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Atracurium Injection

[21 July 2014]

Products Affected - Description

Atracurium besylate 10 mg/mL, Bedford
5 mL vial, single dose vial (NDC 55390-0102-05)
10 mL vial, multi-dose vial (NDC 55390-0103-10)
 
Atracurium besylate 10 mg/mL, Sagent
5 mL vial, single dose vial (NDC 25021-0659-05)

Reason for the Shortage

  • Ben Venue has stopped production in its plant in Bedford, Ohio and will close in 2014. Ben Venue has stopped production in its plant in Bedford, Ohio and will close in early 2014. Ben Venue supplies multiple sterile injectable products for Bedford Laboratories. Supplies of product that has already been manufactured will continue to be released until inventory is depleted. Bedford Laboratories has a small number of products manufactured elsewhere that are not affected by this closure.1
  • Hospira launched atracurium in mid-2013.2
  • Sagent as atracurium on allocation due to manufacturing delays.3

Available Products

Atracurium besylate 10 mg/mL, Hospira2
5 mL vial, single dose vial (NDC 00409-1109-01)
10 mL vial, multi-dose vial (NDC 0040-1105-02)  
Atracurium besylate 10 mg/mL, Sagent3
10 mL vial, multi-dose vial (NDC 25021-0672-10)

Estimated Resupply Dates

  • Bedford has atracurium on long-term back order and the company cannot estimate a release date. Ben Venue manufactured atracurium for Bedford.1
  • Sagent has atracurium 10 mg/mL 5 mL vials on allocation.3

Implications for Patient Care

Atracurium 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.4

Safety

Clinicians must use extreme caution when switching between NMBAs.

Alternative Agents & Management

  • Alternative NMBAs vary in onset time and duration of action, particularly based on dose; see Table below. Times to re-dose also differ based on agent and dose. Doxacurium, mivacurium, and tubocurarine have been discontinued.5-7
  • 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.5-7
     
  • Some presentations of alternative agents including pancuronium and vecuronium are in short supply.8

 

Characteristics of NMBAs 5-7

NMBA

Type of NMBA

Onset of Action (min)

Clinical Duration After Initial Dose (min)

Atracurium

Nondepolarizing

2 – 3 

20 – 35

Cisatracurium

Nondepolarizing

1.5 – 2

20 – 35

Pancuronium

Nondepolarizing

2 – 3 

60 – 100

Rocuronium

Nondepolarizing

1 – 2

22 – 67 min (depending on initial bolus dose)

Succinylcholine

Depolarizing

0.5 – 1

4 – 6a

Vecuronium

Nondepolarizing

2.5 – 3

20 – 40

aClinical duration of effects may increase or decrease with continued administration of succinylcholine; monitor patients carefully.5-7

Related Shortages

References

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

Updated

Updated July 21, 2014 by Jane Chandramouli, PharmD, Drug Information Specialist. Created April 11, 2002 by Jane Chandramouli, PharmD, Drug Information Specialist, and Erin R. Fox, PharmD, Director, Drug Information Service. 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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