Medication Safety Updates

Medication Safety Communications


Date last updated: 24 Jan 2023

The information provided on this page is intended for use by NSW health clinicians. It may not be relevant to clinicians from other states or territories and is not the complete list of medicine shortages reported to the Therapeutic Goods Administration – refer to the TGA Medication Shortages Information Initiative and Medicines Safety Update.

Medicine Affected Issued Updated Update Status
Amoxicillin 12-Oct-22 23-Jan-23 There is a current disruption to the supply of multiple amoxicillin products due to an unexpected increase in demand. Multiple suppliers have received approval under section 19A (S19A) of the Therapeutic Goods Act to import supply of alternative international agents – it should be noted that some of these alternatives contain sorbitol. The TGA has made a Serious Scarcity Substitution Instrument (SSSI) which allows community pharmacists to dispense another amoxicillin product of a different strength to a patient when one is available without prior approval to substitute from the prescriber (for more information click on medication name to the left). A shelf-life extension for Amoxil Forte Sugar Free Syrup 250 mg/5 mL has been approved by the TGA. The shelf life has been extended from 36 months to 48 months for batch number AHBHV0015 (meaning it can be used for an additional 12 months from the printed expiry date). Supply of the 250 mg/5 mL product is available from the NSW Health Stockpile. Please contact Noman.Masood@health.nsw.gov.au to access. Current
Flucloxacillin 7-Dec-22 20-Jan-23 There is a current disruption to the supply of flucloxacillin (Flucil) 250 mg/5 mL and 125 mg/5 mL oral liquid due to manufacturing issues until 6 January 2023. Medsurge have received approval under section 19A (S19A) of the Therapeutic Goods Act to import supply of flucloxacillin (Athlone) 125 mg/5 mL 250 mg/5 mL Oral solution from the UK until 28 February 2023. The S19A alternatives are identical in active ingredient and strength to the Australian registered product, however, differ with regard to storage requirements once reconstituted. For further information regarding the differences between the 250 mg/5 mL products, please refer to the Dear Health Care professional letter by clicking the medicine name on the left. Resolved
Phenoxymethylpenicillin 11-Oct-22 20-Jan-23 There is a current disruption to the supply of multiple brands of phenoxymethylpenicillin 250 mg and 500 mg capsules and phenoxymethylpenicillin (Aspecillin VK) 250 mg tablets until 31 January 2023 due to manufacturing issues. Medsurge has received approval under section 19A (S19A) of the Therapeutic Goods Act to import supply of phenoxymethylpenicillin (Penicillin Potassium Rising Health) 250 mg and 500 mg tablets (Aurobindo Pharma Limited) from the USA until 31 January 2023. The S19A approved USA product is identical in active ingredient and strengths to the Australian registered products. Information regarding differences in excipients, form, pack size and storage requirements are available in the Dear Health Care Professional letter (by clicking the medication name to the left). Current
Adrenaline 1:10,000 19-Mar-20 20-Jan-23 There is an ongoing disruption to the supply of multiple brands of adrenaline 1:10,000 (1 mg/mL) ampoules for injection due to commercial changes. The Aspen product is expected back in stock in mid-February 2023, the expected date of return for the Link product is unclear at this stage. Supply of an alternative ampoule formulation is currently being considered for approval under section 19A (S19A) of the Therapeutic Goods Act. If urgently required, facilities can switch to the prefilled syringe formulation which is unaffected by the disruption to supply, ensuring that a local risk assessment is undertaken given connector incompatibility issues outlined in SN015/22. Current
Codeine linctus 7-Dec-22 20-Jan-23 There is a current disruption to the supply of codeine 5 mg/mL (Gold Cross) linctus until end of February 2023 due to a product recall. Supply of the alternative product codeine 5 mg/mL (Actacode) is available via wholesalers. Current
Mesalazine (Mesasal) 26-Oct-22 20-Jan-23 There is a current disruption to the supply of mesalazine 250mg (Mesasal) tablets until 30 November 2022 due to unexpected increases in consumer demand. Brands of mesalazine are not interchangeable due to differences in formulation and release characteristics. In cases of complete disruption to supply, specialist advice should be sought about alternative treatment options. Resolved
Pristinamycin 13-Jan-23 13-Jan-23 There is a current disruption to the supply of pristinamycin (SAS) 500 mg tablets due to an international export ban. The length of the export ban is unclear. Supply of 250 mg tablets as an alternative may be available via the Therapeutic Goods Administration Special Access Scheme (SAS) through Pro Pharma. Facilities are encouraged to preserve residual stock for existing patients, avoid initiating new patients on pristinamycin and contact the Infectious Diseases/Microbiology department for advice if patients require a modification in therapy. Current
Cefalexin oral liquid 22-Dec-22 22-Dec-22 There is a current disruption to the supply of multiple cefalexin oral liquid formulations due to an unexpected increase in demand and manufacturing issues which is expected to extend into quarter 1 of 2023. The TGA has made a Serious Scarcity Substitution Instrument (SSSI) which allows community pharmacists to dispense another cefalexin oral liquid product of a different strength to a patient when one is available without prior approval to substitute from the prescriber. Further information about the substitution and the conditions required is available on the PBS Medicine Shortages page. For patients admitted to hospital, consider reserving remaining oral liquid formulations for paediatric patients and utilise the capsule formulation for patients with enteral feeding and swallowing difficulties (see Do Not Rush to Crush, accessible via CIAP for further information). Current
Barium sulfate oral suspension products 8-Jun-22 22-Dec-22 There is a disruption to the supply of barium sulfate oral suspension products. International alternatives are available via the Therapeutic Goods Administration Special Access Scheme (SAS). For more information regarding the shortage and the SAS alternatives please refer to the medication safety communication by clicking on the medication name on the left. Current
