The Canadian Rheumatology Association (CRA) has been recently notified by members across the country of shortages in certain medications that are integral to patient care. The CRA has previously responded to alerts of shortages of Plaquenil, Colchicine and others by working with the Ministry of Health, Health Canada, as well as pharmaceutical companies, to provide information and work toward solutions to members.   Below are the current shortages the CRA is following:   1. Cyclophosphamide (oral)   A shortage has been reported between February 25 – April 14 due to a delay in shipping. This medication is provided by a single manufacturer (Baxter). This issue should now be resolved. Oral Cyclophosphamide is a niche product used mainly in rheumatology. Although it was previously manufactured by three companies, there is currently only one manufacturer. Please inform the CRA immediately if you continue to have difficulty accessing this medication, or if it recurs in the future.   2.Tocilizumab (Actemra ™) subcutaneous (-SC)   Pharmacists and patients are currently reporting difficulties in obtaining their usual three-month prescription refills of Actemra-SC. As a result, this has been interpreted as a potential shortage. This is primarily due to its success in managing critically ill COVID-19 patients in the ICU, when administered intravenously. As you may recall, to ensure sufficient ongoing supply for legacy rheumatology patients, the CRA and its members worked with Health Canada and the manufacturer, and we have successfully avoided a critical shortage in 2021. However, with the current high worldwide caseload of COVID-19, and especially in the USA, the IV formulation was exhausted, and the subcutaneous product was utilized for the IV dosing in critically ill patients.   The manufacturer in concert with the distributers have initiated a mitigation strategy to ensure all legacy patients continue to have access to Actemra-SC. This includes limiting the doses dispensed with each renewal, to ensure access for all and thus avoid a ‘real’ shortage, while they continue working on enhancing their manufacturing capacity. Please see a letter from the manufacturer here.   If you continue to have difficulty accessing Actemra-SC, including access for urgent new starts (i.e., GCA), please contact your Roche representative. Please remain vigilant for any disruption in access and report any concerns to info@rheum.ca.   3. Intra-articular Steroids   Due to a reduced manufacturing capacity (staffing impacted by COVID-19) Depo-Medrol 80mg has been in shortage since January 2022, and more recently Depo-Medrol 40mg. As of May 4, Pfizer informs us that Depo-Medrol 40mg will be available for distribution as of the second week of May. Unfortunately, they cannot commit to a date for return to market for Depo-Medrol 80mg.  Given that Depo-Medrol represents 80% of the market share of intra-articular steroids, other manufacturers will be limited in their capacity to supply beyond 2-3 weeks’ worth of inventory.   As for alternatives, Kenalog brand of triamcinolone acetonide has also been recently reported to be in short supply although the issue may have been resolved but there may be a delay before the shelves are filled. Two other manufacturers state that they have sufficient inventory for approximately one month, including Trispan (Medexus formulation of Triamcinolone hexacetonide 20mg*; current supply expires August 2022 and future supplies are uncertain after that) and Sterimax (Triamcinolone acetonide 40mg; currently supplying hospital contracts and therefore supply for community and retail use may be limited). You may access product directly from the manufacturer, so contact your local rep or the company’s website.   *In the pediatric rheumatology community, it is considered the preferred product due to its durability of response. Some adult rheumatologists are also using it and are experiencing a similar response. Similar efficacy should be expected in the adult population. Recommended standard dosage for large joints is 40mg and medium joints is 20mg. The CRA will continue to work with all stakeholders to keep our members informed, so you in turn can continue focusing on delivering excellent care to your patients. In the meantime, please remain vigilant for any disruption in access to these medications and any others and report any concerns to info@rheum.ca.