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Drug shortages are associated with suboptimal therapy, delayed recovery, increased adverse effects, and higher healthcare costs. 1 The FDA Safety and Innovation Act requires manufacturers to provide early notification of any product discontinuation or supply issues. 2 This action helped to reduce the number of new drug shortages each year from 267 in 2011 to 185 in 2014. 3 However, the act has had little effect on the resolution of active drug shortages, as the total number of ongoing drug shortages increased from 239 in January 2011 to 301 in April 2014. The necessity to use alternative therapies during drug shortages presents an opportunity to gain information on the effectiveness of therapeutic substitutions. We describe the use of such a therapeutic alternative in the setting of a drug shortage.

Studies of high-dose methotrexate for oncological indications have used iv sodium bicarbonate infusion to raise the …