Thiamine injection is in short supply from the Manufacturer. Bon Secours Pharmacy has pulled all available inventories into the Pharmacy Department to assure product is available for patient needs. Pharmacists may contact you to reserve supplies for patients that do not meet the alternative management guidelines below.

Thiamine Injection Shortage

13 February 2007

Products Affected — Description

Thiamine hydrochloride (vitamin B₁) for injection 100 mg/mL, 1 mL vials (NDC 63323-0013-02), Abraxis Bioscience

Reasons for the Shortage

• Abraxis cannot provide a reason for the shortage.¹ Abraxis is the sole supplier of thiamine injection.
• Oral preparations of thiamine are not affected by this shortage.

Estimated Resupply Dates

Abraxis estimates supplies will be available in mid-March 2007. The company has no emergency supplies available.¹

Implications for Patient Care

• Thiamine treats and prevents thiamine deficiency disorders, such as Wernicke's encephalopathy syndrome, beriberi, pellagra-associated peripheral neuritis, and pregnancy-associated neuritis if accompanied by severe vomiting.² Thiamine supplementation is also commonly used in chronic alcoholic and malnourished patients.²
• Oral administration is the preferred route for thiamine, although intravenous or intramuscular administration is preferred for medical emergencies, such as Wernicke's encephalopathy or high-output heart failure due to beriberi.² Patients with malabsorption syndromes may also require parenteral thiamine.

Alternative Agents & Management

• During a previous shortage of thiamine injection, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommended the following: reserve thiamine injection for patients who cannot take thiamine orally; patients with medical emergencies, such as Wernicke's encephalopathy; and comatose patients presenting to the emergency department with unknown etiology.⁴
• Consider switching patients to oral therapy when possible.

References

1. Abraxis Bioscience, (personal communication) February 13, 2007.
2. Thiamine Hydrochloride. In: AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; 2004: 3502-3503.
3. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Pharmacy Practice Section. Thiamine Shortage Alert, available at http://www.nutritioncare.org/thiamine.html (accessed May 2, 2001).

Updated

Updated February 13, 2007, by Erin R. Fox, PharmD, Drug Information Specialist. Created by Erin R. Fox, PharmD, Drug Information Specialist, and Michelle Wheeler, Pharm.D. Copyright 2007, Drug Information Service, University of Utah, Salt Lake City, UT.

• Tigecycline use is restricted to infectious disease specialists and is non-formulary at this time. Formulary status will be reevaluated in one year when sensitivity data is available.
• The microbiology department will obtain sensitivity panels and sensitivity testing is recommended for all patients receiving Tigecycline.  Tigecycline will not be available for use until sensitivity testing can be performed. Note: The MIC range for numerous bacteria is above the breakpoint for tigecycline. 
  • Antimicrobial therapy should be directed by culture and sensitivity results.
• Patients who become septic or develop septic shock have higher mortality rates when treated with tigecycline (1.5%) versus comparator agents (0.5%).  Alternative agents are recommended.
• Tigecycline should not be used in neutropenic, immunosuppressed patients, or patients with endocarditis as it is bacteriostatic.
• Bactericidal agents are preferred for the treatment of serious, life threatening infections.
• Tigecycline is expensive, $88 per day, and should be reserved for conditions where less expensive agents cannot be used. It is only available in an IV formulation.

Pharmacokinetic dosing is available from the pharmacy. Pulse dosing, 5 mg/kg, is recommended for adults, unless exclusion criteria apply. The graphic tools are available for gentamicin / tobramcyin and amikacin.

Pulse Dosing Calculator for Aminoglycosides

Traditional Dosing Calculator for Aminoglycosides

Patient Monitoring Form

Aminoglycoside and Vancomycin Dosing & Monitoring Protocol