[11 December 2013]
Products Affected - Description
Pancuronium Injection, Hospira
1 mg/mL, 10 mL vial, package of 25 (NDC 00409-4646-01)
Reason for the Shortage
- Teva discontinued their pancuronium presentations in May, 2010.1
- Hospira’s product is on back order due to manufacturing delays and retesting of raw material. Hospira is the only manufacturer of pancuronium.2
No presentations are available.
Estimated Resupply Dates
Hospira has pancuronium injection 1 mg/mL in 10 mL vials on back order and the company estimates a release date of January 2014.2
Implications for Patient Care
Pancuronium is a non-depolarizing neuromuscular blocking agent (NMBA) used to facilitate intubation and relax skeletal muscles as an adjunct to general anesthesia during surgery or mechanical ventilation.3
Alternative Agents & Management
- Alternative NMBAs vary in onset time and duration of action, particularly based on dose; see Table. Times to re-dose also differ based on agent and dose. Doxacurium, mivacurium, and tubocurarine have been discontinued.3-6
- 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.3-6
- Some presentations of alternative agents including atracurium, rocuronium and vecuronium are in short supply.7
- Teva. Urgent Market Withdrawal Notice. May 4, 2010.
- Hospira, Customer Service (website and personal communication) October 20, December 27, 2011; February 17, March 21, May 7 and 25, June 29, July 25, September 12, October 24, 2012; January 21, March 18, April 9, June 18, August 19, September 23, October 25, and December 11, 2013.
- Hospira. Pancuronium Injection product label. Lake Forest, IL; Hospira; September, 2010.
- Baughman VL, Golembiewski J, Gonzales JP, Alvarez, W, eds. Anesthesiology and Critical Care Drug Handbook. 9th ed. Hudson, OH: Lexi-Comp; 2010.
- 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.
- 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.
- American Society of Health-System Pharmacists. Drug Shortage Resource Center. Accessed on December 14, 2011.
Updated December 11, 2013 by Michelle Wheeler, PharmD, Drug Information Specialist, Drug Information Service. Created May 7, 2010 by Erin R. Fox, PharmD, Manager, Drug Information Service and Jane Chandramouli, PharmD, Drug Information Specialist. Copyright 2013, Drug Information Service, University of Utah, Salt Lake City, UT.
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