From: David Collette
To: grp allpharm
Sent: Wednesday, August 1, 2018 4:46:02 PM
Subject: CRITICAL hydrALAZINE shortage

hydrALAZINE injection has now reached a critical level. We have about a 2-week's supply with no release date available. Beginning immediately, please review your profiles and either (1) automatically discontinue hydrALAZINE IV if there is another PRN hypertension drug ordered OR (2) work with the prescriber to choose an alternative agent. Please note the possible options from the following e-mail that was sent out about a month ago:

We are currently unable to obtain IV hydrALAZINE and the product is "zeroed out" at our wholesaler. Here is what we need our pharmacists to work on in non-L&D adult patients now:

*Review profiles now and daily for hydrALAZINE IV orders.
*Automatically discontinue orders for hydrALAZINE IV in patients who have another option (commonly labetalol) for acute hypertension control
*Work with the prescriber to choose an alternate drug for these patients (again, generally, this will be labetalol) for acute control of hypertension. Some IV options (after labetalol) include clevidipine, niCARdipine, and nitroPRUSSide (all with their own issues, including $$$). If the patient can take PO, labetalol, cloNIDine, NIFEdipine, and captopril are options.
*This was presented at P&T and they are aware that we will be pursuing these steps
*Our current supply of hydrALAZINE will be primarily reserved for L&D patients since they have few options for b/p control, especially if labetalol does not control it.

Please address this issue in your patients now so that we can reserve a small supply for OB patients who have no other option for b/p control.

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