Injectable Medication Shortages: Why Hospital Pharmacies Are on the Front Line

January 24, 2026 2 Comments Jean Surkouf Ariza Varela

When a patient needs an IV drip of saline, a life-saving chemotherapy drug, or an anesthetic before surgery, they expect it to be there. But in hospitals across the U.S., that expectation is becoming a gamble. As of July 2025, there were 226 active drug shortages in the country - and nearly two-thirds of them involve sterile injectables. These aren’t minor inconveniences. They’re life-or-death disruptions that hit hospital pharmacies harder than anywhere else.

Why Injectables Are the Weakest Link

Not all drugs are created equal when it comes to supply chain fragility. Oral pills can be stockpiled, substituted, or delayed. Injectable medications? Not so much. They require sterile, contamination-free manufacturing - a process so complex that even a tiny flaw can shut down an entire production line. That’s why 89% of the shortages that plagued hospitals in 2024 were carryovers from 2023. Many have lasted years.

The problem isn’t just about volume. It’s about precision. Sterile injectables make up about 60% of all drugs in shortage. That includes everything from normal saline and potassium chloride to critical cancer drugs like cisplatin and anesthetics like propofol. These aren’t optional. They’re the backbone of emergency care, surgery, and intensive treatment. When they’re gone, hospitals don’t just scramble - they stop.

Manufacturers of these drugs operate on razor-thin margins, often just 3% to 5% profit. That’s not enough to invest in modern equipment, backup systems, or redundant supply lines. And when a tornado tears through a Pfizer plant in North Carolina or the FDA shuts down a facility in India over contamination, there’s no backup. Just silence.

Hospital Pharmacies Are the First to Feel It

Retail pharmacies might run out of a common antibiotic now and then. But hospital pharmacies? They’re drowning. While community pharmacies see shortages affecting 15% to 20% of their inventory, hospitals report 35% to 40% of their essential meds are unavailable. And 60% to 65% of those are injectables.

Academic medical centers - the ones treating the sickest, most complex cases - are hit three times harder than community hospitals. Why? Because they use specialized drugs that no one else does. A patient on a ventilator in the ICU doesn’t have the luxury of waiting for a pill. They need an IV. When that IV fluid runs out, nurses have to improvise. Some hospitals started using oral rehydration for post-op patients. Others postponed surgeries. One nurse manager in Massachusetts documented 37 canceled procedures in just three months because of anesthetic shortages.

The impact isn’t just logistical - it’s ethical. Nearly 70% of hospital pharmacists say they’ve faced impossible choices: give a patient a less effective drug because the best one is gone, or delay treatment and risk deterioration. Over 40% admit they’ve had to use alternatives that likely hurt outcomes.

A broken sterile drug production line with contamination and natural disasters disrupting the global supply chain.

The Root Cause: A Broken System

This isn’t a glitch. It’s a design flaw. Eighty percent of the raw ingredients for generic injectables come from just two countries: China and India. One flood, one political dispute, one factory inspection failure - and the entire U.S. supply chain shudders.

Quality issues cause 55% of all drug shortages. That’s not bad luck. That’s systemic. The FDA can’t force manufacturers to fix problems. They can only ask. And only 14% of shortage notifications lead to timely fixes, according to internal FDA data reviewed by the Senate.

The market is also dangerously concentrated. Just three companies control 65% of the market for basic injectables like sodium chloride and potassium chloride. That means if one fails, the whole system fails. No competition. No backup. No safety net.

Even policy changes haven’t helped much. The Consolidated Appropriations Act of 2023 required earlier shortage warnings - but it only cut shortage duration by 7%. The FDA’s new strategic plan offers incentives for better quality - but no penalties for failure. The $1.2 billion federal investment to rebuild domestic manufacturing sounds promising, but experts say it’ll take 3 to 5 years to show results. Patients won’t wait that long.

A nurse holds an empty IV bag in an ICU as doctors and pharmacists struggle with treatment alternatives.

