Medication Safety Updates

Medication Safety Communications


Date last updated: 21 Sep 2022

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
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
Olanzapine 9-Sep-22 9-Sep-22 There is an anticipated disruption to the supply of olanzapine (Zyprexa) 10 mg/mL injection vials until 15 December 2022. Supply of an alternative product under section 19A is currently under consideration by the Therapeutic Goods Administration. SAS alternatives may be available from Link, Medsurge, Orspec and ProPharma. Clinicians may be required to consider use of alternative short-acting antipsychotics agents during the supply disruption. Current
Metronidazole tablets 22-Aug-22 9-Sep-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 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 oral suspension 7-Sep-22 7-Sep-22 There is a disruption to the supply of multiple brands of amoxicillin 250 mg/5 mL oral suspension. Reach Pharmaceuticals has received approval under Section 19A (S19A) of the Therapeutic Goods Act to import supply of amoxicillin 250 mg/5 mL oral suspension (Kent) brand from the UK until 28 February 2022. The S19A approved UK product is identical in active ingredient and strength to the Australian registered product. Information regarding differences in excipients are available in the Dear Health Care Professional letter (by clicking the medication name to the left). Note – the S19A product contains sorbitol. 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
Nirmatrelvir 150 mg/ritonavir 100 mg (Paxlovid) 1-Aug-22 7-Sep-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). A 6-month extension 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. Click on the medication name to the left to access a fact sheet outlining affected batches and for information on an expiry date extension sticker that is available from Pfizer. Current
Amoxicillin plus clavulanic acid tablets 5-Sep-22 5-Sep-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 for further information on this disruption to supply, available alternatives and associated safety considerations (by clicking on the medication name to the left).   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
Oxybutynin tablets 10-May-22 18-Aug-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. 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
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
Naloxone nasal spray 10-Aug-22 10-Aug-22 There is a disruption to the supply of naloxone hydrochloride dihydrate (Nyxoid®) 2.2 mg/actuation nasal spray vial until 15 November 2022. A Written Direction has been issued by the Australian Government Department of Health to wholesalers to limit quantities being supplied in an attempt to prevent stockpiling. To date, the pre-filled injection formulation Prenoxad® is not subject to a Written Direction or experiencing a disruption to supply. Contact Noman.Masood@health.nsw.gov.au for any difficulties in accessing stock. Current
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
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
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
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
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
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
Barium sulfate oral suspension products 8-Jun-22 8-Jun-22 There is a disruption to the supply of barium sulfate oral suspension products. A Medication Safety Communication was issued which provides further information on the shortage, potential alternatives and associated safety considerations – click on the medication name to access. 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
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
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
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
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
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
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
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
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
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
Ceftolozane/tazobactam 12-Jan-21 9-Feb-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. Current
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
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
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
Gadobutrol 1-Feb-22 1-Feb-22 There is a temporary disruption to the supply of Gadobutrol 9.0708 g/15 mL injection (GADOVIST 1.0) until 18 March 2022. Current
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
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
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
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
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
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
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
Primidone 250 mg tablets 18-Nov-21 18-Nov-21 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. Current
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 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
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
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
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
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
Azathioprine injection 29-Jul-21 29-Jul-21 The Australian registered product, azathioprine 50 mg powder for injection (Imuran®) will be discontinued and deleted from market on 28 February 2022. Supply of an alternative product Imuran® (Canada) 50 mg injection is available via Advanz Pharma under the Special Access Scheme (SAS) of the Therapeutic Goods Act. 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
