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5/26/2016

Pancuronium Injection

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]

Available Products

    • Pancuronium injection, Pfizer, 1 mg/mL, 10 mL vial, 25 count, NDC 00409-4646-01

Estimated Resupply Dates

    • Hospira has a consistent supply of pancuronium injection available.[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 the table below. Times to re-dose also differ based on agent and dose. Doxacurium, mivacurium, and tubocurarine have been discontinued.[3,4,5,6]
    • 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.[3,4,5,6]
    • Some presentations of alternative agents including atracurium, rocuronium and vecuronium are in short supply.[7]
    Table 1. Characteristics of NMBAs3,4,5,6
    NMBATYPE OF NMBAONSET OF ACTION (MIN)CLINICAL DURATION AFTER INITIAL DOSE (MIN)
    a Clinical duration of effects may increase or decrease with continued administration of succinylcholine; monitor patients carefully.4,5,6
    AtracuriumNondepolarizing2 to 320 to 35
    CisatracuriumNondepolarizing1.5 to 220 to 35
    PancuroniumNondepolarizing2 to 360 to 100
    RocuroniumNondepolarizing1 to 222 to 67 (depending on initial bolus dose)
    SuccinylcholineDepolarizing0.5 to 14 to 6 a
    VecuroniumNondepolarizing2.5 to 320 to 40

References

    1. Teva. Urgent Market Withdrawal Notice. May 4, 2010.
    2. 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.
    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 May 26, 2016 by Leslie Jensen, PharmD, Drug Information Specialist. Created June 11, 2015 by Jane Chandramouli, PharmD, Drug Information Specialist. Copyright 2017, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Vizient 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. Vizient, 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 Vizient, 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 Vizient, ASHP nor University of Utah endorses or recommends the use of any drug.

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