Public Information

Ontario Drug Supply Interruption

Frequently Asked Questions

What is happening?

Due to a backorder notification and subsequent recall of two lots of injectable sodium bicarbonate vials made by Pfizer, the only Canadian manufacturer of this product, there is a reduced supply of this critical drug used for treatments and some surgeries.

What is the cause of the shortage?

Pfizer has reported that manufacturing delays, in addition to potential sterility issues that resulted in the recall of the vial format, have led to the current supply shortage in Canada and around the world.

To mitigate the impact in Canada, Pfizer has been allocating supply based on historical order volumes and working with hospitals to conserve supply of the vial and pre-filled syringe formats.

When is injectable sodium bicarbonate used?

Injectable sodium bicarbonate is used in a wide range of conditions including metabolic acidosis (buildup of acid in the body), in open heart surgery, as an antidote to certain poisons, in cases of organ failure, and in some types of cancer chemotherapy to keep blood levels in check. It is administered by health care professionals, usually in a health care setting.

What is the ministry doing to help health care providers manage the situation?

The ministry is actively working with health care providers and other provinces to implement a coordinated plan in response to the drug shortage issue.

The plan includes:

  1. Monitoring the Situation and its Impact
  2. Making Best Use of Available Product
  3. Identifying Other Sources and Alternatives
  4. Modifying Services
  5. Communications

How will the drug shortage affect healthcare to the public?

In communications to all health care provider across Canada, Pfizer has encouraged that injectable sodium bicarbonate be used for critical and emergency use only.

The ministry is encouraging Ontario hospitals to implement strategies as outlined in the Action Plan to meet patient need during the current shortage of injectable sodium bicarbonate.

How are services being modified in Ontario?

Some patients may see changes to their treatments such as a need to switch to a medication to be taken by mouth as an alternative, or changes to the timing of procedures and when they receive their medications. These strategies are important to preserve the use of the injectable products for the patients with the most critical illnesses and conditions and for whom there is no alternative.

The ministry is encouraging and facilitating discussions with health sector partners to ensure coordinated approaches to service modifications within specific clinical care settings. This includes the collection of information on how frequently this product has been used and the identification of conservation strategies and currently available therapeutic alternatives to promote inventory availability where it is most needed. The ministry is also working with experts to identify and share resources that include strategies for conservation that are currently used across the system.

Have any alternative supplies been located on the international market?

Health Canada is gathering information about the supply situation of this drug and is exploring the possibility of importing additional product from abroad to meet patient demand.

Addressing drug shortages is a multi-stakeholder responsibility, requiring collaborative action on the part of provinces and territories, manufacturers, distributors, practitioners and the federal government.

Pfizer has implemented an allocation strategy to prioritize distribution of the available supply of the pre-filled syringes, which can be used as an alternative to the vials, to reduce the potential impact on patients.

Decisions on the use of specific drugs are best made by physicians in consultation with their patients. Clinical experts recommend that patients who can safely use other formulations, such as tablets taken by mouth, be transitioned appropriately so as conserve existing supplies of vials and syringes for use in the most urgent cases.

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