Products Affected - Description

Reason for the Shortage

• Hospira has diazepam on back order due to manufacturing delays.¹
• Hospira is the sole supplier of diazepam injection.
  

Available Products

Diazepam injection 5 mg/mL, Hospira
2 mL Carpuject Luer-Lock syringes, package of 10 (NDC 00409-1273-32)

Estimated Resupply Dates

Hospira has diazepam 5 mg/mL 10 mL vials on intermittent back order and the company is releasing product as it becomes available. The 2 mL iSecure syringes are on back order and the company cannot estimate a release date.¹

Implications for Patient Care

Diazepam injection is labeled for treating anxiety disorders (short-term), alcohol withdrawal symptoms, status epilepticus and severe recurrent seizures, and skeletal muscle spasms associated local pathology, upper motor neuron disorders, athetosis, tetanus, or stiff-man syndrome. Diazepam injection is also labeled as an adjunct prior to endoscopic procedures and as premedication prior to surgical procedures or cardioversion.^2,3,4

Off-label uses of diazepam injection include sedation in the critical care setting for patients on mechanical ventilation, reduction of opioid requirements and production of amnesia in labor and delivery, management neonatal opiate withdrawal, and treatment of tardive dyskinesia.^3,4

Alternative Agents & Management

• During this shortage use alternative injectable benzodiazepines or agents from another pharmacologic class as appropriate for the indication.
• There are no direct dosage conversions between the benzodiazepines because each has a distinct pharmacokinetic profile that dictates the agent’s therapeutic use and dosing. The Table compares the pharmacokinetics of injectable benzodiazepines.
• Lorazepam and midazolam injection are also on shortage.⁵
• Institutions may consider reserving injectable benzodiazepines for initial treatment of status epilepticus, as no other well established injectable therapeutic options are available for this indication. Diazepam rectal gel may be an alternative for some patients.^6-10

Related Shortages

• Acetaminophen Suppositories— Resolved
• Acetaminophen/dichloralphenazone/isometheptene— No Longer Available
• Alfentanil Injection— Resolved
• Aspirin Tablets (Buffered)
• Buprenorphine and Naloxone Tablets— No Longer Available
• Buprenorphine Injection
• Butorphanol Injection
• Choline Magnesium Trisalicylate
• Diclofenac 1% Gel— Resolved
• Fentanyl Injection
• Fentanyl Transdermal System Patch— Resolved
• Indomethacin Injection
• Ketorolac Tromethamine Injection
• Meperidine Injection
• Methadone Hydrochloride Injection— Resolved
• Morphine Injections
• Morphine Sulfate: Oral Concentrated Solution— Resolved
• Oxycodone Immediate Release Tablets and Capsules— Resolved
• Piroxicam Capsules— Resolved
• Sufentanil Injection
• Tolmetin Sodium— Resolved

1. Hospira (personal communications). August 12, September 14, October 11, 20, and 31, and December 20, 2011; February 13 and 27, March 12 and 28, April 11 and 30,  June 5, August 6, September 17, October 9, November 6 and 29, December 10 and 31, 2012; January 21, February 21, March 5 and 25, and April 10 and 23, 2013.
2. Diazepam injection product information. Lake Forest, IL: Hospira, Inc., April 2007.
3. McEvoy, G. K., E. K. Snow, et al., Eds. (2011). AHFS DI (Lexi-Comp Online). Bethesda, MD, American Society of Health-System Pharmacists.
4. Wickersham, R. M., K. K. Novak, et al., Eds. (2011). Drug Facts and Comparisons (eFacts). St. Louis, MO, Wolters Kluwer Health, Inc.
5. American Society of Health-System Pharmacists. Drug Shortage Resource Center available online. (Accessed December 22, 2011.)
6. Aminoff MJ, Greenberg DA, Simon RP, eds. Clinical Neurology. 6^th ed. New York, NY: Lange Medical BooksMcGraw-Hill; 2005.
7. Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. Mar 2010;17(3):348-355.
8. Millikan D, Rice B, Silbergleit R. Emergency treatment of status epilepticus: current thinking. Emerg Med Clin North Am. Feb 2009;27(1):101-113, ix.
9. Rabinstein AA. Management of status epilepticus in adults. Neurol Clin. Nov 2010;28(4):853-862.
10. Rowland LP, ed. Merritt's Neurology. 6^th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
11. Baughman, V. L., J. Golembiewski, et al., Eds. (2010).
12. Anesthesiology and Critical Care Drug Handbook. Hudson, OH, Lexi-Comp.
13. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill. Am J Health-Syst Pharm. 2002;59:150-178.
14. Mosby’s Drug Consult 2006. St Louis, MO: Elsevier-Mosby; 2006.

Updated

Updated April 23, 2013 by Michelle Wheeler, PharmD, Drug Information Specialist. Created December 22, 2011, by David M. Peterson, PharmD, Drug Information Specialist. Copyright 2013, Drug Information Service, University of Utah, Salt Lake City, UT.