title: Cardiovascular Drug Shortages: Predominant Etiologies, Clinical Implications, and Management Strategies.
abstract: OBJECTIVE
  To review the literature surrounding the incidence, significance, and management of cardiovascular (CV) drug shortages.
  
  
  METHODS
  A literature search was conducted using all available indexing databases from January 1996 to August 2013, coupled with assessments of the ASHP (American Society of Health System Pharmacists) and Food and Drug Administration Web sites designated to drug shortages. Data were also gathered through a review of listservs discussing this topic.
  
  
  RESULTS
  CV drug shortages are among the top 5 national drug class shortages that are posing a threat to patient care and public health. When a drug shortage occurs, it requires modifications to prescribing and the method medications are processed by the pharmacy. These necessary yet cumbersome changes can potentially result in less-than-desirable prescribing options and increases in personnel time because of administrative and dispensing obstacles. Any one of these has the potential to increase costs and/or lead to worse outcomes. Several factors have been shown to contribute to these shortages, including manufacturing delays, increased demand, medication discontinuations, and lack of raw materials. In this article, we review 13 of the critical CV drug shortages, describe their role in therapy, discuss the reasons for the shortage, define their impact on patient care, and recommend alternative therapies.
  
  
  CONCLUSIONS
  CV drug shortages are common and can potentially lead to deleterious patient outcomes. Institutions should develop plans for early identification, management, and resolution to minimize the clinical sequelae associated with drug shortages.
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA South Carolina College of Pharmacy-MUSC Campus, Charleston, SC, USA.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Wiggins
authors.affiliation: South Carolina College of Pharmacy-MUSC Campus, Charleston, SC, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Nappi
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Fortier
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA taberd@musc.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
keywords: antiarrhythmics; cardiovascular; diuretics; drug shortages; electrolytes; inotropes; vasoactive agents