Products Affected - Description
All presentations are currently available.
Reason for the Shortage
- Teva discontinued their pancuronium presentations in May 2010.1
- Hospira had pancuronium on shortage due to manufacturing delays and retesting of raw material. Hospira is the only manufacturer of pancuronium.2
Hospira has a consistent supply of pancuronium injection available.2
Estimated Resupply Dates
Hospira has pancuronium injection 1 mg/mL in 10 mL vials on back order and the company cannot estimate a release date.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 (personal communications and website) October 20, December 27, 2011; February 17, March 22, 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, December 11, 2013; January 17, April 11, May 9, June 23, July 25, August 21, September 29, October 23, November 25, 2014; March 23, June 11, September 11, and October 13, 2015.
- 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 October 13, 2015 by Jane Chandramouli, PharmD, Drug Information Specialist. Created June 11, 2015 by Jane Chandramouli, PharmD, Drug Information Specialist. Copyright 2015, Drug Information Service, University of Utah, Salt Lake City, UT.
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