From: David Collette
To: grp allpharm
Sent: Tuesday, April 17, 2018 9:14:46 AM
Subject: ondansetron shortage update

I have received several replies to my urgent request to change patients from IV ondansetron to another product. Based on these replies, please review the following info before you make changes:

    * ondansetron IV was approximately 29 cents per dose
    * our first choice for an alternative is ondansetron ODT (or regular tab), which costs about the same as (or less than) the IV
    * if parenteral route is needed, promethazine IM is approximately $1 per dose
    * if an IV 5-HT3 is needed, Kytril is about $4 per dose and is on formulary
    * suppositories are NOT that cost effective, costing about $6 each for promethazine and prochlorperazine
    * injectable prochlorperazine is $9 per dose
    * we should NOT be switching to Tigan ($29 per dose) or Aloxi ($100 per dose)

Thanks for your help with this shortage. If we are unable to obtain further supply, we will be out of ondansetron in about 2 weeks. DAVID

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From: David Collette
To: grp allpharm
Cc: Keith Moss
Sent: Monday, April 16, 2018 3:49:51 PM
Subject: URGENT SHORTAGE - please read now!

We have just found out that ondansetron injection 4 mg in 2 mL is on indefinite backorder and we have about a two week's supply on hand. We need pharmacists to take the following actions ASAP:

• identify adult patients who are receiving IV ondansetron (Travis is building a Sentri-7 rule to help identify these patients)
• convert appropriate patients to oral or ODT ondansetron (Keith is ordering both, so we will have a plentiful supply, at least in the short term) - be sure to work with nursing to make the switch in appropriate patients (especially oncology patients)
• if oral/ODT administration is not an option, other possibilities include:

• promethazine injection (IM) - <$1
• promethazine or prochlorperazine supp (about $6 each)
• prochlorperazine injection (about $9 per dose)
• granisetron (Kytril) - $4 per dose

• We are evaluating other options (such as using multi-dose vials much like we did with labetalol) and will keep you informed of any further changes.

Thanks for all that you do to take care of our patients! DAVID

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David R. Collette, Pharm.D., FASHP
Operations Manager, Professional Services