Trimethoprim-sulfamethoxazole tablets 21-Dec-22 21-Dec-22 There is a current disruption to the supply of trimethoprim-sulfamethoxazole (Resprim Forte and Septrin Forte) 160 mg/800 mg tablets until February 2023 due to manufacturing issues. ProPharma has received approval under section 19A (S19A) of the Therapeutic Goods Act to import supply of sulfamethoxazole/trimethoprim USP (Aurobindo and Rising Health) 800 mg/160 mg tablets from the USA until 28 February 2023. The products are identical in active ingredient to the Australian registered products but differ in storage requirements and pack sizes. The USA alternatives also contains sodium benzoate as an additional excipient. For further information regarding the differences between the products, please refer to the Dear Health Care Professional letters by clicking the medicine name on the left. Clinicians are encouraged to reserve trimethoprim-sulfamethoxazole tablets for priority indications such as treatment of pneumocystis jirovecii infection and prophylaxis in immunocompromised patients, treatment of stenotrophomonas maltophilia and nocardia infections. Current
Hyoscine butylbromide 21-Dec-22 21-Dec-22 There is an anticipated disruption to the supply of hyoscine butylbromide (Buscopan) 20 mg/1 mL ampoules from 1 January 2023 to 13 March 2023 due to manufacturing issues. Facilities are encouraged to place orders for Buscopan prior to the anticipated disruption date. Alternative products listed on the Australian Register of Therapeutic Goods (ARTG) include hyoscine butylbromide (Medsurge and SXP) 20 mg/1 mL. The alternative products are identical in active ingredient and strength, however differ in regard to storage requirements. The alternative products must be protected from light. For further information regarding the differences between the products, please refer to the Product Information available via the ARTG website (by clicking on the medication name on the left). Current
Quinapril 15-Dec-22 15-Dec-22 There is a current disruption to the supply of quniapril and quniapril with hydrochlorothiazide products due to ongoing investigations by the Therapeutic Goods Administration (TGA) into potential contamination with low levels of N-nitroso-quinapril. The disruption to supply is expected to continue into 2023. On 13 December 2022, The Therapeutic Goods Administration (TGA) recalled multiple brands and strengths of quinapril tablets (APO, Generic Health, Acquin) due to identifying unacceptable levels of N-nitroso-quinapril. As a precautionary measure, sponsors of all marketed quinapril and quinapril with hydrochlorothiazide products have paused supply of quinapril products while the TGA continues to investigate. In cases of complete disruption to supply, advice should be sought regarding alternative treatment options. Further information regarding the shortage and TGA investigation is available by clicking the medication name on the left. Current
Nirmatrelvir 150 mg/ritonavir 100 mg (Paxlovid) 1-Aug-22 15-Dec-22 A shelf-life extension for nirmatrelvir 150 mg/ritonavir 100 mg (Paxlovid) tablets has been approved in Australia by the Therapeutic Goods Administration (TGA). The shelf life has been extended from 18 months to 24 months and may be applied retrospectively to Paxlovid products manufactured prior to this approval being granted. The storage conditions of ‘Store below 25 degrees Celsius’ remain unchanged. As Paxlovid is a co-packaged product and the active ingredients may have had different production dates, the updated expiry date must be determined by identifying the specific batch number. A full list of batches and updated expiries can be accessed in the Dear Health Care Professional Letter from Pfizer, by clicking on the medication name to the left. Current
Prednisolone acetate 1%/phenylephrine 0.12% suspension (Prednefrin Forte) eye drops 3-Mar-21 14-Dec-22 There is a disruption to supply of Prednefrin Forte eye drops, anticipated to resolve on 1 Jan 2022. See Medication Safety Communication for further information Resolved
Ceftolozane/tazobactam 12-Jan-21 14-Dec-22 The recall on all batches of ceftolozane/ tazobactam (Zerbaxa®) in December 2020 (due to sterility results of numerous batches being out of specification) continues to impact the supply of Zerbaxa® worldwide. The published expected supply date for Zerbaxa® has been revised to 1 March 2022. Alternative therapy should be sought in consultation with local Infectious Diseases/Microbiology service. Resolved
Atenolol 50 mg/10 mL oral solution 8-Jun-21 14-Dec-22 Disruption to the supply of Atenolol-AFT 50 mg/10 mL oral solution due to manufacturing delays. Supply of an alternative product, Atenolol 25 mg/5 mL Sugar Free Oral Solution (Essential Generics) is available via LINK under Section 19A (S19A) of the Therapeutic Goods Act 1989. Resolved
Gadobutrol 1-Feb-22 14-Dec-22 There is a temporary disruption to the supply of Gadobutrol 9.0708 g/15 mL injection (GADOVIST 1.0) until 18 March 2022. Resolved
Primidone 250 mg tablets 18-Nov-21 14-Dec-22 There is a disruption to the supply of primidone (Mysoline) 250 mg tablets. Supply of an alternative product is available from Link under Section 19A (S19A) of the Therapeutic Goods Act 1989 (Lannett brand from USA). Note that the S19A alternative comes in a pack size of 100 tablets (compared to the ARTG pack size of 200 tablets) and contains lactose which is not present in the ARTG product. Resolved
Flebogamma 10% DIF – all vial sizes 1-Apr-21 14-Dec-22 All vial sizes of Flebogamma 10% DIF immunoglobulin are temporarily unavailable and cannot be ordered in BloodNET. Click on the medicine name for more information regarding the reallocation process and information for clinic staff. Resolved
Minoxidil 16-Nov-22 14-Dec-22 There is a disruption to supply of minoxidil (Loniten) 10 mg tablets until 31 July 2023 due to manufacturing issues. Orspec Pharma has received approval under section 19A (S19A) of the Therapeutic Goods Act to import supply of minoxidil (Roma Pharmaceuticals) from the UK until 30 August 2023. Stock is expected to be available from 27 December 2022, and sites are encouraged to place orders as soon as possible to ensure continuous supply during the shortage period. The s19A alternative is identical in active ingredient and strength to the Australian registered product. Information regarding differences in pack sizes are available in the Dear Health Care Professional letter (by clicking the medication name to the left). Current
