Atracurium Injection

[17 September 2015]

Products Affected - Description

Atracurium Besylate injection

Reason for the Shortage

  • West-Ward discontinued atracurium in September 2014.1
  • Hospira has atracurium available.2
  • Sagent has atracurium on shortage due to product recall.3

Available Products

Atracurium besylate, Hospira
10 mg/mL, 5 mL vial, single dose vial, 10 count (NDC 00409-1109-01)
10 mg/mL, 10 mL vial, multi-dose vial, 10 count (NDC 0040-1105-02)
Atracurium besylate, Sagent
10 mg/mL, 5 mL single dose vial, 10 count (NDC 25021-0659-05)
10 mg/mL, 10 mL vial, multi-dose vial, 10 count (NDC 25021-0672-10)

Estimated Resupply Dates

All presentations are currently available.

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


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


Type of NMBA

Onset of Action (min)

Clinical Duration After Initial Dose (min)



2 – 3 

20 – 35



1.5 – 2

20 – 35



2 – 3 

60 – 100



1 – 2

22 – 67 min (depending on initial bolus dose)



0.5 – 1

4 – 6a



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


  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, September 5 and 29, November 4 and 14, December 12, 2014; January 9 and 16, February 3, 23, and 27, March 5, 12, and 27, May 21, June 22, July 17, and September 17, 2015.
  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, September 5 and 25, October 30, November 13, December 12, 2014; January 8, 15, and 29, February 19 and 26, March 5, 12, and 27, May 21, and June 22, July 16, and September 17, 2015.
  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 September 17, 2015 by Jane Chandramouli, PharmD, Drug Information Specialist. Created June 22, 2015 by Jane Chandramouli, PharmD, Drug Information Specialist. Copyright 2015, Drug Information Service, University of Utah, Salt Lake City, UT.


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