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
Atracurium 17-Nov-20 26-Jul-21 Tracrium and DBL brands available for ordering via regular wholesalers. Resolved
Labetalol 19-Jul-21 19-Jul-21 The drug sponsor for Trandate tablets has advised that both strengths (100 mg and 200 mg) will be discontinued effective immediately. Presolol brand remains available through regular wholesalers. Clinicians should be aware that Presolol tablets contain sulfites (not present in Trandate). Current
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
Atenolol 50 mg/10 mL oral solution 8-Jun-21 8-Jun-21 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. 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
OntoTICE BCG (Bacillus Calmette-Guerin) injection vial (antineoplastic) 11-Feb-21 4-Jun-21 The Australian registered product, OncoTICE BCG 5 hundred million CFU powder for injection vial is out of stock until 31 December 2021. Supply of an alternative product, BCG Culture SSI BCG 30 mg/vial (AJ Vaccines), is available via LINK under Section 19A (S19A) of the Therapeutic Goods Act 1989. The S19A product differs from the Australian registered product as they are derived from different substrains of Mycobacterium bovis BCG. Therefore, the recommended therapeutic dose and potency are NOT equivalent. Current
Cernevit injection 1-Jun-21 1-Jun-21 Disruption to the supply of Cernevit injection vials until 30 September 2021. Supply of compounded products available from Baxter containing Cernevit (including TPN) remain unaffected at this time. Alternate parenteral multivitamin preparations (e.g. combination of Soluvit N and Vitalipid N) may be required during this time. Consider differences in presentation, reconstitution steps and formulation – treating clinicians should assess suitability of available alternatives for patients on a case-by-case basis. Resources such as the Australian Society for parenteral and enteral nutrition (AuSPEN) adult vitamin guidelines for parenteral nutrition may aid clinicians in decision-making. Current
Adrenaline 1:1,000 21-May-20 29-Apr-21 Disruption to the supply of LINK adrenaline 1:1,000 1 mg/1 mL ampoules (both pack sizes) until September 2021. Other brands unaffected at this stage. Resolved
Glyceryl trinitrate injection 8-Dec-20 29-Apr-21 Supply disruption has been resolved. Stock is being distributed to regular wholesalers and should be available for ordering this week. Resolved
Ergometrine maleate 12-Jan-21 27-Apr-21 Supply disruption has been resolved. Stock is being distributed to regular wholesalers and should be available for ordering this week. Resolved
Furosemide (frusemide) 20 mg/2 mL injection 14-Jan-21 14-Apr-21 Disruption to the supply of Lasix® 20 mg/2 mL injection ampoules until late March 2021. Access to NSW HealthShare stock is open for this strength – follow order process as distributed by HealthShare. If urgent requirement or problems submitting request, contact Noman.Masood@health.nsw.gov.au. Shortage resolved. Resolved
Flebogamma 10% DIF – all vial sizes 1-Apr-21 1-Apr-21 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. Current
Tenofovir/Emtricitabine 12-Jan-21 24-Mar-21 Recall on all batches of Tenofovir Disoproxil Emtricitabine Mylan 300/200 tablets on 23 December 2020 due to potential for split tablets to lead to ineffective dose. Supply of the Apotex brand should be available at wholesalers. S19A alternative also available through Link Pharmaceuticals until 28 February 2021 – Teva brand imported from the UK. Please note, the S19A product displays the dose of emtricitabine first (200 mg) followed by the dose of tenofovir disoproxil (245 mg). Tenofovir disoproxil is the active ingredient name – all brands ultimately have 245 mg of tenofovir disoproxil but are presented in different salt forms. Shortage resolved. Resolved
Prednisolone acetate 1%/phenylephrine 0.12% suspension (Prednefrin Forte) eye drops 3-Mar-21 3-Mar-21 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 Current
Pristinamycin (SAS) 500 mg tablets 14-May-20 24-Feb-21 Steady supply now available through Medsurge. Supplies through Link remain intermittent – ensure backorders are in place. Shortage resolved. Resolved
Adrenaline 1:10,000 19-Mar-20 24-Feb-21 Link and Juno (Aguettant) pre-filled syringe formulations available from wholesalers. Critical shortage of Link ampoules EXTENDED until 31 January 2021 (manufacturing issue) however there are ampoules available for ordering from Aspen. Hospitals are advised to put in a backorder with their preferred wholesaler. ACCESS TO NSW HEALTHSHARE STOCK WILL REMAIN OPEN FOR 1:10,000 AMPOULES – follow order process as distributed by HealthShare. If urgent requirement or problems submitting request, contact Noman.Masood@health.nsw.gov.au. Shortage resolved. Resolved
Olmesartan 27-Jul-20 24-Feb-21 Olmesartan MYL, Alphapharm and Sandoz brands 20 mg and 40 mg tablets are now available. Accord brand (UK) 40 mg olmesartan tablets available as S19A from Link Pharmaceuticals. Shortage resolved. Resolved
Tranylcypromine 21-Oct-20 24-Feb-21 Supply disruption of Parnate® has been extended until 31 January 2021. Emergency stock is available through Amdipharma. Both Amdipharma and Medsurge also have S19A products available (Packs of 100 tablets in a bottle compared to Australian registered product, 50 tablets in a blister). Shortage resolved Resolved