Azathioprine injection 29-Jul-21 7-Dec-22 The Australian registered product, azathioprine 50 mg powder for injection (Imuran®) has been discontinued. The product sponsor anticipates that their stock will be exhausted by the end of 2022, with minimal stock available at regular wholesalers. Supply of a USA registered alternative 100 mg Azathioprine powder for injection is available under the Therapeutic Goods Administration Special Access Scheme via Link Pharmaceuticals. Current
Methylprednisolone sodium succinate injection 25-Nov-22 25-Nov-22 There is a current disruption to the supply of methylprednisolone sodium succinate (Solu-Medrol Act-O-Vial) 40 mg powder for injection vials. The product sponsor have advised that stock is constrained and being managed via wholesalers. If sites require stock urgently or experience problems obtaining supply, please contact wholesalers or Pfizer directly. Current
Bupivacaine with fentanyl (Marcain 0.125%) 25-Nov-22 25-Nov-22 Bupivacaine with fentanyl 100 mcg/20 mL (Marcain 0.125%) injection ampoules will be discontinued from 1 May 2023, with a reduction in supply until stock is exhausted. Sites are encouraged to review current protocols containing this medicine and consider alternative agents in consultation with anaesthetic teams. Current
Phenobarbital (phenobarbitone) elixir 22-Nov-22 22-Nov-22 There is a current disruption to the supply of phenobarbital (phenobarbitone) (Orion) 15 mg/5 mL elixir 100 mL bottles due to logistical issues. The disruption is expected to resolve in late January 2023. There are no alternative phenobarbital (phenobarbitone) liquid products listed on the ARTG. Consider reserving remaining supply of elixir for paediatric patients, and utilise the tablet formulation for patients with enteral feeding and swallowing difficulties (see Do Not Rush to Crush, accessible via CIAP for further information). Current
Ertapenem 18-Oct-22 22-Nov-22 There is a current disruption to the supply of ertapenem 1 g injection vials (Juno and Fresenius Kabi brands) due to unexpected increases in demand. The shortage is expected to resolve in November 2022. Facilities are encouraged to place orders for an alternative product manufactured by MSD available through regular wholesalers. If urgent requirements or problems obtaining supply, please contact Damien.Dowling@Health.nsw.gov.au Resolved
Oxybutynin tablets 10-May-22 22-Nov-22 There is a disruption to the supply of oxybutynin 5 mg tablets (Ditropan) until 15 December 2022. There are alternative oxybutynin tablet products accessible via an exemption granted by the Therapeutic Goods Administration (TGA) under section 19A. The Niche Generics S19A alternative from the UK (accessible via Orspec Pharma) will be PBS listed from 1 December 2022 for detrusor overactivity. An updated Medication Safety Communication was released on 17 August 2022 which provides further information on the shortage, potential alternatives and associated safety considerations – click on medication name to the left to access. Current
Itraconazole 16-Nov-22 16-Nov-22 The product sponsor has advised that itraconazole (Sporanox) 100 mg capsules will be discontinued from 28 February 2023, with a reduction in supply until supply is exhausted (refer to the Dear Health Care Professional letter by clicking the drug name on the left). The APO generic alternatives were also discontinued in September 2022, however Itranox remains available. Sites are encouraged to review current protocols and consider treating patients with alternative itraconazole products. Clinicians are reminded that Lozanoc and Sporanox capsule brands are not interchangeable. Sporanox liquid will remain unaffected and continue to be available. Current
Exenatide 9-Nov-22 9-Nov-22 The drug sponsor, AstraZeneca have advised that exenatide (Byetta) 5 mcg and 10 mcg pre-filled pens will be discontinued from the Australian market from 1 December 2022 (refer to Dear Health Care Professional letter by clicking on medicine name to the left). The 5 mcg product is currently out of stock with most wholesalers across Australia and will not be replenished. The 10 mcg stock is expected to be exhausted in December 2022. Clinicians will need to consider alternative therapies for their patients, prior to a complete exhaustion of supply. Due to the current disruptions to the supply of alternative glucagon-like peptide-1 analogues (including semaglutide and dulaglutide), specialist advice may be required. Current
Funnel web spider antivenom 7-Nov-22 7-Nov-22 There is a current disruption to the supply of funnel web spider antivenom vials until 31 January 2023 due to manufacturing issues. The drug sponsor, Seqirus has advised that emergency stock is available and that supply can be delivered within 12 hours in most cases. If emergency supply is required, sites are advised to escalate requests via the Seqirus customer service line – (03) 9389 2000. Current
Eprosartan 7-Nov-22 7-Nov-22 There is a current disruption to the supply of eprosartan 400 mg and 600 mg tablets until 1 June 2023 due to manufacturing issues. Once supply is completely exhausted, clinicians will need to switch patients to the equivalent dose of another angiotensin receptor blocker or an alternative antihypertensive medicine. Current
Semaglutide 3-Nov-22 3-Nov-22 There is an ongoing national disruption to the supply of semaglutide (Ozempic) solution for injection. The disruption to supply is a result of increased global demand for semaglutide products which is impacting availability and certainty of supply in Australia until early 2023. Clinicians are encouraged to follow the most up-to-date advice of the Therapeutic Goods Administration regarding this issue (accessible by clicking the medication name to the left). A number of Section 19A alternatives are available through Medsurge and Pro Pharmaceuticals. Please note – while all the alternatives approved under S19A are the Ozempic brand, some are not labelled in English. Current
Naloxone nasal spray and PFS 10-Aug-22 28-Oct-22 There is a disruption to the supply of naloxone nasal spray (Nyxoid) and pre-filled syringes (Prenoxad). Further supply of the pre-filled syringe formulation is expected in early November and the nasal spray in mid-November. Access to naloxone nasal spray may be available under the TGA’s Special Access Scheme via Orspec Pharma (with a 7-10 business day lead time). The product available from Orspec Pharma is the Nyxoid brand from Germany and is labelled in English, German and Spanish. It is identical to the Australian registered product in terms of pack size, storage and excipients. Please note – 1.8 mg naloxone is equivalent to 2 mg naloxone hydrochloride or 2.2 mg naloxone hydrochloride dihydrate. Current
