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Sodium Bicarbonate Injection

Last Updated: June 5, 2018
Status: Current

Products Affected - Description
    • Sodium Bicarbonate injection, Pfizer, 4.2%, 10 mL LifeShield syringe, 10 count, NDC 00409-5534-34
Reason for the Shortage
    • Amphastar has sodium bicarbonate injection available.[1]
    • Pfizer has sodium bicarbonate injection on shortage due to manufacturing delays.[2]
    • Fresenius Kabi has reintroduced sodium bicarbonate injection in response to the shortage.[3]
Available Products
    • Neut, Pfizer, Additive solution 4%, 5 mL vial, 1 count, NDC 00409-6609-02
    • Sodium Bicarbonate injection, Amphastar, 8.4%, 50 mL syringe, 10 count, NDC 76329-3352-01
    • Sodium Bicarbonate injection, Fresenius Kabi, 4.2%, 5 mL vial, 25 count, NDC 63323-0083-05
    • Sodium Bicarbonate injection, Fresenius Kabi, 8.4%, 50 mL vial, 25 count, NDC 63323-0089-50
    • Sodium Bicarbonate injection, Pfizer, 7.5%, 50 mL LifeShield syringe, 10 count, NDC 00409-4916-34
    • Sodium Bicarbonate injection, Pfizer, 8.4%, 10 mL syringe, 10 count, NDC 00409-4900-34
    • Sodium Bicarbonate injection, Pfizer, 8.4%, 50 mL LifeShield syringe, 10 count, NDC 00409-6637-34
    • Sodium Bicarbonate injection, Pfizer, 8.4%, 50 mL vial, 25 count, NDC 00409-6625-02

Estimated Resupply Dates

    • Pfizer has sodium bicarbonate 4.2% 10 mL LifeSheid syringes on back order and the company estimates a release date of August 2018. The 8.4% 10 mL syringes are available.[2]

Implications for Patient Care

    • Sodium bicarbonate injection is commonly used in critical care settings during advanced cardiac life support (ACLS). The product is also used to manage metabolic acidosis and hyperkalemia and to increase urinary pH. Sodium bicarbonate injection may be used as an antidote for selected products such as tricyclic antidepressants, methyl alcohol, phenobarbital, or salicylates.[4-5]
    • Some centers have used the injectable product to prepare extemporaneous oral solutions of omeprazole or lansoprazole.[6]

Safety

    • Few alternatives are available. Clinicians should make every effort to reserve supplies for critical care uses.
    • If using sodium acetate as an alternative, infuse the product over 15 to 20 minutes rather than 1 to 2 minutes with sodium bicarbonate.[8]
    • When drawing up doses from vials, ensure appropriate sterility measures are taken following USP <797> recommendations for batching.
    • Pfizer has issued a recall on 42 lots of sodium bicarbonate 8.4% 50 mL vials and Neut 4% additive solution due to sterility concerns. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm563382.htm

Alternative Agents & Management

    • Conserve sodium bicarbonate for critical uses. Avoid using product for non-essential purposes such as buffering lidocaine during this shortage. The Society of Critical Care Medicine (SCCM) has recommendations for conserving sodium bicarbonate. http://www.learnicu.org/Lists/Web%20Contents/Attachments/14258/Drug-Shortages-Alert-9-16.pdf.
    • Evaluate vial use and consider methods to conserve supplies such as drawing up doses from vials rather than wasting unused product. Review storage locations such as crash carts and reduce inventory where possible.
    • If purchasing premade Continuous Renal Replacement Therapy (CRRT) solutions, consider those with higher sodium bicarbonate concentrations.
    • Sodium acetate injection may be an appropriate substitute for toxicology emergencies. The initial dose for salicylate overdose, severe cardiac arrhythmias, and initial rapid treatment of QRS widening is 1 mEq per kg body weight infused over 15 to 20 minutes with a goal serum pH of 7.5 to 7.55. Maintenance infusions are sodium acetate 150 mEq in 1 L 5% dextrose.[8]
    • Prepare oral solutions of omeprazole or lansoprazole using a sodium bicarbonate solution prepared from baking soda (1 teaspoon baking soda dissolved in 240 mL water).[7]
    • Oral sodium bicarbonate 650-mg tablets (Rising Pharmaceuticals, NDC 64980-0294-10) may be an appropriate alternative for urine alkalinization in patients receiving high-dose methotrexate.[9]

References

    1. Amphastar (personal communications). February 17, May 4, 2017; and April 20, 2018.
    2. Pfizer (personal communications). February 17, March 13 and 21, April, 14, May 3, 18, and 19, June 9, 15, and 22, July 6, 14, 28, and 31, August 15, September 1 and 29, October 27, November 2 and 15, December 29, 2017; January 26, February 2, March 20, April 13 and 20, and June 5, 2018.
    3. Fresenius Kabi (personal communications). July 25 and 27, September 15 and 28, October 27, November 10, and December 22, 2017; January 26, February 5, March 16, and April 13, 2018.
    4. Sodium Bicarbonate. In: Baughman VL, Golembiewski J, Gonzales JP, Alvarez W, eds. Anesthesiology & Critical Care Drug Handbook, 10th ed. Hudson, OH: Lexi-Comp; 1444 - 1447.
    5. Sodium Bicarbonate. In: McEvoy GK, Snow EK, Miller J, eds. AHFS 2017 Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; 2017:2852 - 2854.
    6. DiGiacinto JL, Olsen KM, Bergman KL, Hoie EB. Stability of Suspension Formulations of Lansoprazole and Omeprazole Stored in Amber-Colored Plastic Oral Syringes. Annals of Pharmacotherapy. 2000;34:600-605.
    7. Walters JK, Zimmermann AE, Souney PF, Katona BG. The Use of Omeprazole in the Pediatric Population. Annals of Pharmacotherapy.1998;32:478-481.
    8. Neavyn MJ, Boyer EW, Bird SB, Babu KM. Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review. J Med Toxicol. 2013;9:250-254.
    9. Rouch JA, Burton B, Dabb A, et al. Comparison of Enteral and Parenteral Methods of Urine Alkalinization in Patients Receiving High-Dose Methotrexate. J Oncol Pharm Practice. 2017;23:3-9.

Updated

Updated June 5, 2018 by Anthony Trovato, Pharmacy Resident. Created February 17, 2017 by Michelle Wheeler, PharmD, Drug Information Specialist. Copyright 2018, Drug Information Service, University of Utah, Salt Lake City, UT.

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