The shortages of major critical care drugs in recent years have forced thousands of hospitals and clinics to rely upon compounding pharmacies to meet critical needs. The shortages have put our patients in danger of not receiving life-saving medications. The affected drugs are mostly generic injectable products, and the reasons for shortages are multifaceted27 and attributed to problems at supply chain, consolidation of manufacturers from several to few, production, quality, and scarcity of raw chemicals.28 Drug shortages have been identified for oncology, antimicrobials, analgesics, anesthetic agents, cardiovascular medications, vitamins, and others, affecting the practice of all providers.28,29 The list of commonly administered critical care medications have included, but not been limited to, amiodarone, atropine, digoxin, diazepam, diltiazem, epinephrine, furosemide, heparin, lidocaine, morphine, norepinephrine, and propofol.30 Cost burden resulting from use of expensive alternate drugs and additional labor costs are estimated at $415 million annually.31 In a survey of 3,063 anesthesiologists in 2012, 7% had to postpone and 4% had to cancel cases because of shortage of anesthetic.32 In a recent publication, event-free survival distributions among children with Hodgkin lymphoma in the chemotherapy regimen with cyclophosphamide (substituted for mechlorethamine) was 75%, compared with 88% in the mechlorethamine regimen group (used prior to shortage).33 The authors commented that “the drug shortage is an intolerable situation for young people with curable diseases.” The number of new drug shortages escalated from 88 in 2002 to 267 in 2011 and 204 in 2012 (Erin Fox, PharmD, Drug Information Resource Center, University of Utah, personal communication, January 4, 2013). As of January 4, 2012, the website of the American Society of Health System Pharmacists lists 228 ongoing shortages, for which there are no therapeutic alternates for several critical drugs.34 Despite the passage of the FDA safety and Innovation Act in 2012 requiring manufacturers to notify of impending shortages, it seems unlikely that the shortages will disappear soon, because other problems associated with shortages need to be addressed. The compounding pharmacies fill the void by repackaging products or preparing them from raw chemicals. The growing reliance on compounding pharmacies further highlights the urgent need for setting regulations for compounding standards and other requirements as required from the manufacturers.