Labetalol 19-Jul-21 26-Oct-22 There is a current disruption to the supply of labetalol (Presolol) 100 mg and 200 mg tablets until 14 November 2022 due to manufacturing issues. Supply of a UK registered product is available via Link, Medsurge and Orspec under the Special Access Scheme (SAS) of the Therapeutic Goods Act. Please note the SAS alternatives may contain lactose (not present in the Australian registered product). Current
Hyoscine hydrobromide 26-Oct-22 26-Oct-22 There is a current disruption to the supply of hyoscine hydrobromide (DBL) 400 microg/1 mL ampoules until mid-November 2022 due to manufacturing issues. Pfizer, the product sponsor, have advised that short dated stock (November 2022) is available via direct purchase order if stock is required. Current
Pyridostigmine 26-Oct-22 26-Oct-22 There is a current disruption to the supply of pyridostigmine (Mestinon Timespan) 180 mg tablets until 24 March 2023 due to manufacturing issues. Medsurge have received approval under section 19A (S19A) of the Therapeutic Goods Act to import supply of pyridostigmine bromide (Rising Pharmaceuticals) from the USA until 30 November 2022. Information regarding differences in pack size and storage requirements are available in the Dear Health Care Professional letter (by clicking the medication name to the left). Current
Cefotaxime 11-Oct-22 26-Oct-22 There is a current disruption to the supply of cefotaxime 1 g and 2 g powder for injection. Supply is expected to be available through regular wholesalers by early next week. If urgent requirement, facilities may place a direct purchase order through the product sponsor, Pfizer. Resolved
Metronidazole tablets 22-Aug-22 24-Oct-22 There is a current disruption to the supply of multiple brands of metronidazole 200 mg and 400 mg tablets. Refer to Medication Safety Communication (updated 19 October 2022) for further information on this disruption to supply, available alternatives and associated safety considerations (by clicking on the medication name to the left). Current
Amoxicillin plus clavulanic acid tablets 5-Sep-22 24-Oct-22 There is a current disruption to the supply of multiple brands of amoxicillin plus clavulanic acid 875 mg/125 mg tablets. Refer to Medication Safety Communication (updated 19 October 2022) for further information on this disruption to supply, available alternatives and associated safety considerations (by clicking on the medication name to the left). Current
Antacid suspensions 21-Oct-22 21-Oct-22 There is a current disruption to the supply of multiple brands and volumes of antacid suspension products. Gastrogel suspensions are expected to be unavailable until late November 2022. Limited stock of Gastrogel 150 mL may be available from wholesalers. There is currently no expected return date for Gaviscon suspensions. Supply of antacid chewable tablets (Gaviscon Dual Action) and granules (Gaviscon Infant) remain unaffected. Granules can be used for nasogastric administration (see Do Not Rush to Crush, accessible via CIAP for further information). Current
Olanzapine 9-Sep-22 17-Oct-22 There is a current disruption to the supply of olanzapine (Zyprexa) 10 mg/mL injection vials until 15 December 2022. Link Pharmaceuticals and Medsurge have received approval under section 19A (S19A) of the Therapeutic Goods Act to import supply of olanzapine for intramuscular injection 10 mg single dose vials (AuroMedics) from the USA until 31st January 2023. The S19A approved USA product is identical in active ingredient, strength and excipient ingredients to the Australian registered product. SAS alternatives may be available from Link, Medsurge, Orspec and ProPharma. Current
Dulaglutide 9-Oct-22 9-Oct-22 There is a current disruption to the supply of dulaglutide (Trulicity) 1.5 mg/0.5 mL solution for injection prefilled pen until 31 December 2022. Medsurge has received approval under section 19A (S19A) of the Therapeutic Goods Act to import supply of dulaglutide (Trulicity) 1.5 mg/0.5 mL solution for injection prefilled pen (Eli Lilly) from the Netherlands until 28 February 2023. The S19A product is identical to the Australian registered product in terms of concentration, excipients and storage requirements. However, the product labelling and Product Information is in German (box clearly states brand name ‘Trulicity’). Clinicians should use this product according to the Australian Product Information. Please note - the S19A alternative is not currently listed on the Pharmaceutical Benefits Scheme. Current
Molnupiravir 30-Sep-22 30-Sep-22 The TGA has recently approved the extension of shelf life of LAGEVRIO molnupiravir 200 mg capsule to 30 months when stored below 30 degrees Celsius. This extension retrospectively applies to all stock that has been imported to Australia noting that stock currently in the market is labelled with an expiry date of 18 months from the date of manufacture. See Dear Health Care Professional letter for further information (by clicking on the medication name to the left). Current
Ephedrine sulfate 30-Sep-22 30-Sep-22 There is a current disruption to the supply of ephedrine sulfate (DBL) 30 mg/mL ampoule for injection. A product substitution has been arranged by the drug sponsor with the ephedrine hydrochloride SXP (Generic Health) 30 mg/mL ampoules. Refer to Medication Safety Communication for further information on this disruption to supply and safety considerations associated with the alternative product (by clicking on the medication name to the left). Current
Dexamethasone 1-Jun-22 21-Sep-22 There is a current disruption to the supply of dexamethasone 4 mg/mL and 8 mg/2 mL injection. Refer to Medication Safety Communication for further information on the disruption to supply, potential alternatives and associated safety considerations (by clicking on the medication name to the left). Current
Pfizer povidone-iodine preparations 23-May-22 13-Sep-22 Multiple Pfizer povidone-iodine preparations were discontinued between July to September 2022. Refer to Medication Safety Communication for further information on the discontinuation, potential alternatives and associated safety considerations (by clicking on the medication name to the left) – communication updated on 12 September 2022. Current
Fluoxetine 7-Sep-22 7-Sep-22 There is a disruption to the supply of fluoxetine hydrochloride (Zactin) 20 mg dispersible tablet. Reach Pharmaceuticals has received approval under Section 19A (S19A) of the Therapeutic Goods Act to import supply of fluoxetine hydrochloride 20 mg dispersible tablets (Olena) brand from the UK until 30 November 2022. Capsule formulations continue to be available and contents can be dispersed for patients with swallowing difficulties or enteral feeding tubes. Current
