• Epinephrine injection, Amphastar
  0.1 mg/mL, 10 mL syringe, 10 count (NDC 76329-3316-01)

• • 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.¹
  • Pfizer stopped distributing epinephrine 1 mg/mL presentations on May 10, 2017.²
  • BPI has epinephrine 1 mg/mL 2 mL ampules available.³
  • Par has Adrenalin 1 mg/mL 1 mL and 30 mL vials available.⁴

• Adrenalin injection, Par Sterile Products
  1 mg/mL, 1 mL vial, 25 count, NDC 42023-0159-25
  1 mg/mL, 30 mL multiple dose vial, 1 count (NDC 42023-0168-01)

Estimated Resupply Dates

• • Amphastar has epinephrine 0.1 mg/mL 10 mL syringes on allocation.¹
  • Pfizer has epinephrine 0.1 mg/mL 10 mL syringes on back order and the company estimates a release date of late-July 2017.²

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.

Safety

• • Epinephrine is a high alert medication and may cause significant patient harm when used in error.⁶
  • Create a dose conversion chart reflecting available epinephrine concentrations to keep in code boxes and post in areas where epinephrine is frequently used.⁷
  • Do not stock the 30 mL multi-dose vials in code boxes.⁷
  • 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.⁷
  • Routine bulk compounding is not an option due to epinephrine having a short stability time and sensitivity to pH, light, and air.⁷
  • FDA has extended the expiration dating for certain lots of epinephrine 0.1 mg/mL 10 mL Abboject syringes.

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.⁷
    

References

• 1. Amphastar (personal communications). May 3, 2017.
  2. Pfizer (personal communications and website). May 3 and 26, June 2 and 14, and July 6, 2017.
  3. BPI Labs. May 3 2017.
  4. Par Pharmaceuticals. May 3, and June 12, 2017.
  5. Epinephrine Injection product information. Lake Forest, IL: Hospira; 2016 March.
  6. Epinephrine. Lexi-Comp Online. Hudson, OH: Lexi-Comp Inc.; 2017.
  7. Institute for Safe Medication Practices. EPINEPHrine pre-filled syringe shortage. Accessed May 31, 2017.