The code-cart drugs on FDA's shortage list, from atropine to dextrose

On Nov. 7, 2025, FDA's shortage database logged a cluster of discontinuation notices. Thirteen of the 14 posted that day came under one manufacturer's labeler code, and 12 of those were drugs a hospital keeps on its crash cart: epinephrine 0.1 mg/mL, atropine in prefilled glass syringes, three strengths of sodium bicarbonate, 50% dextrose in a glass syringe, calcium chloride, and lidocaine labeled "For Cardiac Use Only," according to FDA's records for that date¹.

Several of those drugs were already in shortage. Atropine injection has been on FDA's current list since at least the start of 2012, sodium bicarbonate since March 2017 and 50% dextrose since January 2022.

These are the drugs reached for in the first minutes of a cardiac arrest, a severe low blood sugar or a dangerous heart rhythm. This explainer uses FDA's shortage data, GxRadar's analysis of it as of Oct. 30 and Nov. 3, 2026, and published studies to show where each one stands, how long such shortages have tended to last and how hospitals and ambulance services have coped.

Where the emergency injectables stand

Source: GxRadar analysis of openFDA drug shortage records retrieved Nov. 3, 2026. *A floor date; see below. Lidocaine injection, which also appears on code carts, is covered in our separate piece on local anesthetics; it has been listed since Feb. 22, 2012.

Epinephrine on its own is not currently listed as in shortage. It appears on FDA's current list only in combination with lidocaine or bupivacaine, as a local anesthetic. FDA's data also contain no listing for the epinephrine auto-injectors patients carry. Anyone unsure about their own supply can ask a pharmacist; our guide on what to ask when your medicine is in shortage has the questions.

A discontinuation notice is not itself a shortage. Other companies may still make the drug, and FDA's FAQ² notes that "FDA can't require a firm to keep making a drug it wants to discontinue." But when an older injectable has few makers, losing one can tip it into shortage, the same FAQ says. FDA's list held 161 to-be-discontinued entries as of Oct. 30, 2026, alongside 69 current shortages.

Suppliers have posted recovery estimates for two of the current listings. The latest note on sodium bicarbonate gives "Next Delivery and Estimated Recovery: June 2027," citing a manufacturing delay. For 50% dextrose the estimate is March 2027.

Reading atropine's 2012 date

FDA's records give atropine a first-posted date of Jan. 1, 2012, a round number. openFDA's documentation¹ says its shortage data cover 2012 onward, which makes that date a floor. The shortage is older.

A 2024 study in the American Journal of Health-System Pharmacy⁶ tracked shortages of common code-cart drugs from 2001 to 2022 using University of Utah Drug Information Service data. It found that the longest active one was atropine injection, at 165 months by the end of the study period. That puts its start in 2009. The atropine records¹ also show FDA's most frequently cited reason for the drug is "Requirements related to complying with good manufacturing practices."

Source: Gentile et al., American Journal of Health-System Pharmacy, 2024⁶. New code-cart shortages peaked in 2010. The most common reason, when one was reported, was manufacturing delays.

That finding on prefilled dextrose syringes, two suppliers across 22 years, explains why one company's exit matters. Our explainer on why some generics have only one maker describes the same thin-market problem in pills.

What a shortage did in one intensive care system

Sodium bicarbonate offers a measured case. FDA first posted it on March 1, 2017. That year a worldwide shortage of the IV drug reached Canada, and a study in Critical Care Medicine⁸ tracked 17 adult intensive care units in Alberta, where it ran from June 8 to Oct. 4, 2017, and the health authority imposed emergency conservation measures.

Among 18,865 admissions of patients with acidemia, the share treated with IV bicarbonate dropped from 29.3 percent to 21.5 percent as soon as the shortage began. Patients who did get it during the shortage had more severe acidemia, and among the most acidemic patients who went without it, more received vasopressors or continuous kidney replacement therapy. The authors found no change in ICU length of stay or mortality.

How hospitals and ambulances cope

For emergency medical services, shortages are routine. A survey of advanced life support agencies in Los Angeles County, published in Prehospital Emergency Care⁷, drew responses from 29 of 30. All but one reported being affected. Epinephrine 0.1 mg/mL, morphine, 10% dextrose and normal saline were the drugs most often reported short. The most common responses were using alternative vendors (71 percent), rotating stock from low- to high-volume units (54 percent) and using expired medicines covered by FDA-approved extensions (50 percent).

Hospitals juggle expiration dates too. One academic medical center described in a 2020 AJHP paper⁹ collected short-dated items from more than 200 emergency drug boxes and sent them to satellite pharmacies and the emergency department before they expired. Of the 16 medicines stocked in those boxes, 12 were short at the institution at the time. The item with the largest cost avoidance was a 30 mL vial of epinephrine 1 mg/mL.

FDA's part in that is its list of extended use dates³. It currently includes three lots of 25% dextrose in 10 mL syringes, with labeled expiration dates of May 1, 2026 extended to Oct. 1, 2026. FDA says the extensions rest on "stability data provided by the manufacturers and reviewed by FDA." Our article on drug expiration dates and shelf life explains why that is possible.

Why the code cart keeps coming up short

FDA's 2019 report on shortage root causes⁴ cited a practitioner survey in which 87 percent of respondents said shortages had affected emergency care, the highest share of any area. The same report found that 63 percent of drugs entering shortage from 2013 to 2017 were sterile injectables, with a median price of $11.05 per unit the year before. GxRadar's Why sterile injectables dominate shortage lists explains the manufacturing side.

FDA's report to Congress for 2025⁵ said shortages persist partly because of "limited manufacturing capacity which results in manufacturers deprioritizing products that are not economically attractive." Prefilled emergency syringes, made in glass by few companies and sold in modest volumes, fit that description.

The dates to watch are March 2027 for 50% dextrose and June 2027 for sodium bicarbonate, and whether other makers pick up the presentations discontinued in November 2025. Our shortage tracker follows each listing, and Pediatric drug shortages covers the overlap: atropine, sodium bicarbonate and every dextrose listing above carry FDA's Pediatric tag.