Tenecteplase 22-Jun-22 5-Sep-22 There is a critical disruption to the supply of tenecteplase (Metalyse®) 40 mg and 50 mg powder for injection vials, which is expected to continue until the end of 2023. An updated Safety Alert (SA 005/22) was released on 1 September 2022 outlining the need for urgent stock preservation across NSW Health – accessible by clicking on the medication name to the left. Facilities requiring stock should contact HealthShare NSW via email: Noman.Masood@health.nsw.gov.au. Orders will be limited to one unit at a time. Current
Paracetamol 48 mg/mL liquid formulations 22-Aug-22 22-Aug-22 There is a current disruption to the supply of multiple brands of paracetamol 48 mg/mL liquid formulations. The exact resolution date is currently unclear. HealthShare NSW have advised that supply of a 50 mg/mL suspension (Dymadon for Kids Strawberry 200 mL) will be available through regular wholesalers early this week – facilities are encouraged to place backorders to secure supply. If urgent requirement or problems obtaining supply, contact Noman.Masood@health.nsw.gov.au. Current
Benzylpenicillin 14-Jun-22 16-Aug-22 Supply of benzylpenicillin 1.2 g powder for injection (Benpen) will be available to order this week. Sequirius anticipate demand to be high and based on availability, the initial order volumes may be limited until a second batch is released later in August 2022. After that point, Sequirius expect continuous and sustained supply of benzylpenicillin 1.2 g powder for injection. Supply of the 600 mg and 3 g strengths continue to be available through regular wholesalers. Resolved
Non-ionic iodinated media agents 10-May-22 4-Aug-22 There is an ongoing global disruption to the supply of non-ionic iodinated media agents. The disruption is due to the recent COVID-19 lockdown in Shanghai which impacted on the operational capacity of the production facility and the shutdown of normal shipping/airfreight routes out of the city. The estimated resolution date is October 2022. Refer to SN008/22 disruption to supply – non-ionic iodinated contrast media agents for further information, guidance on stock conservation and potential alternatives (by clicking on the medication name to the left). Current
Trimethoprim-sulfamethoxazole 80 mg/400 mg injection 6-May-20 1-Aug-22 The disruption to supply of trimethoprim-sulfamethoxazole 80 mg/400 mg injection has been extended until 24 February 2023. Supply of an alternative product, registered in the UK, is available via Link under Section 19A (S19A) of the Therapeutic Goods Act until 31 March 2023; stock is available for direct order Current
Healon GV OVD (sodium hyaluronate) 22-Jun-22 19-Jul-22 Johnson & Johnson Vision (J&J Vision) has advised that they will be discontinuing the production of Healon GV OVD (sodium hyaluronate). Facilities are advised to speak to their J&J vision representative about other alternatives to Healon GV OVD. Healon Endocoat and Healon 5 remain available. Link have identified alternative options to hyaluronic acid eye injections accessible via the Special Access Scheme (SAS) of the Therapeutic Goods Act. Zeiss also has a product which may be used as an alternative to Healon GV OVD. Please contact Link or Zeiss directly for more information. Local assessment of these products is required to determine suitability. Current
Miochol-E (acetylcholine intraocular solution) 13-Jul-22 19-Jul-22 There is a disruption to the supply of Miochol-E (acetylcholine intraocular solution 20 mg/2 mL). Normal supply is anticipated to resume in Quarter 3, 2022. Refer to the Dear Healthcare Professional Letter (DHCP) for further information (by clicking on the medication name to the left). Supply of a USA registered product is available via Link, Medsurge and Orspec under the Special Access Scheme (SAS) of the Therapeutic Goods Act. This product is the same as the Australian registered product. Lead time to order is 7-10 business days. Miostat (carbachol 150 microgram/1.5 mL) supplied by Alcon is available if deemed to be a suitable alternative by local clinicians during this supply disruption. Please note that this product contains latex. Current
Cidofovir 30-May-22 19-Jul-22 The disruption to supply of cidofovir (Empovir) 375 mg/5 mL concentrated injection for infusion vials has been extended, an expected date of return has not been confirmed. CH2 have stock of cidofovir 375 mg/5 mL concentrated injection for infusion vials, available to access under the Special Access Scheme (SAS) of the Therapeutic Goods Act. This product is the same as the ARTG product. Current
Atracurium 22-Jun-22 23-Jun-22 There is a disruption to the supply of multiple brands of atracurium injection and DBL has discontinued production of atracurium 25 mg/2.5 mL injection. Supply of an alternative product registered in Europe, Atracurium Hameln 25 mg/2.5 mL solution for injection, is available via Medsurge under the Special Access Scheme (SAS) of the Therapeutic Goods Act. Current
Cisatracurium 21-Apr-20 23-Jun-22 There is a disruption to the supply of cisatracurium 150 mg/30 mL injection until 17 May 2022. Stock of cisatracurium 10 mg/5 mL injection strength is available and there is also supply of an alternative product of cisatracurium 10 mg/5 mL (Kalcex) under Section 19A (S19A) of the Therapeutic Goods Act, accessible from the NSW Health pharmaceutical stockpile. A Medication Safety Communication was produced in September 2021 to provide guidance on alternatives to cisatracurium. Click on medication name to the left to access Resolved
Sodium valproate 16-Dec-21 23-Jun-22 There is a temporary disruption to the supply of multiple brands of sodium valproate 400 mg injection. Juno Pharmaceuticals has an unregistered product from France, Valproate de Sodium Aguettant 400 mg/4 mL, that has been approved for supply under section 19A of the Therapeutic Goods Act 1989 until 30 March 2022. Juno has confirmed that this product can be used according to the Australian Product Information. Resolved
Atropine 22-Jun-22 23-Jun-22 There is a temporary disruption to the supply of atropine 600 microgram injection until 16 September 2022. Stock of atropine 1.2 mg injection (expiring 30 September 2022) is available. Current
