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    IV nitroglycerin shortage concerning, but manageable

    Although every drug shortage is a concern to healthcare professionals, the shortage of IV nitroglycerin that the New York Times first reported on, is especially concerning: Unlike with the IV saline shortage, in dealing with refractive chest pain and hypertensive crisis in the emergency room, there is no substitute or direct alternative for IV nitroglycerin.

    Nitroglycerin is used to treat chest pain. Spray and tablet forms of the drug are typically used to treat patients with heart disease, who might take medication to keep their condition stable or before exercise or other strenuous activities to prevent chest pain from occurring. These forms of nitroglycerin are not in short supply.

    For patients who are experiencing myocardial Infarction and other types of heart decompensation, IV nitroglycerin is the best choice, according to Marvin Finnefrock, PharmD, divisional vice president, clinical services at Comprehensive Pharmacy Services (CPS), a pharmacy management services.

    “There is no direct substitute for [IV nitroglycerin] and to date, none of the manufacturers can provide an estimate of when they expect to return to normal production of IV nitroglycerin, leading us to conclude—just like we did with the IV saline situation—that health facilities should prepare for a protracted shortage of IV nitroglycerin,” Dr Finnefrock said. “Even if it appears that the shortage is easing up, we often do see a reoccurrence of the shortage several months or even years after the initial event.”

    Supply shortages rather than increased demand, is responsible for the shortage of IV nitroglycerin, according to Dr Finnefrock.

    “Two of 3 US manufacturers have had manufacturing difficulties and the third [Baxter], while still producing nitroglycerin, issued a recall on some of their IV nitroglycerin back in November,” he said. “Currently, the sole manufacturer is unable to meet demand for the product and has resorted to rationing in order to ensure that all hospitals receive some of what they typically order. According to public reports, FDA is trying to secure IV nitroglycerin from international sources to help meet demand until US supplies can be fully restored.”

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