How Hospitals Are Fighting Back - With Limited Tools

Hospital pharmacies aren’t sitting idle. They’ve become crisis managers. Pharmacists now spend nearly 12 hours a week tracking down alternatives, negotiating with suppliers, and rewriting protocols. That’s 12 hours they’re not spending counseling patients or checking for interactions.

Some hospitals created formal shortage committees. But only 32% feel those teams are properly staffed or funded. Others have started consolidating stock - keeping all the scarce drugs in one central location so nothing gets wasted. Some have built lists of approved therapeutic substitutes, so when propofol disappears, they can switch to ketamine or midazolam - if the pharmacy and therapeutics committee approves it in time.

But even the best strategies only reduce disruption by 15% to 20%. And they take months to implement. A new pharmacy director might take over six months just to learn how to manage these shortages effectively. Meanwhile, 31% of hospitals still rely on ad-hoc, informal fixes - increasing the risk of medication errors.

What’s Next? A Long Road Ahead

The number of shortages dipped from 270 in April 2025 to 226 by July - a small win. But the underlying causes haven’t changed. Geopolitical tensions, climate-driven disruptions, and economic pressure on generic manufacturers are all getting worse. And only 12% of sterile injectable producers have adopted newer, more resilient manufacturing methods like continuous production.

Hospital pharmacy directors are clear: shortages won’t improve by 2026. Most expect them to stay the same - or get worse. Without real policy changes - like financial incentives for manufacturers to build redundancy, mandatory quality standards, or penalties for chronic shortages - hospitals will keep paying the price.

Patients don’t see the behind-the-scenes chaos. They just know their surgery got moved. Or their IV ran dry. Or they got a different drug that didn’t work as well. The system is designed to keep them in the dark. But for the pharmacists, nurses, and doctors on the front lines - this isn’t a supply chain issue. It’s a patient care crisis.

Why are injectable medications more prone to shortages than pills?

Injectable medications require sterile, contamination-free manufacturing - a process that’s far more complex and expensive than making pills. Even minor quality issues can shut down production lines. They also have low profit margins, so manufacturers don’t invest in backup systems or redundant facilities. Plus, most active ingredients come from just two countries, making the supply chain vulnerable to geopolitical or environmental disruptions.

Which drugs are most affected by shortages?

Anesthetics have the highest shortage rate at 87%, followed by chemotherapeutics at 76%, and cardiovascular injectables at 68%. Commonly affected drugs include normal saline, potassium chloride, propofol, cisplatin, and epinephrine. These are all essential for surgery, cancer treatment, emergency care, and ICU management.

How do shortages affect patient outcomes?

Shortages lead directly to treatment delays, canceled surgeries, and the use of less effective or riskier alternatives. Over 78% of hospital pharmacists report that shortages have delayed care for critically ill patients. In some cases, patients receive substitutes that increase side effects or reduce effectiveness - which can lead to longer hospital stays, complications, or even preventable deaths.

Can hospitals just order more from other suppliers?

It’s not that simple. Many injectables are made by only one or two manufacturers. Even if another company makes the same drug, it may not be FDA-approved for the same use, or the hospital’s pharmacy committee may not have approved it as a substitute. Switching requires clinical review, legal approval, and staff training - which can take weeks. In emergencies, there’s no time.

What’s being done to fix this?

The FDA has a strategic plan with incentives for quality improvements, and Congress passed laws requiring earlier shortage notifications. The Biden administration also allocated $1.2 billion to boost U.S. manufacturing. But these measures lack enforcement, and experts say they’re too slow. Without mandatory quality standards, financial support for redundancy, or penalties for chronic shortages, the system won’t change.

Are there any alternatives hospitals can use?

Yes - but only in limited cases. For example, when saline is unavailable, some hospitals use oral hydration for stable patients. For anesthesia, alternatives like ketamine or midazolam may be used. But these aren’t perfect substitutes. They can cause different side effects, require different monitoring, or aren’t suitable for all patients. Using them often means compromising care quality - which is why pharmacists face ethical dilemmas daily.