Hospitals cope with the IV nitroglycerin shortage

The seemingly sudden shortage of intravenous (IV) nitroglycerin is causing alarm in hospitals across the nation. The shortage is serious since, on average, a mid-sized hospital will use approximately 2,000 doses of IV nitroglycerin annually.

"With two of three U.S. manufacturers unable to supply nitroglycerin, the sole manufacturer has resorted to rationing – delivering just 20% of historical orders, in order to provide healthcare facilities with limited supplies of the drug," said Marvin Finnefrock, PharmD, divisional vice president for clinical services at pharmacy services provider Comprehensive Pharmacy Services.

"While steps are being taken to ease the shortage, such as seeking overseas sources and manufacturer ramp-ups of domestic production, as we’ve seen with the IV saline shortage, hospitals need to be prepared for a protracted nitroglycerin shortage,” Finnefrock added.

The IV nitroglycerin shortage follows on the heels of the ongoing IV saline shortage, and is the second shortage of a hospital and emergency room drug staple in less than six months.

"In the 40 years we've been in the pharmacy services business, we've never seen a time when two critical drugs have been in such short supply, let alone virtually unavailable, as is the case with nitroglycerin," Finnefrock said. "Unlike with the IV saline shortage, for some conditions there are no alternatives or substitutes for IV nitroglycerin, so managing through this crisis requires a much different response and action plan.”

CPS is advising that medical, nursing, and pharmacy staff work together on a three-part approach to manage through the nitroglycerin shortage:

1. Inventory Control: Immediately conduct a usage review in all areas where IV nitroglycerin is routinely used. Set up basic guidelines leading to conservation of a limited resource. For 24-hour pharmacies, relocate supply and dispense from the main pharmacy.

2. Substitution: There is no direct substitution. Alternative routes can include topical, under the tongue, and oral use where clinically indicated.

3. Communication: Implement a timely communication plan to all clinical staff involved in ordering or administering IV nitroglycerin, keeping them informed of the status of the shortage and supplies available to the facility.