The current nationwide saline shortage has the potential to negatively impact rheumatology patients dependent on infusible products to manage their disease. Bags of normal saline (0.9%) in the 250ml-1000ml volumes are especially low. An announcement by the FDA on March 24, 2014 also states 0.45% (1/2 NS) saline bags in volumes of 500ml and 1000ml are also in decreased supply. The FDA foresees this shortage to remain a problem at least into May 2014. Hospitals have begun rationing saline and looking to alternatives for fluid replacement. Rationing is not an alternative in infusion centers that are not hospital based.
The American Society of Health-System Pharmacists has published Intravenous Solution Conservation Strategies. This document can be found at: http://www.ashp.org/DocLibrary/Policy/Conservation-Strategies-for-IV-Fluids.pdf_
Not all fluids are compatible with biologic infusibles. Before substituting an alternative to 0.9% normal saline, please contact the pharmaceutical company to find out if a safe alternative can be used. For example, Janssen has clinical trial data on 0.45% normal saline and infliximab. Click here for publication.
The table below defines the solutions used with infusible medications for rheumatic diseases. This information has been compiled from the prescribing information for each medication. Also listed are the medical information numbers for each manufacturer.
|Tocilizumab Actemra||0.9% Sodium Chloride||Genentech||800 821-8590|
|Belimumab Benlysta||0.9% Sodium Chloride||GlaxoSmithKline||877-356-8368|
|Cyclophosphamide Cytoxan||5% dextrose
5% dextrose and 0.9% sodium chlorideLactated Ringer’s0.45% sterile sodium chloride
|Bristol Myers Squibb||800-321-1335|
|IVIg||5% Dextrose0.9% Sodium Chloride||CSL BehringBaxter||800-504-5434 (Privigen)866-424-6724 (Gammagard)|
|Abatacept Orencia||0.9% Sodium Chloride||Bristol Myers Squibb||800-321-1335|
|Infliximab Remicade||0.9% Sodium Chloride||Janssen||800-526-7736|
|Rituximab Rituxan||0.9% Sodium Chloride5% Dextrose in Water||Genentech||800 821-8590|
|Golimummab Simponi Aria||0.9% Sodium Chloride||Janssen||800-526-7736|