Last Updated: March 4, 2019
- Epinephrine injection, Amphastar, 0.1 mg/mL, 10 mL syringe, 10 count, NDC 76329-3316-01
- Epinephrine injection, Amphastar, 1 mg/mL, 30 mL vial, 1 count, NDC 76329-9061-00 - discontinued
- Epinephrine injection, Pfizer, 0.1 mg/mL, 10 mL 20 gauge LifeShield syringe, 10 count, NDC 00409-4921-34
- Epinephrine injection, Pfizer, 1 mg/mL, 1 mL ampule, 25 count, NDC 00409-7241-01 - discontinued
- Amphastar stopped distributing epinephrine 1 mg/mL 30 mL vials on May 10, 2017. They are continuing to supply 0.1 mg/mL 10 mL syringes. These are on shortage due to increased demand.
- Pfizer stopped distributing epinephrine 1 mg/mL presentations on May 10, 2017.
- BPI has epinephrine 1 mg/mL 2 mL ampules available.
- Par has Adrenalin 1 mg/mL 1 mL and 30 mL vials available.
- Adrenalin injection, Par Sterile Products, 1 mg/mL, 1 mL vial, 25 count, NDC 42023-0159-25
- Adrenalin injection, Par Sterile Products, 1 mg/mL, 30 mL multiple dose vial, 1 count, NDC 42023-0168-01
- Epinephrine Snap-V Kit injection, Snap Medical Industries, 1 mg/mL, 1 mL 1 count, NDC 24357-0811-20
- Epinephrine injection, BPI Labs, 1 mg/mL, 2 mL containing 1 mL sulfite-free and preservative-free ampule, 10 count, NDC 54288-0103-10
Estimated Resupply Dates
- Amphastar has epinephrine 0.1 mg/mL 10 mL syringes on allocation.
- Pfizer has epinephrine 0.1 mg/mL 10 mL syringes on back order and the company estimates a release date of March 2019.
- Snap Medical Industries has the Epinephrine Snap-V Kit available. Each kit contains an epinephrine 1 mg/mL 1 mL vial, (3) 1 mL luer lock syringes, and (3) 23-gauge 1-inch needles.
Implications for Patient Care
- Epinephrine 0.1 mg/mL emergency syringes are unapproved products. 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.[5-6]
- Until the launch of the BPI 1 mg/mL 1 mL ampules, there had been no epinephrine products that were FDA-approved for intravenous use. Epinephrine 1 mg/mL 1 mL ampules from Hospira were unapproved products. These and all other epinephrine product were used off-label if given intravenously.
- Epinephrine is a high alert medication and may cause significant patient harm when used in error.
- Create a dose conversion chart reflecting available epinephrine concentrations to keep in code boxes and post in areas where epinephrine is frequently used.
- Do not stock the 30 mL multi-dose vials in code boxes.
- If the 1 mg/mL 1 mL ampules or vials need to be used in place of the 0.1 mg/mL emergency syringes, include the diluent and syringe along with instructions for dilution of the 1 mg/mL epinephrine vial or ampule.
- Routine bulk compounding is not an option due to epinephrine having a short stability time and sensitivity to pH, light, and air.
- FDA has extended the expiration dating for certain lots of epinephrine 0.1 mg/mL 10 mL Abboject syringes. https://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm563360.htm
- Medical providers must prepare and administer injections from the Epinephrine Snap-V Kits.8 This is not an auto-injectable product.8
Alternative Agents & Management
- Consider conserving current supplies of epinephrine emergency syringes for code boxes or code situations.
- Consider limiting the number of emergency syringes that are stocked in the code boxes.
- Amphastar (personal communications). May 3 and 30, 2017.
- Pfizer (personal communications and website). May 3 and 26, June 2 and 14, July 6, August 4 and 28, September 29, November 7 and 15, December 1 and 8, 2017; January 6, February 9 and 20, March 9, May 11, June 29, August 10 and 30, September 28, November 1, December 7, 2018; January 31, and March 1, 2019.
- BPI Labs. May 3 2017.
- Par Pharmaceuticals. May 3, and June 12, 2017; and January 24, 2018.
- Epinephrine Injection product information. Lake Forest, IL: Hospira; 2016 March.
- Epinephrine. Lexi-Comp Online. Hudson, OH: Lexi-Comp Inc.; 2017.
- Institute for Safe Medication Practices. EPINEPHrine pre-filled syringe shortage. https://www.ismp.org/NAN/files/NAN-201006.pdf . Accessed May 31, 2017.
- Snap Medical Industries (personal communications). June 7, 2018.
Updated March 4, 2019 by Michelle Wheeler, PharmD, Drug Information Specialist. Created May 4, 2017 by Michelle Wheeler, PharmD, Drug Information Specialist. © 2019, Drug Information Service, University of Utah, Salt Lake City, UT.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.