Gallium injection 10-May-22 9-Jun-22 There is a current disruption to the supply of gallium citrate 74 MBq/mL injection. The supplier, GMS, is communicating directly to facilities on a weekly basis to inform them of the availability of Gallium injection for the coming week. Please escalate concerns to CEC-MedicationSafety@health.nsw.gov.au. Current
Isoprenaline 9-Oct-20 1-Jun-22 Several new isoprenaline products have recently been registered in Australia and can now be ordered via wholesalers. S19A isoprenaline alternatives may still be in available in NSW Health facilities. Refer to the Medication Safety Communication for important safety information regarding these alternatives (by clicking on the medication name to the left). Resolved
Thiopental (thiopentone) 1-Jun-22 1-Jun-22 There is a disruption to supply of thiopental sodium (Pentothal) 500 powder for injection until the end of July 2022. An alternative thiopental sodium (Omegapharm) 470mg powder for injection is available from wholesalers. Clinicians should note the lower strength of the Omegapharm product and that a smaller dilution volume is required to achieve the desired concentration. Refer to the Omegapharm Product Information for further information (by clicking on the medication name to the left). Resolved
Leucovorin calcium folinic acid (as calcium folinate) 1-Jun-22 1-Jun-22 There is a current shortage of DBL leucovorin calcium folinic acid 50 mg/5 mL (as calcium folinate) injection and an anticipated shortage of Pfizer leucovorin calcium folinic acid (as calcium folinate) 50 mg/5 mL injection. The 100 mg/10 mL injection continues to be available, as are the 15 mg tablets. Current
Urokinase 16-Dec-21 26-Apr-22 Urokinase is a thrombolytic agent accessible via the Special Access Scheme (SAS) – some facilities have reported difficulties accessing supply through their normal channels. Reach Pharmaceuticals have stock of Urokinase injection available (contact Hala Raghib via hala@reach-pharma.com). Current
Phebra electrolyte products 22-Mar-22 22-Mar-22 Phebra will be updating all packaging and labelling of electrolyte products to make the millimole (mmol) concentration more prominent. To ensure uninterrupted supply while Phebra enacts these changes, some products will continue to be supplied in their current labelling which does not have the mmol concentration displayed prominently. A memo was released by Phebra on 21 March 2022 – click on ‘Phebra electrolyte products’ to the left to access. Current
Hydromorphone 2 mg and 4 mg (Dilaudid) tablets 22-Mar-22 22-Mar-22 There is a disruption to supply of hydromorphone 2 mg and 4 mg (Dilaudid) tablets which is expected to resolve by the first week of April. SAS stock may be accessible if urgently required, Noman.Masood@health.nsw.gov.au can be contacted for more details. Resolved
Japanese encephalitis vaccine 16-Mar-22 16-Mar-22 Pharmacy departments should contact Noman.Masood@health.nsw.gov.au if they are having difficulty securing stock of Japanese encephalitis vaccines. Vaccines are available through wholesalers, but supply may be constrained due to recent increased demand. Current
Sulfamethoxazole-trimethoprim 2-Mar-22 2-Mar-22 There is an anticipated shortage of sulfamethoxazole 40 mg/trimethoprim 8 mg oral liquid (Septrin) from 4 March 2022 to 29 July 2022. Supply is available from the NSW Health Stockpile. Please contact Noman.Masood@health.nsw.gov.au to access. Current
Epoprostenol (Flolan®) 2-Mar-22 2-Mar-22 There is an anticipated disruption to the supply of epoprostenol (Flolan®) 0.5 mg injections until 25 April 2022. Stock is still available from wholesalers. Staff should use alternative brands (e.g. Veletri®) or alternative strengths of Flolan® to manage this disruption to supply. Resolved
Tuberculosis medicines – multiple products 2-Mar-22 2-Mar-22 Pharmacy departments or TB programs should contact Noman.Masood@health.nsw.gov.au for assistance, if they are having difficulty sourcing the following agents from wholesalers: cycloserine 250 mg capsules, levofloxacin 500 mg tablets, pyrazinamide 500 mg tablets, prothionamide 250 mg tablets, aminosalicyclic sachets, clofazimine 100 mg tablets, rifampicin/isoniazid 75 mg/50 mg dispersible tablets OR rifampicin/isoniazid/pyrazinamide 75 mg/50 mg/150 mg dispersible tablets. Current
Fleet Ready-to-Use Enema 15-Feb-22 15-Feb-22 There is a disruption to supply of Fleet Ready-to-Use Enema with supply expected to resume in mid-late March, subject to updates from the supplier. A Medication Safety Communication has been issued - click on product name on the left to access Resolved
HYDROmorphone (Dilaudid®) Oral Liquid 1 mg/mL 14-Apr-21 9-Feb-22 The Australian registered medicine HYDROmorphone hydrochloride (Dilaudid®) oral liquid 1 mg/mL has been discontinued. Supply of two alternative HYDROmorphone hydrochloride oral solution 1mg /mL, USP 473 mL products are available; Rhodes brand is available via Medsurge under Section 19A (S19A) of the Therapeutic Goods Act until 31 January 2023; Hikma brand (previously branded as West-Ward) is available via Link under S19A until 31 August 2022. Both S19A products differ from Dilaudid® oral liquid in that they contain sodium metabisulfite, a sulfite that may cause allergic type reactions. Use of this product is contraindicated in patients with hypersensitivity to sulfite containing medications. Current
DRAXIMAGE MACROSALB® Kit 7-Dec-21 9-Feb-22 There is a temporary disruption to supply of DRAXIMAGE MACROSALB® Kit until 31 March 2022. ANSTO has arranged supply of a substitute medicine DRAXIMAGE MAA (Canada). This product is due to arrive in Australia on 15 December and will be available for supply to customers from the week commencing 20 December. Supply is authorised under an exemption granted by Therapeutic Goods Administration (TGA) under section 19A of the Therapeutic Goods Act 1989. Resolved
Bivalirudin 27-Aug-21 9-Feb-22 There is an anticipated disruption to the supply of bivalirudin 250 mg injection vials. A Medication Safety Communication was issued on 27 August 2021 – click on medication name to the left to access. Resolved
Oxycodone and naloxone (Targin®) 9-Feb-22 9-Feb-22 There is an anticipated disruption to supply of oxycodone and naloxone (Targin®) 2.5/1.25 mg, 5/2.5 mg. 10/5 mg and 20/10 mg tablets. Supply return dates vary between the strengths and range from 1 – 2 weeks, with a potential further delay for the 20/10 mg tablet. Resolved
