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09/09/20 sh Critical Hydralazine IV shortage
September 14, 2020

From: "Steven Higginbotham" <steven.higginbotham@hhsys.org>
To: "Pharmacy" <grp_pharmacy@hhsys.org>
Sent: Wednesday, September 9, 2020 4:15:41 PM
Subject: Critical Hydralazine IV Shortage

Hydralazine injection has now reached a critical level. We have a limited supply with no release date available. Beginning immediately, please review your profiles and either (1) automatically discontinue PRN hydralazine IV if there is another PRN hypertension drug ordered OR (2) work with the prescriber to choose an alternative agent.

We will reserve our remaining supply of hydralazine IV for use in OB patients and in non-profiled/procedural areas.

Here is what we need our pharmacists to work on in non-OB patients and in inpatient areas. 

• Review profiles now and daily for hydralazine IV orders.
• Automatically discontinue orders for PRN hydralazine IV in patients who have another option (commonly labetolol) for acute hypertension control
• IF needed, work with the prescriber to choose an alternate drug for these patients (again, generally, this will be labetolol) for acute control of hypertension. Some IV options (after labetolol) include clevidipine, nicardipine, and nitroprusside (all with their own issues, including $$$). If the patient can take PO, labetalol, clonidine, nifedipine, and captopril are options.
• Our current supply of hydralazine IV will be reserved for OB patients since they have few options for b/p control, and for use in non-profiled/procedural areas.
• A Sentri7 rule will be created under the “Clinical Alerts” tab to help identify patients with active hydralazine IV orders. 

This shortage is expected to continue until mid to late October. 

Thanks,