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Atracurium Injection

[05 September 2014]

Products Affected - Description

Atracurium besylate 10 mg/mL, West-Ward (formerly Bedford product)
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

  • West-Ward Pharmaceuticals’ parent company, Hikma Pharmaceuticals, acquired several products from Bedford Laboratories in July 2014 including atracurium injection. West-Ward is not actively marketing atracurium.1
  • Hospira launched atracurium in mid-2013.2
  • Sagent as atracurium on shortage 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

Sagent has atracurium 10 mg/mL 5 mL vials on back order and the company estimates a release date in October 2014.3

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. West-Ward, Customer Service (personal communications and website). August 5 and September 5, 2014.
  2. Hospira, (personal communication and website). August 26, October 15, November 15, 2013; February 10, March 20, April 30, May 15, July 18, and September 5, 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, July 18, and September 5, 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 September 5, 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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