Of the 13 Pfizer essential drugs the United States Pharmacopeia named as the most likely to go into new or worsened shortages, all of them are already in short supply.
On July 19, a tornado struck Pfizer's Rocky Mount, N.C.-based drug manufacturing and warehouse plant. The warehouse experienced more of the damage, and Pfizer listed 65 drugs that have about three months' worth of supply left. The USP assigned a vulnerability score to each solution to quantify the likelihood of future shortages.
The 13 essential medicines with a vulnerability score higher than 90 percent in shortage, according to the American Society of Health-System Pharmacists:
1. Atropine sulfate injection 1 milligram/10 milliliter solutions have a 98 percent vulnerability score. Two of Pfizer's solutions are in shortage and eight solutions are available. The atropine 0.1 milligram/milliliter 10 milliliter Ansyr syringes are expected to be in shortage until November, and the 0.1 milligram/milliliter 10 milliliter LifeShield syringes are in limited supply.
2. Dobutamine in 5% dextrose injection containers — 250 milligram/250 milliliter, 500 milligram/250 milliliter and 1,000 milligram/250 milliliter — have a 99 percent vulnerability score. Six solutions are in shortage and three are not. Baxter told the ASHP it has all its solutions on "protective allocation," and Pfizer forecasts the shortage to ease in October and November.
3. Epinephrine injection 1 milligram/10 milliliter syringes have a 92 percent vulnerability score. One Pfizer solution is in limited supply and seven are available. The ASHP said hospital pharmacy teams might consider conserving supply for code situations and curbing the number of syringes in code boxes.
4. Fentanyl citrate injection 250 microgram/5 milliliter and 100 microgram/2 milliliter solutions have a 96 percent vulnerability score. Four solutions are in shortage and 14 are not. Resupply dates range between August and January.
5. Heparin sodium in 0.45% sodium chloride injections — 25,000 units/250 milliliter and 12,500 units/250 milliliter — have a 94 percent vulnerability score. Two solutions are discontinued, one is in shortage and five are available. Pfizer's shortage is expected to clear up in August.
6. Ten lidocaine hydrochloride and epinephrine injections have a 96 percent vulnerability score. Twenty-two solutions are in shortage and one is not. Resupply dates range between August and July 2024.
7. Magnesium sulfate in water for injection 20 milligram/500 milliliter containers have a 99 percent vulnerability score. Twelve are in shortage and 22 are not. Release dates are in August and September.
8. Mannitol injection 12.5 gram/50 milliliter vials have a 94 percent vulnerability score. Two solutions are on back order and five are available. Pfizer's release date is in July and Fresenius Kabi said it could not estimate a resupply date.
9. Midazolam injections — 2 milligram/2 milliliter and 10 milligram/2 milliliter — have a 98 percent vulnerability score. One solution is discontinued, seven are in shortage and 21 are available. The shortage is forecast to end in July.
10. Morphine sulfate injections — 1,000 milligram/20 milliliter and 2,500 milligram/50 milliliter — have a 98 percent vulnerability score. Six solutions are on back order and 21 are available. The shortage is expected to last until mid-August.
11. Potassium chloride for injection 20 milliequivalent/10 milliliter solutions have a 99 percent vulnerability score. Three solutions are in shortage and 24 are not. Drugmakers did not offer predicted release dates.
12. Rocuronium bromide injection 50 milligram/5 milliliter solutions have a 93 percent vulnerability score. Twelve are in shortage and eight are available. Most drugmakers did not share a resupply date, but Hikma Pharmaceuticals predicted August or September, and Sagent Pharmaceuticals and X-Gen Pharmaceuticals forecast July.
13. 23.4% Sodium chloride injection 400 milliequivalent/100 milliliter solutions have a 96 percent vulnerability score. Two are in shortage and two are not. No release dates were given.