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3/3/2021

Multiple Vitamins for Infusion

Products Affected - Description

    • Infuvite injection, Baxter, Adult, 2 x 5 mL single dose vial, 100 count, NDC 54643-5649-01
    • Infuvite injection, Baxter, Adult, 2 x 50 mL bulk vial, 10 count, NDC 54643-5650-02
    • Infuvite injection, Baxter, Pediatric, 5 mL single dose vial, 100 count, NDC 54643-5646-01
    • Infuvite injection, Baxter, Pediatric, 50 mL bulk vial, 1 count, NDC 54643-5647-00
    • Multivitamin for infusion (MVI) Adult, Pfizer, MVI Adult, 2 x 5 mL Dual vial, 1 count, NDC 61703-0434-82
    • Multivitamin for infusion (MVI) Adult, Pfizer, MVI Adult, 2 x 50 mL Dual vial, 10 count, NDC 61703-0422-83
    • Multivitamin for infusion (MVI) Pediatric lyophilized powder for solution for injection, Pfizer, MVI Pediatric, 5 mL vial, 10 count, NDC 61703-0421-53

Reason for the Shortage

    • Baxter has Infuvite on shortage due to 3rd party supplier manufacturing delays. Baxter provided a new Dear Customer letter that can be found at: https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines_and_Clinical_Resources/Shortages/Baxter%20Customer%20Letter%20Infutive%2001.22.21.pdf.
    • Pfizer states the shortage of M.V.I. is due to manufacturing delays.

Available Products

    • There is insufficient supply for usual ordering

Estimated Resupply Dates

    • Baxter has all Adult Infuvite 10 mL vials and Pediatric Infuvite 5 mL vials on a limited allocation. The Adult Infuvite 100 mL vials and Pediatric Infuvite 50 mL vials are on back order and the company cannot estimate a release date.
    • Pfizer has M.V.I. Adult 2 X 5 mL Dual vials, M.V.I. Adult 2 X 50 mL vials, and Pediatric 5 mL vials on back order and the company estimates a release date of September 2021.

Alternative Agents & Management

    • The American Society for Parenteral and Enteral Nutrition (ASPEN) has detailed recommendations for managing an intravenous multivitamin shortage in adults and pediatric patients: https://www.nutritioncare.org/Guidelines_and_Clinical_Resources/Product_Shortages/2021_Parenteral_Nutrition_Multivitamin_Product_Shortage_Considerations/
    • Key recommendations include:
    • Use oral or enteral multivitamin preparations whenever possible.
    • Use of pediatric intravenous multivitamins for adults is not recommended and may result in a shortage of pediatric products.
    • Use of multivitamin preparations without vitamin K is fine with individual supplementation of Vitamin K products. Ensure patients receiving vitamin K are getting adequate anticoagulation if they are on warfarin.
    • Reserve intravenous multivitamins for patients receiving parenteral nutrition.
    • Reserve pediatric intravenous multivitamins for children less than 2.5 kg or less than 36 weeks gestational age. Consider using 5 mL of adult intravenous multivitamins in children weighing greater than or equal to 2.5 kg or gestational age of 36 weeks or older. Supplement intravenous vitamin K (total daily dose = 200 mcg).
    • If no pediatric intravenous multivitamins are available, infants less than 2.5 kg or less than 36 weeks gestation should receive adult intravenous multivitamin at a daily dose of 1 mL/kg up to a maximum of 2.5 mL per day. Supplement intravenous vitamin K daily (total daily dose = 200 mcg).
    • When all supply options are exhausted, ration intravenous multivitamins in parenteral nutrition or administer individual parenteral vitamins.
    • Purchase only the supply needed, do not stockpile.
    • Use oral products when appropriate, however review the oral product to ensure it contains sufficient amounts of essential vitamins (eg, folate, thiamine). Oral vitamin products are considered dietary supplements and are not approved by FDA. Availability and contents of these products varies widely. Components can change at any time.

Updated

Updated March 3, 2021 by Stephen Andrews, PharmD, BCPS, Drug Information Specialist. Created June 23, 2008 by Jane Chandramouli, PharmD, Drug Information Specialist. © 2021, Drug Information Service, University of Utah, Salt Lake City, UT.

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