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Epinephrine Shortage Epinephrine 0.1 mg/mL Emergency Syringes

June 18, 2010

There is currently an Epinephrine shortage. The following information was pulled from the American Society of Health-System Pharmacists. Use the link provided in the table for reference.

Epinephrine 0.1 mg/mL Emergency Syringes 10 mL LifeShield Abboject syringe with 1.5 inch, 21-gauge needle (NDC 00409-4921-34)

New 6/4/2010

Hospira Inc.,

Unanticipated increased demand

Hospira is working to increase production to respond to the increased demand and plans to have releases by end of June with additional releases in July and beyond.

Please see the American Society of Health Systems Pharmacists link below for important safety information regarding the use of alternate epinephrine injectables during the shortage: Epinephrine 0.1 mg/mL Emergency Syringes

Products Affected - Description

Epinephrine 0.1 mg/mL Emergency Syringes, Hospira
10 mL LifeShield Abboject syringe with 1.5 inch, 21-gauge needle (NDC 00409-4921-34)

Reason for the Shortage

  • Hospira has epinephrine 0.1 mg/mL emergency syringes on back order due to increased demand.
  • Amphastar discontinued their unapproved emergency drug syringes, including epinephrine 0.1 mg/mL, in December, 2009.

Estimated Resupply Dates

Hospira has available epinephrine 0.1 mg/mL Abboject emergency syringes with attached 3.5 inch, 18-gauge needle (NDC 00409-4901-18). LifeShield Abboject emergency syringes are on back order with an estimated release date of late-June, 2010.

Implications for Patient Care

Epinephrine injection emergency syringes and vials are unapproved products.However, epinephrine injection is considered a standard of care for the management of anaphylactic reactions (approved auto-injectors available), cardiopulmonary resuscitation, and cardia arrhythmias.Epinephrine emergency syringes are commonly used for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to initial defibrillatory shocks, pulseless electrical activity, and asystole.


  • ASHP and the Institute for Safe Medication Practices (ISMP) issued a National Alert Network message warning that the shortage of EPINEPHrine pre-filled syringes can cause serious or fatal medication errors.
  • Hospira epinephrine emergency syringes with attached 3.5 inch needles are for intracardiac use only. LifeShield epinephrine emergency syringes should not be replaced with the intracardiac Abboject syringe in code boxes or emergency department settings. The intracardiac needles cannot be removed and are not compatible with needleless IV access systems. LifeShield syringes are compatible with needleless IV access systems due to a “shield” covering the 1.5 inch needle.
  • Epinephrine is a high alert medication and may cause significant patient harm when used in error.Medication errors may occur due to confusion related to epinephrine products labeled as ratio strengths. Minimize confusion by storing a single concentration where possible.If LifeShield epinephrine 0.1 mg/mL syringes must be replaced or supplemented with epinephrine 1 mg/mL ampules or vials in code boxes or other locations during the shortage, apply auxiliary labels to the vials to alert staff of the epinephrine concentration in milligrams and to dilute before IV use. Create a dose conversion chart reflecting available epinephrine concentrations to keep in code boxes and post in areas where epinephrine is frequently used.

Alternative Agents & Management

  • There are no alternative manufacturers of epinephrine 0.1 mg/mL emergency syringes.
  • There are no adapters available to make intracardiac Abboject syringes compatible with needleless IV access systems.1
  • Consider conserving current supplies of LifeShield Abboject epinephrine emergency syringes for code boxes or code situations.
  • Hospira, American Regent, and JHP have available epinephrine 1 mg/mL 1 mL ampules.American Regent, Amphastar, and JHP have available epinephrine 1 mg/mL 30 mL vials.



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