Products Affected - Description

Reason for the Shortage

• Hospira states the shortage is due to manufacturing delays.^1,2
• Teva states the shortage is due to manufacturing delays.³

Available Products

Estimated Resupply Dates

• Hospira has vecuronium 10 mg vials on back order and the company cannot estimate a release date.¹
• Teva has both vecuronium presentations on back order and the company cannot estimate a release date.³
• Bedford has vecuronium 10 mg and 20 mg vials available but with short expiration dating.⁵

Implications for Patient Care

Vecuronium is an intermediate-acting neuromuscular blocking agent (NMBA) used to facilitate intubation and relax skeletal muscles as an adjunct to general anesthesia during surgery or mechanical ventilation.⁸

Safety

Clinicians must use extreme caution to prevent dosing errors when switching between the various vial sizes (eg, if 20 mg vials are used in place of 10 mg vials).

Alternative Agents & Management

• Alternative NMBAs vary in onset time and duration of action, particularly based on dose; see the table below. Times to re-dose also differ based on agent and dose. Doxacurium, mivacurium, and tubocurarine have been discontinued.^9-11
• Non-depolarizing neuromuscular blocking agents may be reversed with neostigmine or edrophonium. Depolarizing NMBAs (ie, succinylcholine) are not reversed by these agents and their toxicity may be worsened by concomitant administration.^9-11
• Some presentations of alternative agents including pancuronium, rocuronium, and atracurium are in short supply.¹²

Characteristics of NMBAs^9-11

Related Shortages

• Atracurium Injection
• Dantrolene Oral— Resolved
• Methocarbamol Injection— Resolved
• Orphenadrine Citrate Injection
• Rocuronium Injection
• Succinylcholine chloride Injection

1. Hospira, Customer Service (personal communications). November 11 and 19, December 2 and 8, 2008; January 5, 6, and 28, February 4, 18, and 27, March 2, 10, 11, 23, and 31, April 13 and 20, May 18 and 27, June 9 and 22, July 1, 2, and 30, August 6 and 12, September 3 and 21, October 15, November 3, December 1, 2009; February 24, March 10 and 15, April 6, May 7 and 28, July 12, September 2, October 7 and 22, November 4, December 15, 2010; January 11 and 26, March 10 and 15, April 5, May 25, June 28, August 22, September 5 and 27, October 26, December 1, 2011; March 21, April 2 and 24, May 2, 7, and 14, June 11, July 3, August 21, and November 27, 2012; February 20 and April 10, 2013.
2. Hospira (website). July 28 and September 27, and October 26, 2011; and January 10 and 27, March 21, October 10, and December 4 and 19, 2012; February 20, and April 15, 2013.
3. Teva, Customer Service (personal communications). November 11 and 19, December 2 and 8, 2008; January 5, 6, and 28, February 4, 18, and 27, March 3, 11, 23, and 31, April 13 and 20, May 18 and 27, June 9, 22, and 30, July 2 and 30, August 3 and 12, September 3 and 21, October 14, November 3, December 4 and 15, 2009; January 8, February 5 and 24, March 11, April 6, May 7 and 28, July 12, September 2, October 6 and 20, November 3, December 16, 2010; January 11, March 10, April 4, May 25, July 28, September 30, and October 26, 2011; and January 10 and 24, March 15, April 24, June 5, July 3, October 10, December 3, 2012; and February 22, 2013.
4. Pfizer, Customer Service (personal communications). October 26, and December 1, 2011; and January 10 and 23, March 13, April 24, June 5, July 3, August 21, and December 3, 2012; February 20, and April 15, 2013.
5. Bedford, Customer Service (personal communications). November 11 and 19, December 8, 2008; January 5 and 28, February 18 and 27, March 10 and 31, April 13, May 18, June 9 and 22, July 2 and 30, August 12, September 4 and 21, October 14, November 3, December 1 and 14, 2009; January 8, February 5 and 24, March 11, April 6 and 13, May 6 and 28, July 12, 22, and 30, September 1, October 7 and 21, November 4, December 17, 2010; January 13, February 10 and 23, March 10, April 4, 11, and 18, May 13 and 25, June 29, July 28, August 25, September 29, October 26, December 1, 2011; January 10 and 11, March 1, April 5, 13, and 30, May 11, June 5, July 3, August 21, October 10 and 11, and December 17, 2012; February 20, and April 15, 2013.
6. Caraco, Customer Service (personal communications). February 5 and 26, March 11, April 6, May 7 and 28, July 12 and 30, August 30, October 6 and 19, November 2, December 15, 2010; January 10, February 10, March 11, April 1 and 13, May 25, June 29, July 28, and September 2 and 29, October 26, and December 2 and 12, 2011; January 10 and 24, March 15, April 30, June 5, July 3, August 21, October 10, and December 3 and 19, 2012; February 20, and April 15, 2013.
7. Sagent, Customer Service (personal communications). August 24 and September 7 and 29, October 26, November 2, and December 1, 2011; and January 10 and 24, March 15 and 28, April 24, June 5, July 3, August 20, October 10, and December 3 and 18, 2012; February 11, and April 15, 2013.
8. Hospira. Vecuronium bromide Injection product label. Lake Forest, IL; Hospira; September, 2010.
9. Baughman VL, Golembiewski J, Gonzales JP, Alvarez, W, eds. Anesthesiology and Critical Care Drug Handbook. 9th ed. Hudson, OH: Lexi-Comp; 2010.
10. Muscle Relaxants – Adjuncts to Anesthesia. In: Wickersham, R. M., Novak K. K., et al., Eds. (2011). Drug Facts and Comparisons (eFacts). St. Louis, MO, Wolters Kluwer Health, Inc.
11. Neuromuscular Blocking Agents. In: McEvoy GK, Snow EK, Miller J, eds. AHFS 2011 Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; 2011:1422-1441.
12. American Society of Health-System Pharmacists. Drug Shortage Resource Center. Accessed on December 14, 2011.

Updated

Updated April 15, 2013 by Elyse A. MacDonald, PharmD, Drug Information Specialist, Drug Information Service. Created April 11, 2002 by Jane Chandramouli, PharmD, Drug Information Specialist, and Erin R. Fox, PharmD, Drug Information Specialist. Copyright 2013, Drug Information Service, University of Utah, Salt Lake City, UT.