The Lidocaine Shortage: An End in Sight?

If you're a nurse practitioner who does a lot of procedures or works in the inpatient hospital setting, you're probably aware of the national lidocaine shortage. As an emergency NP, I've been receiving emails about the shortage for awhile now. Just how bad is the shortage and when will it end? I'm not interested in resorting to performing procedures without anesthesia. 

Earlier this month, we discussed drug shortages and how they happen. The American Society of Health-System Pharmacists (ASHP) also maintains a helpful database of drug shortages to keep clinicians up to date and help conserve medications in short supply. Here's the scoop on the current lidocaine shortage.

Current lidocaine products on the drug shortage list

According to the American Society of Health-System Pharmacists (ASHP), there are roughly seventy-five lidocaine products on the current drug shortage list, all of which are made by a multiple pharmaceutical manufacturers.

The list of products affected includes:

  • 2% lidocaine hydrochloride topical jellies

  • 5% lidocaine and 7.5% dextrose injections

  • Lidocaine hydrochloride and 5% dextrose injections

  • Xylocaine-MPF and lidocaine hydrochloride injections and

  • Lidocaine with epinephrine injections

Shortage specifics according to the manufacturers

In general, most pharmaceuticals run scarce due to manufacturing issues. The supply is then worsened by market complexities that make it hard for drugs to come off the shortage list.

In regards to the shortage of lidocaine, most of the drugs’ manufacturers have provided information on why they’re experiencing a shortage as well as when and when end-users can expect to see some of the products back on their supply shelves.  

  • 2% lidocaine hydrochloride topical jellies

    • Akorn states its shortage is due to increased demand

    • Teva discontinued its lidocaine jelly in early-2018

  • 5% lidocaine and 7.5% dextrose injections

    • As the sole supplier of this combination, Pfizer states the shortage is due to manufacturing delay. The injections are not currently available, and are on long-term back order. Pfizer estimates a release date of 2019.

  • Lidocaine hydrochloride and 5% dextrose injections

    • BBraun has not provided a reason for its shortage but does currently have 5% dextrose 4 mg/mL 250 mL, 4 mg/mL 500 mL, and 8 mg/mL 250 mL premixed bags on allocation to its contracted customers.

  • Lidocaine Injections

    • Fresenius Kabi cited its shortage due to a supply interruption of raw ingredients

    • Pfizer’s lidocaine injections are on shortage due to manufacturing delays

    • Drug manufacturers Hikma and AuroMedics have not provided a reason for its shortages. 

  • Lidocaine with epinephrine injections

    • Fresenius Kabi has Xylocaine with epinephrine presentations on shortage due to increased demand for the product and manufacturing delays. The company has released specific information as to when end-uses can expect release dates on these injections, which can be found here.

    • Pfizer has lidocaine with epinephrine presentations on shortage due to manufacturing delays. The company expects its lidocaine with epinephrine injections to be released over the course of September 2018 through November 2018.

More specific details on the various lidocaine products affected by a shortage can be found on the ASHP’s website.

Safe Alternatives
 
In some cases there's simply not a good substitute for good 'ole lidocaine. But, in other cases there can be a few good options to help conserve what's left of your facility's lidocaine supply. First, for lower acuity, less complex lacerations or procedures, a topical anesthetic such as Emla cream might do the trick. Alternately, as an injectable anesthetic, consider something like bupivacaine (Marcaine). While its onset of action is a bit slower than lidocaine's, bupivacaine has a significantly longer duration of action. 
 
Fortunately, there is some light at the end of the tunnel with the national lidocaine shortage. Pfizer estimates that this fall manufacturing hangups for lidcaine with epinephrine will resolve and a new supply of the drug will be available on the market. 
 
Have you experienced any challenges in your practice related to the lidocaine shortage?