Please be advised the following monographs have been updated on the Drug Monographs page. For IV Parenteral Drug Manual holders, please add/replace/discard as indicated.

REPLACE ADULT Monograph:
Discard the old monograph, PRINT (using the hyperlink) & replace with the new monograph in the Adult Parenteral Drug Monograph Manual as listed below:

Submitted by: Cécile Dumesnil, Manager – Pharmacy
For more info. contact: 204-371-5952 or

CADHAM PROVINCIAL LABORATORY

Beginning January 1, 2025, new cases of syphilis detected by Cadham Provincial Laboratory (CPL) using serologic techniques will no longer be routinely confirmed by Treponema pallidum particle agglutination (TPPA).

All syphilis serologic investigation tends to begin with the CMIA syphilis screen test. As a rule, syphilis cases (beyond the early incubation period) will be positive by CMIA syphilis screen test. All screen test positive individuals will then have syphilis titres checked using the Rapid Plasma Reagin (RPR) test. Most new cases of syphilis have mid- to high RPR titres, and in the past have uniformly confirmed using TPPA. TPPA confirmation will no longer routinely be performed on these types of specimens.

TPPA confirmation will continue to be routinely be performed in the following circumstances:

• CMIA screen positive but RPR negative specimens
• Borderline CMIA positive specimens, regardless of RPR titre

Retrospective studies of recent CPL syphilis serology indicates that these scenarios benefit the most with the addition of TPPA confirmation.

In general terms, there should be little to no impact to clinicians or public health practitioners with this change. If you feel you have a case that requires further investigation with TPPA, please contact CPL or the CPL physician on-call to discuss.

References/Resources:
Please refer to the CPL Guide to Services (G2S) for collection and submission information.

More Information:
CPL G2S website
Manitoba Syphilis Protocol

Contact Information:
Paul Van Caeseele, MD
Medical Director, Cadham Provincial Laboratory | Shared Health
204-945-6456 or email

Submitted by: Loreley Fehr, Manager, Health Services – Public Health-Healthy Living

Overview:

• Production of hydroxocobalamin kits was temporarily suspended due to an investigation into a possible deviation relating to a risk of microbial contamination.
• Lot number 2413, expiry date 30-Oct-2026 was manufactured during this time period and is potentially impacted.
• Based on risk assessment provided by the manufacturer, Health Canada has made the decision to authorize distribution of the affected batch as the risk of microbial contamination is considered minimal.

Note the following guidelines:

• Reserve hydroxocobalamin for patients with clinical signs of acute intoxication in a context suggestive of exposure to cyanide: cardiac arrest, shock, respiratory distress, coma, high lactic acidemia (>8 mmol/L)
• Hydroxocobalamin should not be used in the absence of hypoxia.
• Any signs/symptoms suggestive of systemic infection should trigger blood cultures and antibiotic therapy.

Supply of hydroxocobalamin kit (CYANOKIT) is constrained and conservation measures need to be implemented in order to avoid stock depletion.

Effective immediately: hydroxocobalamin is to be restricted for use in clinical situations requiring antidote for cyanide poisoning. Alternative treatment to consider for vasoplegic syndrome or refractory hypotension is methylene blue at a suggested dose of 1.5 to 2 mg/kg IV administered once over 20 to 60 minutes.

Please not that serotonin syndrome may occur in patients taking serotonergic agents and concomitant use of methylene blue.

Thank you for your support of the ongoing efforts to manage drug supply issues.

For questions, please contact your site pharmacy or please contact Rizwan Ahmed at or Libby Gair at

Submitted by: Pharmacy Program

Supply of dextrose 50% prefilled syringes 50 mL has stabilized in the Canadian market and is freely available. Inventory is sufficient to use without restriction.

Thank you for your support of the ongoing efforts to manage drug supply issues.

For questions, please contact your site pharmacy or please contact Rizwan Ahmed at or Libby Gair at

Submitted by: Pharmacy Program