1. Calcium Carbonate (1250mg salt/500mg elemental calcium/5mL) suspension – national shortage. The date of shortage resolution is unknown at this time.
    1. For patients on oral therapy, alternatives include:
      1. Calcium carbonate tablets (e.g., oyster shells) and alternative salt, such as calcium citrate
      2. Calcium carbonate custom compounding – Compounding pharmacies option – many compounding pharmacies are able to compound calcium carbonate suspension with varied shelf life/stability of 7-14 days, which will need to be checked with the specific compounding pharmacy.
    2. For patients receiving enteral treatment via gastrostomy, nasogastric, tansgastric-jejunal, or jejunal tubing devices:
      1. Calcium citrate liquid (21% elemental calcium)
      2. Calcium gluconate solution (9.3% elemental calcium) – due to low amount of elemental calcium, large volumes would require to achieve a desirable dose.
      3. Calcium carbonate compounding – Compounding pharmacies option – many compounding pharmacies are able to compound calcium carbonate suspension with varied shelf life/stability of 7-14 days, which will need to be checked with the specific compounding pharmacy.
        1. The solution is compatible with feeding tube devices for administration but may require extra flushing.

 

Calcium salt Elemental Calcium (%)
Carbonate 40
Citrate 21.1
Gluconate 9.3
Glubionate 6.4

 

  1. Calcitriol Oral Solution – shortage

Calcitriol oral solution, Hikma, 1 mcg/mL, 15 mL bottle, NDC 00054-3120-41

Calcitriol oral solution, Sun Pharma, 1 mcg/mL, 15 mL bottle, NDC 63304-0241-59

  1. Reason for the Shortage
    1. Hikma did not provide a reason for the shortage.
    2. Sun Pharma did not provide a reason for the shortage.
    3. Available Products
    4. Calcitriol oral solution, Rising Pharmaceuticals, 1 mcg/mL, 15 mL bottle, NDC 64980-0447-15
    5.       Estimated Resupply Dates
    6. Hikma has calcitriol 1 mcg/mL oral solution in 15 mL bottles on allocation.
    7. Sun Pharma has calcitriol 1 mcg/mL oral solution in 15 mL bottles on back order and the company cannot estimate a release date.

 

  1. IV Calcitriol:
    1. Major issue: Akorn pharma announcing bankruptcy and stopping their operations.
    2. Update: In addition to the national shortage, Calcitriol inj is on the recall list now (this will affect all prior supply that was still available). Akorn had 100% of the market share.
    3. No alternatives at this time

 

Authors: By Anna Ryabets-Lienhard, DO and Ryan Miller, MD

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