How to handle the shortage of extensively hydrolyzed (EHF) and amino acid-based (AA) powdered infant formulas.
Canada is experiencing a shortage of extensively hydrolyzed (EHF) and amino acid-based (AA) powdered infant formula for community use. Some examples of these types of formulas include
- Similac® Alimentum®,
- Nutramigen® A+®,
- Pregestimil® A+®,
- Neocate® Infant DHA & ARA, and
- Puramino® A+.
Canada is currently not experiencing a shortage of standard infant formulas.
To facilitate communication with healthcare professionals about infant formula shortages in Alberta, a new Alberta Health Services (AHS) webpage has been launched: Infant Formula Shortages.
Please check the webpage regularly. AHS will be sharing updating documents and links as available.
Important messages from AHS:
- EHF or AA formulas should be prescribed only for infants with a specific indication (allergy or severe GI intolerance).
- Health Canada has released a national clinical decision tree entitled Use of Specialized Infant Formula During a Shortage. This is intended to support healthcare providers to make informed formula choices while rationing the use of specialty infant formulas.
- The document Typical formula consumption amounts for Healthy Term Infants is intended to provide pharmacists with a tool to estimate how much of each formula an infant would typically require. This will help when rationing the use of specialty infant formulas.
- Prescribers are asked to consider if it would be safe to transition an infant using one of these formulas to an alternate formula.
- If greater than 12 months, consider transition to a follow-up formula such as Neocate® Junior or Vivonex® Pediatric.
- If an infant is greater than six months of age with a cow’s milk protein allergy, soy formula may be considered if a tolerance to soy protein has been established under physician guidance.
- Consider if a lactose-free or partially hydrolyzed formula could meet the infant’s needs if the patient is not tolerating a standard infant formula with mild GI intolerance (e.g., Enfamil A+® Lactose Free, Similac™ Total Comfort, Nestle® Good Start® Plus 1).
- Health Canada is allowing some EHF to be imported into Canada to support these shortages—see the link on AHS webpage.
- Pharmacies have been asked to keep these formulas behind the counter and limit sales to prevent stockpiling.
For questions or help accessing formula contact: Enteral.Nutrition@ahs.ca.
