Medication Safety Updates

Medication Safety Communications

Date last updated: 20 Apr 2021

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
Furosemide (frusemide) 500 mg tablet 3-Mar-21 14-Apr-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). Current
HYDROmorphone (Dilaudid®) Oral Liquid 1 mg/mL 14-Apr-21 14-Apr-21 The Australian registered medicine HYDROmorphone (Dilaudid®) oral liquid 1 mg/mL has been discontinued. Supply of an alternative product, HYDROmorphone Hydrochloride Oral Solution 1mg /mL, USP 473mL (Rhodes), is available via Medsurge under Section 19A (S19A) of the Therapeutic Goods Act until 9 January 2022. Due to this product requiring import and export permits, it will take approximately 3-4 weeks to receive the first shipment. The S19A product differs from Dilaudid® oral liquid in that it contains 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
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 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
Ceftolozane/tazobactam 12-Jan-21 24-Mar-21 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 1st January 2022. Alternative therapy should be sought in consultation with local Infectious Diseases/Microbiology service. Current
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
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 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
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
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
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 ( 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
ONCOTICE BCG (Bacillus Calmette-Guerin) vaccine 11-Feb-21 11-Feb-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. The S19A product differs from the Australian registered product ONCOTICE. It is derived from a different substrain of Mycobacterium bovis BCG. Therefore, the recommended therapeutic dose and potency are NOT equivalent. Current
Fluoxetine 7-Oct-20 9-Feb-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. Current
Cisatracurium 21-Apr-20 5-Feb-21 Supply disruption to all strengths of Cisatracurium Juno has been resolved. Stock should be available through regular wholesalers. Resolved
Ergometrine maleate 12-Jan-21 25-Jan-21 Supply disruption to DBL ergometrine 500 microgram/1 mL until 18 June 2021. See Medication Safety Communication for further information. Current
Glyceryl trinitrate injection 8-Dec-20 15-Jan-21 Supply disruption to DBL glyceryl trinitrate concentrate injection 50 mg ampoule from 24 January to 31 March 2021. As an alternative, glyceryl trinitrate Wockhardt 50 mg in 50 mL vials are now available for immediate supply via regular wholesalers. PLEASE NOTE the following differences compared to the Australian registered product; 50 mg in 50 mL concentration rather than 50 mg in 10 mL, vial rather than ampoule presentation and ethanol free formulation. A local risk assessment should be completed prior to ordering and use in your facility. Current
Flucytosine 7-Oct-20 14-Jan-21 Disruption to the supply of Ancotil® flucytosine injection bottles has been extended until 30 June 2021. Most sites with usage of this medication in the last 12 months have at least 2 boxes (10 bottles) of stock on hand. Emergency stock is also available during business hours directly from iNova Pharmaceuticals for patients in immediate medical need. Current
Atracurium 17-Nov-20 14-Jan-21 Supply disruption to both strengths of DBL® atracurium injection – remaining stock currently on constrained supply. Tracrium® brand unaffected at this stage. 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 Current
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
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
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
Triamcinolone acetonide injection 29-Jun-20 17-Nov-20 Supply disruption resolved. Resolved
Gentamicin 10 mg/1 mL 28-Apr-20 16-Nov-20 Safety communication has been updated to reflect extended resolution date and availability of additional S19A product that is a different strength to the Australian registered product (10 mg/2 mL compared to 10 mg/1 mL). Current
Adrenaline 1:1,000 21-May-20 4-Nov-20 Supply disruption to Link and Aspen brands has been resolved. Stock available from wholesalers. 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
Isoprenaline 9-Oct-20 9-Oct-20 Safety information regarding S19A alternatives highlighted in 9 October 2020 communication. Current
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
Dobutamine hydrochloride 250 mg/20 mL 15-May-20 26-Jun-20 Shortage of ARTG listed product now resolved. Please exercise caution if holding both DBL and S19A stock as they are different strengths. Resolved
Trimethoprim-sulfamethoxazole 80 mg/400 mg injection 6-May-20 25-May-20 Shortage of S19A product now resolved, ARTG listed product in unavailable until 30 June 2021. 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.