Lignocaine (Xylocaine®) with adrenaline sterile theatre packs 15-Dec-21 1-Feb-22 Disruption to the supply of lignocaine (Xylocaine®) with adrenaline sterile theatre packs, anticipated to last until 15 September 2022. Reach Pharmaceuticals has an unregistered product from Austria, Xylanaest 1% with Epinephrine 1:200,000 5 mL ampoule (Gebro Pharma), that has been approved for supply under section 19A of the Therapeutic Goods Act 1989 until 30 November 2022. Reach has confirmed that this product can be used according to the Australian Product Information. The S19A product contains sodium metabisulfite (as does the Australian registered product), a sulfite that may cause allergic-type reactions including anaphylactic symptoms in susceptible people. Use of Xylanaest 1% with Epinephrine 1:200,000 5 mL ampoule (Gebro Pharma) is contraindicated in patients with hypersensitivity to sulfite-containing medications. The S19A product must be stored below 25oC and in its original packaging to protect from light. The attached Medication Safety Communication provides further information and guidance on alternatives as well as potential safety issues for local mitigation. Current
Bupivacaine and adrenaline 11-Jan-22 11-Jan-22 There is a disruption to the supply of bupivacaine 0.25% and adrenaline 1:400,000 (Marcain 0.25% with adrenaline 1:400,000) in 20 mL until September 2022. Supply of bupivacaine 0.5% and adrenaline 1:200,000 (Marcain 0.5% with adrenaline 1:200,000) in 20 mL is also low. There is limited short-dated stock (expiring May 2022) of both strengths still available – facilities have been advised to submit backorders with Symbion, allocations of this stock will occur from this week. Aspen are investigating alternatives to minimise the disruption during this long-term shortage. Information will be updated here as it becomes available. Current
Calcium gluconate 16-Dec-21 16-Dec-21 Phebra has changed the labelling of ‘Calcium Gluconate Injection 2.2 mmol of calcium in 10 mL’ to ‘Calcium Gluconate Injection - calcium gluconate monohydrate 931 mg in 10 mL solution for injection’. The new label does not specify the millimole (mmol) concentration of calcium gluconate prominently which is a potential safety risk. A Safety Notice was issued on 15 December 2021 – click on medication name to the left to access. Current
Thiopental sodium 16-Dec-21 16-Dec-21 There is a disruption to the supply of thiopental sodium (Pentothal) powder for injection until late April 2022. Limited stock is available – facilities with insufficient stock to see them through the disruption period have already been contacted by HealthShare NSW to advise them of their stock allocation which must be ordered directly from Link. Please contact HealthShare NSW (Noman.Masood@health.nsw.gov.au) or Link if you require supply further to your allocation. Resolved
Gentamicin 10 mg/1 mL 28-Apr-20 15-Dec-21 DBL gentamicin 10 mg/1 mL ampoules have been discontinued. The attached Medication Safety Communication provides further information and guidance on alternatives as well as potential safety issues for local mitigation. Current
Ketorolac 10 mg/1 mL injection 18-May-21 15-Dec-21 Ketorolac-Baxter 10 mg/1 mL ampoules are being discontinued effective 1 September 2022, however remaining stock is anticipated to be exhausted before this date. The attached Medication Safety Communication provides further information and guidance on alternatives as well as potential safety issues for local mitigation. Resolved
Artemether with lumefantrine 7-Dec-21 7-Dec-21 Artemether and Lumefantrine (20 mg/120 mg) (Riamet) tablets are available to order as a direct shipment through the wholesaler. Wholesalers may be reducing stock kept on hand of artemether and lumefantrine due to low usage, however supply is still available. Resolved
Aciclovir 250 mg/10 mL injection 8-Jun-21 30-Nov-21 Supply of DBL aciclovir 250 mg/10 mL injection vials will be unavailable until early November 2021. The 500 mg/20 mL strength is currently unaffected and can be ordered from Pfizer or regular wholesalers. Resolved
Ipratropium 250 microgram nebules 30-Nov-21 30-Nov-21 Disruption to the supply of ipratropium (Aeron) 250 microgram/mL nebules until 31 March 2022. Ipratropium (Aeron) 500 microgram/mL continues to be available – clinicians should be informed that 0.5 mL of the 500 microgram/mL is required for a 250 microgram dose. Resolved
Heparin 5000 units/0.2 mL 14-Sep-21 30-Nov-21 Disruption to the supply of Pfizer heparin sodium injection 5000 units/0.2 mL 5 pack extended until late April 2022. Supply of short dated stock is available from the NSW Health Stockpile. Please contact Noman.Masood@health.nsw.gov.au to access this supply. Heparin sodium injection 5000 units/0.2 mL 50 pack is still available. Resolved
Promethazine 29-Jul-21 19-Oct-21 DBL promethazine hydrochloride 50 mg/2 mL injection is out of stock until 30 August 2021. Link and Medsurge have alternative promethazine injection products available via the Therapeutic Goods Administration’s Special Access Scheme. Both companies have also applied to supply under Section 19A (S19A) of the Therapeutic Goods Act 1989 – currently awaiting outcome of application. Details will be updated when available. Resolved
Tocilizumab subcutaneous pre-filled syringes and pens 1-Oct-21 1-Oct-21 There is a critical disruption to the supply of tocilizumab pre-filled syringes and pens. During the period of supply disruption Medsurge may be able to supply alternatives, RoActemra tocilizumab 162 mg/0.9 mL solution for injection in pre-filled syringe and RoActemra tocilizumab 162 mg/0.9 mL solution for injection in pre-filled pen, under section 19A of the Therapeutic Goods Act 1989. Clinicians are reminded to regularly check the TGA website regarding this shortage for updated information including priority indications – https://www.tga.gov.au/alert/shortages-tocilizumab-actemra-medicines. Resolved
Tocilizumab injection vials 9-Jul-21 1-Oct-21 There is a critical disruption to the supply of all strengths and formulations of tocilizumab. Orders for intravenous tocilizumab for all indications are to be placed via the NSW Health stockpile. Supply will no longer be accessible via regular wholesalers and the drug sponsor. Please see factsheet available in ‘General information relating to COVID-19 treatments' tab at the top of the page for further information. A Safety Alert was issued on 31 August 2021 (accessible via the SABS register or by clicking drug name to the left). Patients should only receive a SINGLE DOSE of tocilizumab for the treatment of COVID-19, with use limited to those who meet the criteria outlined in the Safety Alert. Current
