Medication shortages are becoming a pretty familiar challenge for patients, pharmacists, and healthcare providers across Canada.
Whether a medication is temporarily unavailable, on backorder, or permanently discontinued by its manufacturer, the impact can be significant, particularly for patients who have been totally fine using the same treatment for years.
The good news is that there might be alternatives. In some cases, pharmacy compounding can help fill the gap when commercially manufactured medications are no longer available.
Why Do Medication Shortages Happen?
There are several reasons why medications become difficult to obtain. Manufacturing disruptions, supply chain issues, increased demand, and shortages of pharmaceutical ingredients can all affect availability. Oftentimes, us pharmacists never actually find out the true reason behind a shortage.
Sometimes, manufacturers make the business decision to discontinue a medication altogether.
For patients, this can be particularly frustrating. A medication that has worked well for years may suddenly become unavailable, leaving patients and their healthcare providers searching for an appropriate replacement.
A Recent Example: Premarin Vaginal Cream Discontinued in Canada
One recent example is Premarin Vaginal Cream 0.625 mg/g.
In November 2026, the manufacturer reported to Health Canada that Premarin Vaginal Cream was being permanently discontinued in Canada. And I found out the hard way – trying to order the product as usual and simply being told it was discontinued.
Premarin Vaginal Cream contains conjugated estrogens and has been prescribed to help manage certain symptoms associated with menopause, including vaginal dryness and discomfort.
For patients who have relied on this treatment, the discontinuation raises an important question: Now what?
Fortunately, there are other prescription vaginal estrogen therapies that healthcare providers may consider, including products containing estradiol or estrone.
However, these products are not directly interchangeable, and the most appropriate treatment depends on each patient’s symptoms, medical history, preferences, and response to therapy.
Can Premarin Vaginal Cream Be Compounded?
While Premarin Vaginal Cream itself is a specific formulation containing conjugated estrogens, compounding pharmacies may be able to prepare customized vaginal estrogen formulations using other appropriate pharmaceutical ingredients, such as estradiol or estriol.
These preparations are not identical to Premarin and should not be considered direct generic replacements.
However, for patients who require a vaginal cream or have specific formulation needs that cannot be addressed by commercially available products, a customized preparation may be an option worth discussing with their prescriber.
At Pace Pharmacy, our compounding team can collaborate with healthcare providers to evaluate potential formulations based on the patient’s individual needs.
What Is Pharmacy Compounding?
Pharmacy compounding involves preparing customized medications based on a prescription from an authorized healthcare professional.
Unlike commercially manufactured medications, which are generally available in standardized strengths and dosage forms, compounded medications can be tailored to meet specific patient requirements.
Depending on the medication and clinical circumstances, compounding may allow pharmacists to:
- Prepare medications in strengths that are not commercially available.
- Create alternative dosage forms, such as oral liquids, creams, or capsules.
- Exclude certain non-medicinal ingredients when appropriate.
- Customize formulations for patients with unique treatment needs.
- Explore suitable preparations when a commercial medication has been discontinued or is unavailable.
Not every medication can be compounded, and the availability of appropriate ingredients, formulation stability, safety, and regulatory requirements must all be considered.
Working Together to Find Solutions
One of the greatest strengths of specialty compounding is the opportunity for collaboration between pharmacists and prescribers.
When a medication becomes unavailable, finding an alternative isn’t always as simple as substituting one product for another.
Different medications may have different active ingredients, concentrations, absorption characteristics, and clinical considerations.
An experienced compounding pharmacy can work with the prescribing healthcare professional to determine whether a customized preparation is appropriate and feasible.
At Pace Pharmacy, we regularly collaborate with physicians, nurse practitioners, and other authorized prescribers to help solve medication-related challenges.
Our goal is not simply to prepare customized medications. It’s to help identify practical, safe, and appropriate solutions that support continuity of patient care.
What Should You Do if Your Medication Is Discontinued?
If you’ve recently learned that a medication you rely on is no longer available, there are several steps you can take:
- Speak with your pharmacist. They may be aware of available alternatives or other options.
- Consult your prescriber. A change in medication or formulation may require a new prescription and clinical assessment.
- Ask about compounding. If commercially available alternatives aren’t suitable, a compounding pharmacy may be able to explore customized options.
- Plan ahead! If possible, begin exploring alternatives before your current supply runs out so you’re left in a panic.
Most importantly, don’t change or discontinue prescribed medication without consulting your healthcare professional.
When Standard Medications Aren’t Enough
Medication shortages and discontinuations highlight an important reality in healthcare: one solution doesn’t always work for everyone.
At Pace Pharmacy, we’ve customized our pharmacy practice around personalized medication solutions and collaboration with healthcare professionals.
Whether it’s a discontinued medication, an unavailable strength, or a patient who requires a different dosage form, our team is committed to exploring appropriate options and going the extra mile.
Looking for an alternative to Premarin Vaginal Cream or another discontinued medication?
Contact Pace Pharmacy to speak with our team. We would be happy to work with you and your prescriber to explore potential options.
Pace Pharmacy | Personalized Compounding Solutions
Compounded medications require an appropriate prescription and are prepared following an individualized assessment. Compounded formulations are not necessarily equivalent to commercially manufactured medications and may differ in their clinical evidence, quality testing, and regulatory approval status.