Hospitals Feeling the Pain of Sedative Shortage

By Adam Marcus and George Ochoa
In late January, the call went out at Rochester Medical Center in upstate New York. Clinicians were advised to dramatically cut back on their use of two mainstay IV sedatives, diazepam and lorazepam, supplies of which were becoming increasingly tight.

Curtis Haas, PharmD, director of pharmacy at the hospital, sent an email to staff clinicians, stating that “we currently have very low supplies of both IV diazepam and IV lorazepam and have directed providers ... to use IV midazolam. However, we’re not counting on receiving any more shipments of any IV products until at least next week and maybe not until mid-February and do expect this shortage to be long-term.”

Dr. Haas said he knew the switch to midazolam, although helpful, would only be a temporary solution; he anticipated there would be a domino effect causing midazolam to become scarce. He thus urged his colleagues to use oral benzodiazepines whenever possible “even in our intubated patients if the gut works,” and to choose propofol for hemodynamically stable intubated patients with gastrointestinal function. For hemodynamically unstable patients, he recommended “trying to use a fentanyl infusion along with intermittent or even ATC [around-the-clock] oral [benzodiazepines],” and to use IV midazolam “as our preferred intermittent-dose benzodiazepine for anxiety and agitation if an oral route is not an option...”

Nationwide Problem

Rochester is far from alone in feeling the pinch on key sedatives and anesthetics. Hospitals across the country are facing similar shortfalls in the supply of these and other important drugs, including certain treatments for cancer. One major facility in the Midwest listed no fewer than eight “new or high-priority” shortages during the second week of January. On the list: etomidate, heparin, ketorolac, morphine, ropivacaine and alfentanil. Those drugs joined a roster of nearly two dozen other agents, from diazepam and midazolam to lorazepam and rocuronium, in the “ongoing” category.

Reasons for the low supply are unclear, but involve production issues, indefinite plant shutdowns and drug makers exiting the market...

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