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Pancuronium Injection

[25 November 2014]

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

Available Products

No presentations are available.

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

Related Shortages

References

  1. Teva. Urgent Market Withdrawal Notice. May 4, 2010.
  2. 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, December 11, 2013; January 17, April 11, May 9, June 23, July 25, August 21, September 29, October 23, and November 25, 2014.
  3. Hospira. Pancuronium Injection product label. Lake Forest, IL; Hospira; September, 2010.
  4. Baughman VL, Golembiewski J, Gonzales JP, Alvarez, W, eds. Anesthesiology and Critical Care Drug Handbook. 9th ed. Hudson, OH: Lexi-Comp; 2010.
  5. 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.
  6. 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.
  7. American Society of Health-System Pharmacists. Drug Shortage Resource Center. Accessed on December 14, 2011.

Updated

Updated November 25, 2014 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 2014, 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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