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Vecuronium Bromide Injection

[13 January 2016]

Products Affected - Description

Vecuronium Bromide lyophilized powder for solution for injection, Caraco
10 mg, vial, 10 count (NDC 47335-0931-44)
20 mg, vial, 10 count (NDC 47335-0932-44)
 
Vecuronium Bromide lyophilized powder for solution for injection, Hospira
10 mg, vial, 10 count (NDC 00409-1632-01)
20 mg, vial, 10 count (NDC 00409-1634-01)
 
Vecuronium Bromide lyophilized powder for solution for injection, Mylan Institutional
10 mg, vial, 10 count (NDC 67457-0438-10)
 
Vecuronium Bromide lyophilized powder for solution for injection, Sagent
10 mg, vial, 10 count (NDC 25021-0657-10)
20 mg, vial, 10 count (NDC 25021-0658-20)
 
Vecuronium Bromide lyophilized powder for solution for injection, Teva
10 mg, vial, 10 count (NDC 00703-2914-03)
20 mg, vial, 10 count (NDC 00703-2925-03)

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
  • Pfizer sold vecuronium injection to Mylan Institutional in December 2013.4,5
  • Ben Venue has stopped production in its plant in Bedford, Ohio and closed in 2014.6
  • Caraco has vecuronium injection available. NDCs changed in mid-2015.7
  • Sagent temporarily suspended the manufacture of vecuronium 10 mg and 20 mg vials.8

Available Products

Vecuronium Bromide lyophilized powder for solution for injection, Mylan Institutional
20 mg, vial, 10 count (NDC 67457-0475-20)

Estimated Resupply Dates

  • Caraco has vecuronium 10 mg and 20 mg vials on back order and the company estimates a release date of March 2016.7
  • Hospira has vecuronium 10 mg and 20 mg vials on back order and the company cannot estimate a release date.2
  • Mylan Institutional has vecuronium 10 mg vials on intermittent back order and the company is releasing product as it becomes available.5
  • Sagent suspended manufacturing of vecuronium 10 mg and 20 mg vials, and future production of this product is uncertain at this time.8
  • Teva has both vecuronium presentations on back order and the company estimates a release date of June 2016.3

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.9

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.10-12
  • 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.10-12
  • Some presentations of alternative agents including pancuronium, rocuronium, and atracurium are in short supply.13

Characteristics of NMBAs10-12

NMBA

Type of NMBA

Onset of Action (min)

Clinical Duration After Initial Dose (min)

Atracurium

Nondepolarizing

2 – 3 

20 – 35

Cisatracuriuma

Nondepolarizing

1.5 – 2

20 – 35

Pancuronium

Nondepolarizing

2 – 3 

60 – 100

Rocuroniumb

Nondepolarizing

1 – 2

22 – 67 min (depending on initial bolus dose)

Succinylcholine

Depolarizing

0.5 – 1

4 – 6a

Vecuroniumc

Nondepolarizing

2.5 – 3

20 – 40

aClinical duration of effects may increase or decrease with continued administration of succinylcholine; monitor patients carefully.10-12

Related Shortages

References

  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, April 10, October 25, December 27, 2013; January 6, March 26, 2014; and March 22, 2015.
  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, April 15, May 14, June 28, July 23, August 8, September 13, December 27, 2013; February 7 and 27, March 26, April 28, June 2 and 19, July 7 and 31, August 29, October 15, December 29, 2014; January 14, February 5 and 23, March 9, May 12, July 6, September 15, and November 12, 2015; and January 13, 2016.
  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; February 22, May 14, September 13, December 9, 2013; January 3, March 26, August 28, 2014; and March 23, 2015; and January 13, 2016.
  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, April 15, May 14, July 2 and 23, August 8, September 6, October 24, and November 6, 2013.
  5. Mylan Institutional, Customer Service (personal communications) December 27, 2013; January 9, February 3, 7, and 27, March 27, April 28, May 5 and 22, June 2 and 18, July 8, August 1 and 25, September 8, and 23, October 13, November 5, December 29, 2014; January 14, February 2 and 23, March 9 and 23, May 12 and 18, June 3, July 6, September 15, November 12, and December 1, 2015; and January 7, 2016.
  6. Bedford, Customer Service (personal communications and website). 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, December 17, 2012; February 20, April 15, May 6, June 28, July 23, September 9, October 21, December 17, 2013; January 3 and 22, March 26, April 28, June 2, 16, and 25, and July 31, 2014.
  7. 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, September 2 and 29, October 26, December 2 and 12, 2011; January 10 and 24, March 15, April 30, June 5, July 3, August 21, October 10, December 3 and 19, 2012; February 20, April 15, May 14, July 3, September 13, October 23, 2013; January 3, March 26, May 1, June 19, July 8, August 28, September 9 and 23, October 13, November 5, December 29, 2014; January 8, February 2 and 23, March 9 and 23, April 6, May 11, July 7, September 11, and November 12, 2015; and January 8, 2016.
  8. Sagent, Customer Service (personal communications). August 24, September 7 and 29, October 26, November 2, December 1, 2011; January 10 and 24, March 15 and 28, April 24, June 5, July 3, August 20, October 10, December 3 and 18, 2012; February 11, April 15, May 9, July 1 and 23, September 12, October 9, December 19, 2013; January 9, February 3, March 26, April 28, June 2 and 13, July 3 and 31, September 19, October 10, December 29, 2014; February 19, March 5 and 19, April 2, May 7, July 2, September 10, and November 12, 2015; and January 7, 2016.
  9. Hospira. Vecuronium bromide Injection product label. Lake Forest, IL; Hospira; September, 2010.
  10. Baughman VL, Golembiewski J, Gonzales JP, Alvarez, W, eds. Anesthesiology and Critical Care Drug Handbook. 9th ed. Hudson, OH: Lexi-Comp; 2010.
  11. 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.
  12. 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.
  13. American Society of Health-System Pharmacists. Drug Shortage Resource Center. Accessed on December 14, 2011.

Updated

Updated January 13, 2016 by Jane Chandramouli, PharmD, Drug Information Specialist. Created September 15, 2015 by Michelle Wheeler, PharmD, Drug Information Specialist. Copyright 2016, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Novation to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Novation, ASHP, and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Novation, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Novation, ASHP nor University of Utah endorses or recommends the use of any drug.

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