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Epinephrine 0.1 mg/mL Emergency Syringes

Last Updated: December 6, 2010
Status: Resolved

Reason for the Shortage

  • Hospira has epinephrine 0.1 mg/mL emergency syringes on back order due to increased demand.1
  • Amphastar discontinued their unapproved emergency drug syringes, including epinephrine 0.1 mg/mL, in December, 2009. Amphastar will be relaunching several emergency syringes including epinephrine 0.1 mg/mL 10 mL syringes over the next several months.2,3

Estimated Resupply Dates

  • Hospira has available epinephrine 0.1 mg/mL Lifeshield Abboject emergency syringes (NDC 00409-4921-34) and 0.1 mg/mL Abboject intracardiac emergency syringes (NDC 00409-4901-18).1
  • Amphastar (IMS) has available epinephrine 0.1 mg/mL 10 mL syringes (NDC 00548-3316-00).3

Implications for Patient Care

Epinephrine injection emergency syringes and vials are unapproved products.4 However, epinephrine injection is considered a standard of care for the management of anaphylactic reactions (approved auto-injectors available), cardiopulmonary resuscitation, and cardic arrhythmias.5-7 Epinephrine emergency syringes are commonly used for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to initial defibrillatory shocks, pulseless electrical activity, and asystole.5-7

Safety

  • ASHP and the Institute for Safe Medication Practices (ISMP) issued a National Alert Network message warning that the shortage of EPINEPHrine pre-filled syringes can cause serious or fatal medication errors.8
  • Hospira epinephrine emergency syringes with attached 3.5 inch needles are for intracardiac use only. LifeShield epinephrine emergency syringes should not be replaced with the intracardiac Abboject syringe in code boxes or emergency department settings. The intracardiac needles cannot be removed and are not compatible with needleless IV access systems. LifeShield syringes are compatible with needleless IV access systems due to a “shield” covering the 1.5 inch needle.1
  • Epinephrine is a high alert medication and may cause significant patient harm when used in error.7,9 Medication errors may occur due to confusion related to epinephrine products labeled as ratio strengths. Minimize confusion by storing a single concentration where possible.9 If LifeShield epinephrine 0.1 mg/mL syringes must be replaced or supplemented with epinephrine 1 mg/mL ampules or vials in code boxes or other locations during the shortage, apply auxiliary labels to the vials to alert staff of the epinephrine concentration in milligrams and to dilute before IV use. Create a dose conversion chart reflecting available epinephrine concentrations to keep in code boxes and post in areas where epinephrine is frequently used.9

Alternative Agents & Management

  • There are no alternative manufacturers of epinephrine 0.1 mg/mL emergency syringes.
  • There are no adapters available to make intracardiac Abboject syringes compatible with needleless IV access systems.1
  • Consider conserving current supplies of LifeShield Abboject epinephrine emergency syringes for code boxes or code situations.
  • Hospira and American Regent have available epinephrine 1 mg/mL 1 mL ampules.1,10,11
  • American Regent, Amphastar, and JHP have available epinephrine 1 mg/mL 30 mL vials.2,10,11

Related Shortages

References

  1. Hospira, Customer Service (personal communication). May 25 and 27, June 29, July 6, 12, 20, and 27, August 5, 16 and 24, September 3 and 16, October 22, November 4, 10, and 15, and December 6, 2010.
  2. Amphastar, Customer Service (personal communication). May 25, August 13, 24 and 25, September 2 and 20, October 20, November 3 and 8, and December 6, 2010.
  3. FDA (personal communication). August 4, 2010.
  4. Center for Drug Evaluation and Research. Electronic Orange Book Query. Food and Drug Administration, Department of Health and Human Services,  Updated April, 2010. Accessed May 28, 2010.
  5. American Heart Association. Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Management of Cardiac Arrest. Circulation 2005;112:IV-58-IV-66.
  6. Epinephrine Injection product information. Lake Forest, IL: Hospira; 2004 October.
  7. Epinephrine. Lexi-Comp Online. Hudson, OH: Lexi-Comp Inc.; 2010.
  8. National Alert Network Message. EPINEPHrine pre-filled syringe shortage. Risk for Serious or Fatal Medication Error. American Society of Health System Pharmacists and the Institute for Safe Medication Practices. Updated June 16, 2010, Accessed June 18, 2010.
  9. Institute for Safe Medication Practices. It doesn’t pay to play the percentages. Medication Safety Alert.  October 16, 2002.
  10. American Regent, Customer Service (personal communication). May 26, 2010.
  11. JHP Pharmaceuticals, Customer Service (personal communication). May 26, and July 20, 2010.

Updated

Updated December 6, 2010, by Megan Dryer, Pharm.D., Drug Information Specialist. Created May 28, 2010, by Megan Dryer, Pharm.D., Drug Information Specialist. Copyright 2010, Drug Information Service, University of Utah, Salt Lake City, UT.

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