Supply constraints in New Zealand and Australia

 
New Zealand – propofol, fentanyl and suxamethonium
 
In New Zealand, Pharmac has issued a detailed memo outlining that there are supply constraints for:
  •        Propofol
  •        50 mcg, 2 ml ampoules of fentanyl
  •        Suxamethonium injection
 
Pharmac has requested that departments do not stockpile these medicines, as it will lead to inequitable access across the country and make it difficult for Pharmac and suppliers to forecast demand. Pharmac is working hard to mitigate supply risks, but seeks a commitment from clinicians to be prudent with use of propofol; 50 mcg, 2 ml ampoules of fentanyl; and suxamethonium injection.
 
ANZCA supports Pharmac’s request, and reiterates that clinicians should consider these supply constraints when managing their patients. This will include:
 
Propofol
Where appropriate, only use TIVA anaesthesia where there is a strong indication, such as previous history of severe post-operative nausea and vomiting, severe intracranial hypertension/brain swelling, or a history of malignant hyperthermia. Please also consider alternative agents for procedural sedation such as midazolam/fentanyl.
 
Fentanyl
Use alternatives to fentanyl injection 50 mcg per ml, 2 ml ampoules where clinically appropriate. Prepare for the need to use unapproved fentanyl injections (in accordance with section 29 of the Medicines Act 1981).
 
Suxamethonium injection
Use alternatives to suxamethonium where clinically appropriate. Prepare for the need to use unapproved suxamethonium injections (in accordance with section 29 of the Medicines Act 1981).
 
ANZCA and the New Zealand Society of Anaesthetists will be working together on this issue, and keeping in close contact with Pharmac for further updates on medicine supply in New Zealand. For more information please see here
 
Australia – suxamethonium, rocuronium, fentanyl and cisatracurium  
 
The college has sought the advice of the Therapeutic Goods Administration (TGA) regarding the full extent of anaesthesia drug shortages and will continue to provide updates on how they may affect ANZCA fellows and trainees.
 
The TGA has active notices for suxamethonium chloride, rocuronium bromide, fentanyl citrate and cisatracurium besilate.
 
The Society of Hospital Pharmacists of Australia is monitoring the supply of key medicines related to intensive care treatment and COVID-19. The results of a snapshot survey of fulfilment of orders can be found here.
 
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