Comprehensive Pharmacy Services Takes Immediate Action to Mitigate National Nitroglycerin Shortage

Tuesday, April 1, 2014 10:00:00 PM

Second significant drug shortage in under six months as IV saline shortage continues

Memphis, TN – April 2, 2014: Comprehensive Pharmacy Services (CPS), the nation’s largest
pharmacy services provider, with 400 hospitals and health systems clients throughout the country,
has immediately taken steps to ensure patient safety and quality of care in response to the recently
announced national shortage of intravenous (IV) nitroglycerin. The IV nitroglycerin shortage follows
on the heels of the ongoing IV saline shortage, and is the second shortage of a hospital and
emergency room drug staple in less than six months.

"In the 40 years we’ve been in the pharmacy services business we’ve never seen a time when two
critical drugs have been in such short supply, let alone virtually unavailable, as is the case with
nitroglycerin," said Marvin Finnefrock, Pharm. D., Divisional Vice President for Clinical Services.
"Unlike with the IV saline shortage, for some conditions there are no alternatives or substitutes for
IV nitroglycerin, so managing through this crisis requires a much different response and action
plan."

Dr. Finnefrock explained that the IV nitroglycerin shortage is of serious concern because it is one
of the most commonly used drugs in hospital emergency rooms, and is often used as first line
treatment. On average, a mid-sized hospital will use approximately 2,000 doses of IV nitroglycerin
annually.

"With two of three U.S. manufacturers unable to supply nitroglycerin, the sole manufacturer has
resorted to rationing – delivering just 20% of historical orders, in order to provide healthcare
facilities with limited supplies of the drug," Dr. Finnefrock added. "While steps are being taken to
ease the shortage, such as seeking overseas sources and manufacturer ramp-ups of domestic
production, as we’ve seen with the IV saline shortage, hospitals need to be prepared for a
protracted nitroglycerin shortage."
CPS is advising that medical, nursing and pharmacy staff work together on a three-part approach
to manage through the nitroglycerin shortage:

1. Inventory Control: Immediately conduct a usage review in all areas where IV nitroglycerin
is routinely used. Set up basic guidelines leading to conservation of a limited resource. For
24-hour pharmacies, relocate supply and dispense from the main pharmacy.

2. Substitution: There is no direct substitution. Alternative routes can include topical, under
the tongue and oral use where clinically indicated.

3. Communication: Implement a timely communication plan to all clinical staff involved in
ordering or administering IV nitroglycerin, keeping them informed of the status of the
shortage and supplies available to the facility. The goal of the communication is to engage
staff in inventory efforts and keep them informed of actions planned by clinical leadership to
mitigate shortage challenges.

About Comprehensive Pharmacy Services:

Employing over 1,800 pharmacy professionals, CPS is the nation’s largest provider of pharmacy
services to more than 400 hospitals and healthcare facilities leading to sustainable improved
quality and reduced cost. CPS services include pharmacy consulting, inpatient and outpatient
pharmacy management, telepharmacy and transition of care services. For more information, visit
www.cpspharm.com.

Contact:

Greg Wenthe
Vice President, Marketing - Comprehensive Pharmacy Services
greg.wenthe@cpspharm.com (901) 748-0470