A.S.P.E.N. Releases Results of Multivitamin Shortage Survey - May 2012 

The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) has been very concerned about the current ongoing shortage of parenteral multi-vitamins. This product is a most critical parenteral nutrition component; shortages of this drug in the past have been associated with death and serious morbidities.  We are in a situation with a very limited number of manufacturers of this product even before the current production delay. We have just completed a survey (April 24-May 2, 2012) of nutrition support clinicians, including pharmacists, nurses, dietitians and physicians, with the help of ASHP.

We would like you to focus on the following survey findings:

1. Almost 800 respondents completed the survey in just over 1 week.
2. Respondents came from across the healthcare setting and served all age groups.
3. About 70% of respondents are in short supply of adult multivitamins and 26% of respondents are in short supply of pediatric multivitamins (this follows respondents patient populations)
4. Almost 27% are giving their patients on PN no IV multi-vitamins.
5. For pediatric practitioners, 25% report a less than 7 day supply and 44% are on a less than 25% purchasing allocation.
6. For adult  practitioners, 28% report a less than 7 day supply and 37% are on a less than 25% purchasing allocation.

A.S.P.E.N. is:

1. Sharing these findings with drug shortage program at the FDA.
2. Strongly encouraging clinicians to use our management recommendations that are found on the A.S.P.E.N. and FDA Drug Shortages website.

Note:  If IV multivitamins are no longer available, administer individual parenteral vitamin entities.  Thiamine, ascorbic acid, pyridoxine, and folic acid should be given daily. Administer cyanocobalamin (B12) at least once per month. Thiamine is critical as several deaths have resulted from cardiac failure due to thiamine deficiency when long-term PN patients did not receive vitamins for three to four weeks.  Patients receiving a carbohydrate load are particularly susceptible to thiamine deficiency.  It should also be noted that megaloblastic anemia secondary to folate deficiency has been reported in PN patients who did not receive folate for 4-5 weeks.  Suggested daily intravenous doses are thiamine 6 mg, folate 0.6 mg, ascorbic acid 200 mg, and pyridoxine 6 mg unless otherwise clinically indicated.