Prazosin 24-Feb-21 24-Feb-21 Disruption to the supply of all brands and strengths of prazosin tablets. Estimated resolution dates between late November to late December 2020. Serious Shortage Substitution Notice was issue by the TGA in October. S19A alternative for all strengths (1 mg, 2 mg and 5 mg) available through Medsurge (Canadian brand with English packaging). Please note – S19A product must be protected from light. Shortage resolved Resolved
Morphine Sulfate - MS Contin (granules for) suspension 24-Feb-21 24-Feb-21 Production of all strengths of MS Contin (granules for) suspension, have been discontinued. Some strengths will be unavailable from March 2021, with a total run-out of stock anticipated by end of 2021. See Medication Safety Communication for further information. Current
Dipyridamole/Aspirin 200 mg/25 mg modified release capsules 17-Feb-21 17-Feb-21 The Australian registered medicine ASASANTIN SR dipyridamole 200 mg/aspirin 25 mg sustained release capsules has been discontinued. The Australian registered medicine DIASP SR Dipyridamole/Aspirin 200 mg/25 mg modified release capsules is unavailable due to unexpected increase in demand. Supply of an alternative product, Aspirin and Extended-release Dipyridamole Capsules 25 mg/200 mg (USA), is available via Medsurge under Section 19A (S19A) of the Therapeutic Goods Act. Current
Phenelzine 15 mg tablet 17-Feb-21 17-Feb-21 The Australian registered medicine, NARDIL phenelzine 15 mg (as sulfate) tablet was discontinued on 2 April 2020. Supply of an alternative product, Phenelzine Sulfate USP 15 mg Tablets (Lupin Pharmaceuticals) is now available via LINK under Section 19A (S19A) of the Therapeutic Goods Act until 30 September 2021. The S19A product differs from NARDIL with respect to storage conditions (it does not require refrigeration) and its reduced pack size (60 tablets). The TGA previously issued a joint statement (https://www.tga.gov.au/sites/default/files/phenelzine-nardil-discontinuation.pdf) with the Royal Australian and New Zealand College of Psychiatrists and the Society of Hospital Pharmacists of Australia to provide advice for health professionals about accessing alternative products and patient management. Current
Flucloxacillin 15-Dec-20 14-Jan-21 Supply disruption of Flubiclox® 1 g vials now resolved. Stock available at wholesalers. Resolved
Hydralazine 12-Jan-21 12-Jan-21 Anticipated shortage of LINK hydralazine hydrochloride 20 mg/1 mL solution for injection vial from 25 January 2021 to 14 May 2021. Apresoline powder for injection (ampoule presentation that requires reconstitution prior to use) unaffected at this stage. Current
Remdesivir 1-Jul-20 21-Dec-20 Correspondence from HealthShare NSW was sent to CEs of LHDs/SHNs on 18 December 2020. A copy of the procurement factsheet and post-marketing adverse event report can be found at the top of this page (see ‘Remdesivir information’ subsection). Please refer to the fact sheet for further information and direct any questions to Noman.Masood@health.nsw.gov.au. Resolved
Verapamil 5 mg/2 mL injection 23-Nov-20 18-Dec-20 Disruption to the supply of verapamil 5 mg/2 mL injection ampoules has been resolved. Resolved
Glyceryl trinitrate tablets 8-Dec-20 8-Dec-20 Anginine® 600 microgram tablet bottle was discontinued from the Australian market on 23 April 2020. Nitrostat® 300 microgram sublingual tablets are available through Pfizer under S19A until 31 January 2022. PLEASE NOTE – the difference in strength compared to the previous Australian registered product and that the S19A tablets must not be broken or halved. Current
Desmopressin acetate 17-Nov-20 17-Nov-20 Disruption to the supply of Minirin® nasal spray and drop formulations with supply not anticipated before 2022. Alternate desmopressin formulations (tablets, sublingual wafers and injection ampoule) are unaffected. S19A alternative of nasal spray available through Medsurge (US brand with English packaging). Please note this product must be stored in an upright position and any solution remaining after 50 sprays must be discarded as the amount delivered thereafter may be substantially less than 10 micrograms of drug (S19A alternative contains 5 mL compared to the 6 mL in the Australian registered product). Current
Posaconazole 17-Nov-20 17-Nov-20 Noxafil® MR tablets and suspension will be delisted from the PBS on 1 December 2020. Whilst a generic alternative to the MR tablet formulation will be available on the PBS from this date (Juno brand), there is currently no sponsor that will be listing a suspension formulation. Facilities should consider the need to supply the suspension to outpatients from the hospital pharmacy following local DTC processes. Juno MR tablets are considered bioequivalent to the Noxafil® MR tablets. Current
Triamcinolone acetonide injection 29-Jun-20 17-Nov-20 Supply disruption resolved. Resolved
Gentamicin 80 mg/2 mL 13-Mar-20 4-Nov-20 Supply disruption to Australian registered product resolved. NOTE – S19A Hospira product contains the preservative, sodium metabisulphite, which is an irritant and may cause bronchoconstriction. Resolved
Suxamethonium chloride 100 mg/2 mL 27-May-20 23-Sep-20 Australian registered product (Suxamethonium Juno) was released in September. This product is in a pack size of 10, presented in a glass ampoule and must be stored between 2-8 degrees Celsius. Juno also has S19A approval to import the Martindale brand (UK) of suxamethonium chloride. This product has a similar presentation to other Martindale products that may be kept in your facility (but is a different colour). A local risk assessment should be completed prior to ordering and use in your facility. Resolved
Methotrexate injection 16-Jul-20 18-Sep-20 Shortage of all affected strengths now resolved. Resolved
Amoxicillin/clavulanic acid IV injection 4-Jun-20 26-Aug-20 Shortage of Curam brand now resolved. Resolved

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.