Midazolam Shortage

Midazolam (thanks Christina!) continues to be affected by ongoing national supply disruptions in 2026. While the medication itself remains available, surgery centers are experiencing limited access to specific vial sizes and presentations, requiring immediate operational adjustments.

Current Shortage Overview

Midazolam injection remains on the active shortage list maintained by theAmerican Society of Health-System Pharmacists.

Key points:

• This is a presentation-based shortage, not a complete absence of the drug

• Availability varies significantly by manufacturer and NDC

• Supply is often inconsistent and allocation-based

  
  

PRIMARY STANDARD: 2 mL VIALS (RECOMMENDED)

Facilities should standardize around:

• Midazolam 2 mg / 2 mL (1 mg/mL)

• Midazolam 10 mg / 2 mL (5 mg/mL)

Key 2 mL NDCs Currently Circulating

1 mg/mL (2 mg / 2 mL):

• NDC 00641-6057-25 (Hikma)

• NDC 00409-0001-25 (Pfizer – newer replacement)

• NDC 00409-2305-17 (Pfizer – older/depleting)

• NDC 65293-0411-25 (The Medicines Company)

5 mg/mL (10 mg / 2 mL):

• NDC 00409-2308-02 (Pfizer)

• NDC 25021-0656-02 (Sagent – preservative-free)

• NDC 63323-0412-02 (Fresenius Kabi)

Important:Not all NDCs will be available at all times. Facilities must remain flexible across manufacturers.

SECONDARY OPTION: 5 mL VIALS

When 2 mL supply is insufficient, facilities may utilize:

• Midazolam 5 mg / 5 mL (1 mg/mL)

• Midazolam 5 mg/mL (5 mL vial)

Key 5 mL NDCs

1 mg/mL (5 mg / 5 mL):

• NDC 00409-2305-05 (Pfizer)

• NDC 63323-0411-25 (Fresenius Kabi)

• NDC 65293-0416-25 (The Medicines Company)

5 mg/mL (25 mg / 5 mL):

• NDC 00409-2596-03 (Pfizer)

• NDC 17478-0524-05 (Akorn)

• NDC 57664-0634-44 (Caraco)

Handling Considerations

Use of 5 mL vials increases:

• Dose preparation complexity

• Risk of medication errors

• Medication waste

Strict adherence to:

• Proper labeling

• Immediate-use standards

• Standardized preparation protocols

  is required.

• 
  

Allocation Status

Midazolam is functionally on allocation.

Facilities may experience:

• Quantity limits

• Partial order fulfillment

• Distribution tied to historical purchasing

Primary distributors include:

• AmerisourceBergen

• McKesson

• Cardinal Health

  
  

Operational Expectations

1. Standardize to 2 mL Vials

• Establish as the primary product for routine use

2. Maintain a Multi-NDC Approach

• Do not rely on a single manufacturer or product

3. Define Use of 5 mL Vials

• Secondary option only

• Clear preparation guidance required

Survey & Compliance Considerations

Surveyors will expect:

• Safe handling of all vial sizes

• Proper labeling of prepared medications

• Compliance with single-dose vial standards

• No unsafe pre-drawing or batching practices

Increased manipulation during shortages must be balanced with stronger controls and oversight.

Key Takeaway

• Midazolam remains in shortage in 2026

• 2 mL vials should be your primary operational standard

• 5 mL vials serve as a controlled secondary option

• Facilities must adapt through standardization, flexibility, and disciplined medication handling