A key treatment for metabolic acidosis linked to chronic kidney failure is currently lacking in French pharmacies, both in town and in hospitals. According to theANSMthe medicine Bicafres 1000 mga gastro-resistant tablet based on sodium bicarbonate, is out of stock for several months, with availability only expected at the beginning of April 2027 according to the Théradial laboratory. This absence concerns adults and adolescents aged 14 and over, for whom this treatment helps correct excessive blood acidity.
To avoid a sudden interruption of cures, the agency took a decision dated August 14, 2026 which authorizes pharmacists to issue, as a replacement, a masterful preparation of sodium bicarbonate in the form of non-gastro-resistant capsules dosed at 500 or 1,000 mg, without a new prescription. This exceptional measure, framed by a decree published in the Official Journal of August 22, 2026, applies until the return of Bicafres, while the ANSM is also studying the importation of equivalent medicines.
Outage of Bicafres 1000 mg: replacement organized in pharmacies
The medication Bicafres 1000 mg is indicated for the treatment of metabolic acidosis in adults and adolescents 14 years of age and older with chronic renal insufficiency. This pharmaceutical specialty is the only one based on sodium bicarbonate which has marketing authorization in France, which explains the particular fragility of this rupture linked to temporary production problems.
Concretely, when Bicafres is unavailable, the pharmacist can now give the patient sodium bicarbonate capsules in 500 mg or 1,000 mg, prepared at the pharmacy. He does not need a new prescription, but must write on the prescription the words “magistral preparation n° (prescribing number) based on sodium bicarbonate to replace the specialty BICAFRES, according to the recommendation of the ANSM“, then immediately inform the prescribing doctor.
Bicarbonate capsules: formats, intake and regulated cost
The compounded preparations come in the form of non-gastro-resistant capsules of 500 mg, packaged in 180 units, or 1,000 mg, in boxes of 90 units, according to data published by Vidal. The ANSM specifies that these capsules must be taken with a little liquid; they can be opened in case of swallowing problems, then mixed immediately in a little water, yogurt or jam.
A decree of August 21, 2026, published in the Official Journal of August 22, 2026, sets the public sale prices of these preparations, production and dispensing costs included. The box of 90 capsules at 1,000 mg costs €26.15, while the packaging of 180 capsules at 500 mg costs €29.72, with coverage by health insurance until it is made available to Bicafres.
Reinforced biological monitoring during the breakup of Bicafres
L’ANSM recommends a biological check within two weeks following the switch to capsules: bicarbonates, blood pH and ionogram. Doctors adjust the dosage if necessary, while the agency studies imports of equivalent drugs and will end this exemption as soon as Bicafres is available again.