Furosemide (frusemide) 500 mg tablet 3-Mar-21 22-Sep-21 The Australian registered medicine, UREX FORTE furosemide (frusemide) 500 mg tablet is unavailable. Supply of an alternative product, Furosemid-ratiopharm 500 mg, is available via Medsurge under Section 19A (S19A) of the Therapeutic Goods Act. The S19A product differs from Urex Forte® tablets in terms of administration, Furosemid-ratiopharm must be taken on an empty stomach and unchewed with sufficient liquid (e.g. 1 glass of water). Resolved
Fluoxetine 7-Oct-20 22-Sep-21 Prozac and APO fluoxetine 20mg tablets have been discontinued. Other brands of capsules and tablets are in short supply. Additional S19A alternatives with English packaging are available from Medsurge (capsules and tablets) and Link (capsules) until 30 April 2021. Please note the S19A Medsurge capsules and tablets come in bottles of 100 and 30 respectively. The S19A Link capsules come in a box of 30. (Compared to Australian registered product which is a 28-capsule or 28-tablet blister pack). The S19A Medsurge and Link tablets are not PBS listed. Resolved
Potassium chloride 14-Sep-21 14-Sep-21 Pfizer has changed the labelling of the outer carton packaging of ‘Sterile Potassium Chloride Concentrate 10 mmol (0.75 g) in 10 mL’ ampoules to ‘Sterile Potassium Chloride Concentrate 75 mg in 1 mL’ ampoules. The new label does not specify the millimole (mmol) concentration of potassium chloride prominently which is a potential safety risk. A Safety Notice was issued on 10 September 2021 – click on medication name to the left to access. Current
Etacrynic acid 29-Jul-21 29-Jul-21 The Australian registered product, etacrynic acid 25 mg tablets (Edecrin®) will be discontinued and deleted from market on 15 August 2021. Supply of an alternative product Edecrin® (Canada) 25 mg tablets are available via Medsurge under the Special Access Scheme (SAS) of the Therapeutic Goods Act. Current
Flucytosine 7-Oct-20 29-Jul-21 The Australian registered product, flucytosine (Ancotil®) 2.5 g/250 mL injection will be discontinued and deleted from market on 31 October 2021. iNova Pharmaceuticals have access to a limited supply of flucytosine injection for hospitals who have patients in immediate need of the product. It is anticipated that stock depletion is likely to occur between July and September 2021 (timing is dependent on product demand). After depletion, no further stock will be available. The final batch has an expiry date of 31 October 2021. Supply of an alternative product Ancotil® 1% 2.5 g/250 mL injection (Austria) is available via Medsurge under the Special Access Scheme (SAS) of the Therapeutic Goods Act. Current
Nitrofurantoin 29-Jul-21 29-Jul-21 The Macrodantin® brand of nitrofurantoin 50 mg and 100 mg capsules has/will be discontinued on 1 July 2021 and 4 November 2021 respectively. Consequently there is a shortage of APO-Nitrofurantoin 50 mg and 100 mg capsules due to an increase in demand until 15 October 2021 and 3 September 2021 respectively. Supply of alternative products; nitrofurantoin 50 mg capsules (Sun Pharma, USA) and nitrofurantoin 100 mg capsules (Morningside Healthcare, UK) are available via Medsurge under Section 19A (S19A) of the Therapeutic Goods Act. The S19A 100 mg capsules must be protected from light (not a requirement of the registered product). Current
Atracurium 17-Nov-20 26-Jul-21 Tracrium and DBL brands available for ordering via regular wholesalers. Resolved
Lignocaine (lidocaine) oral gel 7-May-21 26-Jul-21 Disruption to the supply of Mucosoothe oral gel 2% lignocaine 200 mL bottles has been resolved. Stock available through regular wholesalers. Resolved
Quinine dihydrochloride 6% solution for injection 6-Jul-21 6-Jul-21 The drug sponsor has advised that this medication will now be supplied in packs of 5 (previously 10). Please see attached letter for further information including new ordering code. Facilities that stock this medication for emergency use may need to increase the number of packs held on-hand. Current
Testosterone undecanoate 40 mg capsule 29-Jun-21 29-Jun-21 The Australian registered product, Andriol Testocaps (testosterone undecanoate 40 mg capsule) has been discontinued. Link Pharmaceuticals may have alternative products available via the Therapeutic Goods Administration’s Special Access Scheme. Local assessments of suitability should be undertaken by the Drug and Therapeutics Committee with particular attention to product labelling. Current
Enoxaparin 29-Apr-21 29-Jun-21 Disruption to the supply of enoxaparin 20 mg and 40 mg strengths of enoxaparin has been resolved. Supply restrictions will remain in place to ensure equitable access – facilities should continue placing orders through regular wholesalers based on historical usage. Resolved
Salbutamol metered dose inhaler 29-Apr-21 24-Jun-21 There has been a recent change in the presentation of salbutamol metered dose inhalers which impacts its off-label use via the endotracheal tube for bronchospasm during anaesthesia. The cannister now has a counter attached, making the adaptor previously used incompatible. Click on the medication name to access the CEC memo regarding this issue recently sent out to CEs and DCGs. A Safety Alert has also been released by ANZCA – https://www.anzca.edu.au/news/safety-alerts-news/safety-alert-ventolin-metered-dose-inhalers Current
BCG (Bacillus Calmette-Guerin) vaccine powder for injection 4-Jun-21 4-Jun-21 The Australian registered product, BCG Vaccine powder for injection with diluent has been discontinued. Supply of an alternative product, BCG Vaccine SSI – Mycobacterium bovis BCG, Danish strain 1331 (AJ Vaccines), is available via LINK under Section 19A (S19A) of the Therapeutic Goods Act 1989. The S19A product differs from the discontinued Australian product as they derived from different substrains of Mycobacterium bovis BCG. Therefore, the recommended therapeutic dose and potency are not equivalent. There are also differences in the contraindications to use and preparation for the S19A (contact LINK for detailed letter to Healthcare Professionals containing this information). Current

The information is intended as a guide only and does not necessarily equate to expert opinion. The CEC does not endorse or recommend the use of any particular medication. Interpretation of recommendations should always be taken in context with the patient’s current condition and formal clinical assessment. Whilst the information is considered to be true and correct at the date of publication, changes in circumstances after the time of publication may impact on the accuracy of the information. The State of New South Wales is not in any way liable for the accuracy of any information printed and stored or in any way interpreted and used by a user.