Shortages of agents used to treat poisoning from 2014 to 2024

Drug shortages are a threat to patient care. Previous research described frequent and prolonged shortages of drugs used to treat poisoned patients. In this study, we characterize more recent trends in toxicology drug shortages. Shortage data from the University of Utah Drug Information Service from 2014 through 2024 were analyzed. Drugs used in the practice of toxicology (antidotes and key supportive agents) were included. Information regarding drug type, formulation, number of shortages, shortage reason and duration, and single-source and marketing status was collected. The availability of alternative therapies and whether the alternative was affected by shortage during the study period was evaluated. Of 1,670 shortages, 223 shortages (13.4%) involved toxicology agents, and 41/223 (18.4%) toxicology shortages remained ongoing at the end of 2024. New shortages peaked at 30 in 2018, and total ongoing shortages consistently exceeded new shortages annually. Median shortage duration was 12.6 months. Shortages predominately impacted parenteral drugs (177/223, 79.4%), and 96.4% (215/223) were generic. Sedative-hypnotics were most frequently impacted. For 186/223 (83.4%) shortages, a therapeutic alternative existed; however, in 93.5% of cases (174/186), the substitute was on shortage. The most common reported reason for shortage was manufacturing problems. Common themes in drug shortages remained over time; however, the shortage landscape has been complicated by discontinuation of the critical antidotes physostigmine and dimercaprol. Therapeutic alternatives may not be readily available, and medication errors and delayed and less effective therapies can impact patient outcomes and increase healthcare costs. Toxicologists are uniquely poised to study and mitigate shortages, and advocate as stakeholders to address the root causes. In the last decade, toxicology drug shortages have persisted and new shortages have emerged. Clinicians caring for poisoned patients should be aware of ongoing shortage trends and implement mitigation strategies to ensure adequate care.