosin SR capsules will not be available until March, 2024. Controlled release (CR) tablets are available. If needing an agent that can be crushed, consider doxazosin or terazosin, making sure to start at low doses and titrate.  See Alpha1-Adrenergic Receptor Antagonists and Lower Urinary Tract Symptoms & Benign Prostatic Hyperplasia in CPS for dosing and more information. CPS is available through SHIRP.  Last updated: Aug 23/23
Tiaprofenic acid oral tablets	Teva-tiaprofenic acid 200mg tablets are shorting. Estimated availability: mid-Oct/23. No other brands are marketed. Alternatives: the 300mg tablets remain available see  RxFiles: NSAIDS & Other Analgesics for therapeutic alternatives. RxFiles is available through SHIRP Last updated: Aug 28/23
Trazodone oral tablets	All brands/strengths of trazodone tablets are shorting with earliest estimated availability: early Oct/23 For therapeutic alternatives see: RxFiles Sleep Disorders or Depression. RxFiles is available through SHIRP Last updated: Sep 21/23
Trifluoperazine	AA-trifluoperazine 1, 2, & 5 mg tablets are shorting. Indeterminate availability date. AA-trifluoperazine 10 & 20mg tablets are available Last updated: Aug 17/23
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: CPS (subscription) - Red Eye. CPS is available through SHIRP.
Ulipristal	Ulipristal 5 mg (Fibristal) has been voluntarily withdrawn from the market in Canada due to risk of drug-induced liver injury. See Health Canada's risk communication.
Valproic Acid EC Capsules	Valproic Acid EC 500mg capsules shorting with availability: late Oct/23 Alternatives: Valproic acid 250mg capsules and 50mg/ml syrup are available. Doses > 250mg/day should be divided BID-TID 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). Monitor for continued control of seizures / mood. Last updated: Sep 21/23
Verapamil IR tablets	All brands of 80mg tablets are shorting. Apotex is predicting availability: mid-Oct/23 Alternatives: Apotex 120mg IR tablets remain available from McKesson, however, Apotex has reported a shortage due to disruption to the manufacturing of the drug. IR capsules can be compounded For therapeutic alternatives, see RxFiles - Calcium Channel Blocker (CCB). RxFiles is available through SHIRP Last updated: Sep 21/23
Verapamil SR tablets	Verapamil SR 180 and 240mg tablets are shorting with indeterminate availability. the SR 120mg tablets are still available.  These should NOT be split. if necessary, switch from the SR product to the immediate release (IR) tablets at the same total daily dose (or closest possible). Monitor and adjust dose as required. the SR capsules can be compounded For therapeutic alternatives, see RxFiles - Calcium Channel Blocker (CCB). RxFiles is available through SHIRP Last updated: Aug 28/23
Vigabatrin oral	Sabril® tablets and sachets are shorting with indeterminate availability For therapeutic alternatives see RxFiles Seizures: Antiepileptics. RxFiles is available through SHIRP Last updated: Sep 7/23

Documents of Resolved Drug Shortages

Depot Antipsychotic Shortages 

Fludrocortisone (Florinef®) English, French

Hydrocortisone tablets (Cortef(R))  English, French 

Ranitidine shortage