TO: Physician, Nursing and Pharmacy Staff

hydrALAZINE 20 mg/ mL (1 mL) injection supply from the sole manufacturer is on back order; inventory will deplete prior to its return without conservation.

Effective immediately, restrict the use of hydrALAZINE injection for use in patients when there are no other therapeutic alternatives or when other alternatives have not been effective.

• Oral hydrALAZINE is freely available and should be used in all situations when the patient can tolerate the oral route.
• Potential formulary alternatives to hydrALAZINE injection that should be considered, if clinically appropriate for the patient and oral hydralazine is not an option, include:
  • Sublingual alternatives: captopril or clonidine (regular tablets will disperse within 1 minute in mouth – contact pharmacy for more information); nitroglycerin sublingual spray or tablets
  • Parenteral alternatives: labetalol, esmolol, or enalaprilat. In critical care, IV hydrALAZINE should only be used when other parenteral alternatives are contraindicated or when other alternatives have not been effective.

Should hydrALAZINE stock become depleted, each pharmacy department will circulate site specific communication.

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

Submitte by: Regional Pharmacy
For more info. contact: your site pharmacy or Rizwan Ahmed or Libby Gair

Please ensure the Overfill poster is in areas where staff work with IV bags so that they are aware of the practice change described.

Submitted by: Tara Stewart, Manager Clinical Initiatives and Mentorship

Attention: Home Care Case Coordinators, LTC Access Coordinators and LTC Navigators

Modernization and provincial standardization – see Clinical Practice Change – Elimination of Diagnostic Testing Requirements in LTC Application

All Clinical Communications can be found under Clinical Practice Changes for Health Providers.

Submitted by: Dana Human, Regional Lead – Community & Continuing Care & Debbie Harms, Clinical Change Lead, Home & Community Care

Dec. 10, 2024, Southern Health-Santé Sud is converting to the Kangaroo OMNI enterel feeding pump is part of an urgent provincial conversion from the Kangaroo ePump and Joey Feeding Pumps due to supply shortages for current feeding system consumables.

Documents below are intended for leadership & clinical staff in acute care, Heritage LIfe PCH leadership and clinical staff.

• Memo with conversion details for sites using enteral feeding pumps
• Poster for communicating upcoming conversion to clinical staff

Submitted by: Tamara Burnham, Collaborative Practice Lead

REMINDER: Shared Health Clinical Laboratories Do Not Split Nasopharyngeal Swab Samples Received for SARS-CoV-2 Only or SARS-CoV-2/Influenza A & B/RSV Quadruplex GeneXpert® Testing for Additional Respiratory Pathogen Testing.

Background Information:
For selected patients, molecular testing for respiratory viruses beyond SARS-CoV-2 (COVID-19), influenza A, influenza B, and respiratory syncytial virus (RSV) may be indicated. This testing is primarily performed by Cadham Provincial Laboratory (CPL) using their RV-16 respiratory virus panel or is a send out test ordered through CPL.

Reminder:
If RV-16 respiratory virus panel or send out testing is ordered through CPL, a separate nasopharyngeal (NP) swab and separate CPL requisition must be sent to CPL for this testing. Shared Health Clinical Laboratories are not able to split and forward NP samples to CPL or elsewhere once SARS-CoV-2 Only or SARS-CoV-2/Influenza A & B/RSV Quadruplex GeneXpert® testing has been performed.

Submitted by: Shared Health Diagnostic Services

For more info. contact:  Dr. James Karlowsky, Medical Director, Clinical Microbiology, Shared Health, 204-237-2105 or email
Joelle Carlson, Technical Director, Clinical Microbiology, Shared Health 204-237-2073 or email

The Chickenpox/Shingles Screening Checklist is a stand-alone form created to assist staff in identifying and managing possible chickenpox/shingles cases in our facilities/community. The form can be used by staff but is not required. The information gathered from the use of the form may assist in diagnosis and treatment of cases, thus providing safe care for both staff and those they are caring for. Please note that there is a link to the Chickenpox and Shingles education presentation on the form and likewise, a link to the form in the education presentation.

Submitted by: Shelly Rempel, Infection Control Coordinator
For more information, contact email

To:  Physician, Nursing and Pharmacy Staff

Health Canada has approved the temporary import and sale of US English labeled FRESENIUS KABI vials. The product is considered interchangeable with the Canadian authorized product. Prescribers are asked to refer to the Canadian product monograph as needed.

Supply of pantoprazole 40 mg injection is tenuous, and our current inventory will not meet usage demand without conservation measures. 

Conservation measures:

1. Prescribers need to assess patients on pantoprazole IV therapy to step down to oral therapy as soon as clinically feasible.
2. For patients with an active gastrointestinal bleed, pantoprazole 40 mg IV twice daily for 72 hours should be prescribed, rather than running a 24-hour continuous IV infusion.
3. For acutely bleeding patients who have been scoped and found not to have a bleeding peptic ulcer, they should immediately be stepped down to an oral proton pump inhibitor.
4. Famotidine injection (H2 receptor blocker) supply is tenuous but remains an option.
5. Esomeprazole-MUPS are freely available for patients who are unable to swallow tablets whole or with tube feeds.

Oral pantoprazole tablets remain freely available.

Due to the pantoprazole injection shortage, alternate brands have been brought in; there may be different brands in use within the same facility. Please note that the JAMP brand pantoprazole injection is INCOMPATIBLE with the MINI-BAG PLUS system.

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 or Libby Gair.

Submitted by:  Rizwan Ahmed, Director – Pharmacy & Libby Gair, Drug Distribution Supervisor

To:  Physician, Nursing and Pharmacy Staff

Megestrol 40 mg and 160 mg are on back order and stock may deplete prior to its return.

For oncology indications please contact Cancer Care Manitoba to discuss with the applicable practitioner alternative therapy.

Details regarding stock depletion will be sent on a site-specific basis.

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 or Libby Gair.

Submitted by:  Rizwan Ahmed, Director – Pharmacy & Libby Gair, Drug Distribution Supervisor