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Archive for the ‘Shortage’ Category

Benzo Shortage

So for at least the foreseeable future, there is a shortage of IV ativan, please consider these alternatives

Sedation for Violent Behavior/Elopement Prevention
Please use droperidol/ versed (5/2) or either agent individually. This is a preferred choice over haldol/ativan even without the shortage. Get an ekg at some point in the patients course to document no prolonged QTc (this doesn’t need to precede the drugs)

Mild ETOH Withdrawal
Ativan 2mg PO Q6 or LIbrium 50 mg PO Q6

Severe ETOH Withdrawal/DTs
We may or may not have IV valium, if we do start with that just like always

If we run out, choose one of these course
Place patient on midazolam drip using standard drip sheet dosages, Patients may need a bolus of 2 mgs; repeated Q5 minutes until sedation achieved prior to the drip. Unintubated patients on midazolam drips must go to an ICU bed
Intubate the patient and place on midazolam, intubated pts on midazolam may go to A4/CCA
Intubate and place on a propofol drip. intubated patients on propofol may go to A4/CCA

Status Epilepticus
Hospital is conserving ativan specifically for these patients, so it should be available, if not:

use midazolam 2-4 mg (max 8mg) just as you would use ativan

Hospital is also adding IV Kepra and IV Valproate, consult neuro for dosing, timing, and usage

If and when we lose IV midazolam, furhter recs will follow

please write with questions


Scott Weingart, MD

Written by reuben

March 9th, 2012 at 3:12 am

Posted in Pharmacy,Shortage

Metoprolol Shortage

Our supply of metoprolol injection is now at a critical level. Based on our current utilization, we will exhaust our supplies by the weekend. We have been unable to obtain additional metoprolol, and it appears unlikely that we will get any in the foreseeable future. We have increased our supplies of propranolol injection, as well as labetalol and esmolol. We are also experiencing difficulty obtaining diltiazem injection and enalaprilat injection. Please use oral therapy or alternative agents when ever possible.

PS- please don’t kill the messenger

Gina Caliendo, BS, Pharm.D, BCPS

Written by reuben

January 31st, 2012 at 10:08 pm

Posted in Pharmacy,Shortage

Ketorolac Shortage

The country and therefore the hospital is running out of ketorolac.

For patients who can take PO, ibuprofen is equally effective. Also, it is not well known that the analgesic ceiling for ketorolac is probably around 10 mg IV. I personally use 15 mg, and the hospital still has a reasonable stock of 15 mg vials, so consider this in patients whom you think would benefit from a parenteral NSAID.


Ketorolac Shortage Announcement



Written by reuben

December 22nd, 2011 at 6:26 am

Posted in Shortage