Products Affected - Description

Reason for the Shortage

• Teva had dacarbazine on back order due to manufacturing delays.¹
• Ben Venue voluntarily suspended all manufacturing in mid-November, 2011 on a temporary basis. Product will become available in stages as manufacturing resumes. Availability of products is updated on the Bedford Laboratories website.²

Available Products

Estimated Resupply Dates

Bedford has dacarbazine powder for injection 200 mg vials on long-term back order and the company will not manufacture this product until capacity permits.²

Implications for Patient Care

• Dacarbazine is an alkylating agent. It is labeled for use as a single agent for malignant metastatic melanoma or in combination with other antineoplastic agents for the treatment of adults with Hodgkin disease.^5-7
• Dacarbazine is used off-label for a variety of neoplastic diseases in adults including medullary carcinoma of the thyroid, various soft-tissue sarcomas, and islet cell carcinomas.^5-7
• Dacarbazine is used off-label for Hodgkin lymphoma, neuroblastoma, and solid tumors in children.^5-7

Safety

• Chemotherapy agents, such as dacarbazine, pose additional safety risks both for patients and for healthcare workers handling these agents.^5,6
• Use additional caution when processing orders for chemotherapy drugs, especially when switching between chemotherapy agents or when processing orders for chemotherapy agents with which staff may be unfamiliar (eg, those not normally prescribed at a specific institution).^5,7

Alternative Agents & Management

• The choice of an alternative agent must be patient-specific and based on renal function, liver function, and the neoplasm type and location. No single agent can be substituted for dacarbazine.^5-7
• Consider evaluating the health-care system’s total supply of dacarbazine before beginning patients on combination chemotherapy regimens containing dacarbazine. If adequate supplies are not available, select an alternative regimen.
• Consult a Hematology/Oncology specialist for patient- and neoplasm-specific recommendations.
• Refer to the ASHP Guidelines on Managing Drug Product Shortages for more guidance on developing a multidisciplinary plan when the supply must be allocated.

Related Shortages

• Asparaginase Injection— No Longer Available
• Bendamustine Injection— Resolved
• Bleomycin Injection— Resolved
• Busulfan— Resolved
• Capecitabine Tablets— Resolved
• Carboplatin Solution for Injection
• Carmustine Injection— Resolved
• Cisplatin Injection— Resolved
• Cyclophosphamide Injection— Resolved
• Cytarabine Injection
• Daunorubicin Hydrochloride Injection
• Denileukin Diftitox Injection
• Doxorubicin Injection
• Doxorubicin Liposomal Injection
• Etoposide Injection— Resolved
• Fludarabine Injection
• Fluorouracil Injection
• Gemtuzumab Ozogamicin Injection— No Longer Available
• Idarubicin Hydrochloride Injection— Resolved
• Interferon Alpha-2b, Intron A— Resolved
• Irinotecan Injection— Resolved
• Leuprolide Acetate 14-Day Kit
• Lomustine Capsules
• Mercaptopurine Tablets
• Methotrexate Injection
• Methotrexate Tablets
• Mitomycin Injection
• Paclitaxel Injection
• Pentostatin Injection
• Streptozocin For Injection— Resolved
• Thiotepa for Injection
• Tretinoin Oral Capsules— Resolved
• Vinblastine Injection
• Vincristine Injection— Resolved

1. Teva (personal communications). June 18, July 20, August 25, September 21, October 29, November 19, December 22, 2010; February 15, March 22, May 31, July 19, August 1, September 7, October 4, and November 29, 2011; January 3, and February 15, July 16, November 12, and December 21, 2012; and March 1, 2013.
2. Bedford (personal communications). June 18, July 21 and 22, August 24, September 9, 22, and 28, October 12, November 4 and 19, December 21, 2010; February 15, March 22, May 2, June 23, July 20, August 3, September 7, October 6, and November 21 and 29, 2011; February 2, April 13, May 7, June 7, July 11, September 26, November 12, and December 19, 2012; February 26, and March 28, 2013.
3. Hospira (personal communications). June 18, July 20, August 23, September 9 and 27, October 11 and 29, November 8 and 22, December 22, 2010; February 14, March 23, April 29, May 31, June 21, July 19, August 2, September 7, October 6, November 21 and 28, 2011; January 3, February 13 and 27, March 12 and 20, April 24, May 7, June 7, July 16, September 26, November 12, and December 19, 2012; February 27, and April 1, 2013.
4. APP (personal communications). June 18, July 19 and 22, August 25, September 13 and 30, November 3 and 24, December 22, 2010; February 16, March 25, April 29, June 1 and 22, July 21, August 3, and September 7, October 3, and November 28, 2011; January 4, February 14, April 24, May 7, June 7, July 16, September 26, November 12, and December 19, 2012; February 26, and March 29, 2013.
5. Beckwith MC, Tyler LS, eds. Cancer Chemotherapy Manual. St. Louis, MO: Wolters Kluwer Health Inc. 2010.
6. Antineoplastic agents. In: McEvoy GK, ed. AHFS 2010 Drug Information. Bethesda, MD: American Society of Health-Systems Pharmacists; 2010: 902-1260.
7. Drug Facts and Comparisons Online. St. Louis, MO: Wolters Kluwer Health Inc. September 2010.

Updated

Updated: April 1, 2013 by Jane Chandramouli, PharmD, Drug Information Specialist; March 1, 2013 by Jane Chandramouli, PharmD, Drug Information Specialist. Created September 10, 2010, by Michelle M. Wheeler, PharmD, and M. Christina Beckwith, PharmD, Drug Information Specialists. Copyright 2013, Drug Information Service, University of Utah, Salt Lake City, UT.