Shortage of L-cysteine hydrochloride for injection
Newborns are unable to make this amino acid, and if they also can’t take food by mouth it must sometimes be supplied by injection. The American Society of Health-System Pharmacists reports a shortage.
Since there is none available, the report also makes the following recommendations:
Reserve supplies for neonatal patients <1 kg or neonatal patient who are >1kg after surgery or with sepsis.
Avoid use of L-cysteine if patient is receiving at least 3 gram/kg per day of protein.
Consider oral or enteral routes for supplementation if possible.
Avoid using L-cysteine for catheter patency.
Compound in central location and add L-cysteine as a separate product from amino acid solutions to help conserve supplies.
Purchase only the supply needed, do not stockpile.
Item one the list translates as, if you have any L-cysteine hydrochloride for injection in stock, only use it on the babies who are likely to need it the most. Item two gives you another definition of a baby who doesn’t need the injection, one who is getting 3 g/kg/day of protein by some other means. In item 3, oral is obvious. Enteral route means a feeding tube. Item 4 means for heavens sake don’t waste your injectable L-cysteine hydrochloride for checking to make your IV line isn’t clotted, use injectable normal saline instead for this routine check. Item 5 means don’t waste your supplies in the compounding pharmacy where you can make up a solution of L-cysteine from the dry powder form instead and add it to the rest of what is prescribed for the baby’s diet. Item 6 is an appeal to avoid the human tendency to cause shortages by stockpiling and hoarding.