Acetylcysteine Critical Shortage
What? Acetylcysteine oral/inhalation solutions are a critical shortage at Methodist and nationwide. Due to the critical shortage, the following action plan will be employed at the adult hospitals only:
1. Oral acetylcysteine solution will be reserved for acetaminophen overdose.
2. The pharmacist will call the prescriber for acetylcysteine orders in the following situations:
a. FOR PO ORDERS
When ordered on the Radiocontrast Nephropathy Prophylaxis Protocol or for this purpose (600-1200mg bid x 2 days), the pharmacist will notify the prescriber of the shortage and recommend the following alternatives:
- Normal Saline IV 1 mL/kg/hr (MAX 100 mL/hr) 12 hours pre & 12 hours post contrast (24 hour total infusion duration)
- Sodium bicarbonate IV 150 mEq in 1 liter of D5W to be administered as 3 mL/kg bolus (MAX 300 mL) 1 hour prior to procedure AND 1 mL/kg/hour (MAX 100 mL/hr) during and for 6 hours post-procedure
- Acetylcysteine 1200 mg IVPB once 1 hour prior to the procedure/contrast. Note: This IV option is also approaching shortage levels and needs to be reserved for the treatment of acetaminophen toxicity.
b. FOR INHALATION ORDERS
The pharmacist will notify the prescriber of the shortage and recommend the following alternative for adult patients:
- Sodium Chloride 7%--4 mL nebulized over 10 minutes twice daily
When: Effective Immediately
Why: Products affected include the 100 mg/mL and 200 mg/mL sizes in the concentrations of 4 mL, 10 mL, and 30 mL. Reasons for the shortage include temporary suspension of distribution of most drug products by American Regent, increased demand (Hospira) and unknown (Roxanne). The estimated resupply date is mid-July for Hospira and October for Roxanne. Currently, Methodist Le Bonheur Healthcare (MLH) is unable to obtain any acetylcysteine oral/inhalation solution and the pharmacy has limited supply. Although currently not a currently recognized shortage, the IV acetylcysteine may become a shortage as a result of the oral/inhalation formulation shortage. In order to maintain a set amount of acetylcysteine for the treatment of acetaminophen toxicity, the above action plan will be implemented during this time of critical shortage.