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11/7/2019

Vecuronium Bromide Injection

Products Affected - Description

    • Vecuronium Bromide lyophilized powder for injection, AuroMedics, 10 mg, vial, 10 count, NDC 55150-0235-10
    • Vecuronium Bromide lyophilized powder for injection, AuroMedics, 20 mg, vial, 10 count, NDC 55150-0236-20

Reason for the Shortage

    • AuroMedics did not provide a reason for the shortage.[1]
    • Pfizer had vecuronium on shortage due to manufacturing delays.[2-3]
    • Teva has vecuronium available.[4]
    • Pfizer sold vecuronium injection to Mylan Institutional in December 2013.[5-6]
    • Mylan Institutional has vecuronium available.[6]
    • Ben Venue has stopped production in its plant in Bedford, Ohio and closed in 2014.[7]
    • Sun Pharma has vecuronium available.[8]
    • Sagent is not marketing vecuronium 10 mg and 20 mg vials.[9]
    • Fresenius Kabi has vecuronium available.[10]

Available Products

    • Vecuronium Bromide lyophilized powder for injection, Fresenius Kabi, 10 mg, vial, 10 count, NDC 63323-0781-10
    • Vecuronium Bromide lyophilized powder for injection, Fresenius Kabi, 20 mg, vial, 10 count, NDC 63323-0782-20
    • Vecuronium Bromide lyophilized powder for solution for injection, Mylan Institutional, 10 mg, vial, 10 count, NDC 67457-0438-10
    • Vecuronium Bromide lyophilized powder for solution for injection, Mylan Institutional, 20 mg, vial, 10 count, NDC 67457-0475-20
    • Vecuronium Bromide lyophilized powder for solution for injection, Pfizer, 10 mg, vial, 10 count, NDC 00409-1632-01
    • Vecuronium Bromide lyophilized powder for solution for injection, Pfizer, 20 mg, vial, 10 count, NDC 00409-1634-01
    • Vecuronium Bromide lyophilized powder for injection, Sun Pharma, 10 mg, vial, 10 count, NDC 47335-0931-44
    • Vecuronium Bromide lyophilized powder for injection, Sun Pharma, 20 mg, vial, 10 count, NDC 47335-0932-44
    • Vecuronium Bromide lyophilized powder for solution for injection, Teva, 10 mg, vial, 10 count, NDC 00703-2914-03

Estimated Resupply Dates

    • AuroMedics has vecuronium 10 mg and 20 mg vials on intermittent back order and the company is releasing product as it becomes available.[1]

Implications for Patient Care

    • Vecuronium 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.[11]

Safety

    • Clinicians must use extreme caution to prevent dosing errors when switching between the various vial sizes (eg, if 20 mg vials are used in place of 10 mg vials).

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.[12-14]
    • 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.[12-14]
    • Some presentations of alternative agents including pancuronium, rocuronium, and atracurium may be in short supply.[15]
    Table 1. Characteristics of NMBAs12-14
    NMBAType of NMBAOnset of Action (min)Clinical Duration After Initial Dose (min)
    *Clinical duration of effects may increase or decrease with continued administration of succinylcholine; monitor patients carefully.12-14
    AtracuriumNondepolarizing2 - 320 - 35
    CisatracuriumNondepolarizing1.5 - 220 - 35
    PancuroniumNondepolarizing2 - 360 - 100
    RocuroniumNondepolarizing1 - 222 - 67 (depending on initial bolus dose)
    SuccinylcholineDepolarizing0.5 - 14 - 6*
    VecuroniumNondepolarizing2.5 - 320 - 40

References

    1. AuroMedics (personal communications). October 23, 2019.
    2. Pfizer, Customer Service (personal communications). November 11 and 19, December 2 and 8, 2008; January 5, 6, and 28, February 4, 18, and 27, March 2, 10, 11, 23, and 31, April 13 and 20, May 18 and 27, June 9 and 22, July 1, 2, and 30, August 6 and 12, September 3 and 21, October 15, November 3, December 1, 2009; February 24, March 10 and 15, April 6, May 7 and 28, July 12, September 2, October 7 and 22, November 4, December 15, 2010; January 11 and 26, March 10 and 15, April 5, May 25, June 28, August 22, September 5 and 27, October 26, December 1, 2011; March 21, April 2 and 24, May 2, 7, and 14, June 11, July 3, August 21, and November 27, 2012; February 20, April 10, October 25, December 27, 2013; January 6, March 26, 2014; March 22, 2015; April 14, May 24, 2016; May 19, June 9, July 10, August 17, November 10, 2017; January 5, February 9, March 23, April 2 and 13, May 15, June 12, August 17, October 12, December 12, 2018; February 8, April 19, May 28, August 20, October 21, and November 7, 2019.
    3. Pfizer (website). July 28 and September 27, and October 26, 2011; and January 10 and 27, March 21, October 10, and December 4 and 19, 2012; February 20, April 15, May 14, June 28, July 23, August 8, September 13, December 27, 2013; February 7 and 27, March 26, April 28, June 2 and 19, July 7 and 31, August 29, October 15, December 29, 2014; January 14, February 5 and 23, March 9, May 12, July 6, September 15, November 12, 2015; January 13, March 1, May 9, August 23, November 10, 2016; January 31, February 21, and April 7 and 19, 2017.
    4. Teva, Customer Service (personal communications). November 11 and 19, December 2 and 8, 2008; January 5, 6, and 28, February 4, 18, and 27, March 3, 11, 23, and 31, April 13 and 20, May 18 and 27, June 9, 22, and 30, July 2 and 30, August 3 and 12, September 3 and 21, October 14, November 3, December 4 and 15, 2009; January 8, February 5 and 24, March 11, April 6, May 7 and 28, July 12, September 2, October 6 and 20, November 3, December 16, 2010; January 11, March 10, April 4, May 25, July 28, September 30, October 26, 2011; and January 10 and 24, March 15, April 24, June 5, July 3, October 10, December 3, 2012; February 22, May 14, September 13, December 9, 2013; January 3, March 26, August 28, 2014; March 23, 2015; January 13, June 9, November 10, 2016; January 13, August 14, November 6, 2017; February 5, March 19, April 2 and 13, May 14, June 13, August 13, October 15, December 10, 2018 February 11, April 22, May 27, August 19, and October 18, 2019.
    5. Pfizer, Customer Service (personal communications). October 26, and December 1, 2011; and January 10 and 23, March 13, April 24, June 5, July 3, August 21, and December 3, 2012; February 20, April 15, May 14, July 2 and 23, August 8, September 6, October 24, and November 6, 2013.
    6. Mylan Institutional, Customer Service (personal communications) December 27, 2013; January 9, February 3, 7, and 27, March 27, April 28, May 5 and 22, June 2 and 18, July 8, August 1 and 25, September 8, and 23, October 13, November 5, December 29, 2014; January 14, February 2 and 23, March 9 and 23, May 12 and 18, June 3, July 6, September 15, November 12, December 1, 2015; January 7, February 29, May 9 and 23, June 2, August 23, November 8, 2016; January 31, February 22, April 4, June 12, July 10, November 9, 2017; January 11, February 9, March 20, May 15, June 12, August 15, October 9, December 12, 2018; February 11, April 23, May 23, and October 22, 2019.
    7. Bedford, Customer Service (personal communications and website). November 11 and 19, December 8, 2008; January 5 and 28, February 18 and 27, March 10 and 31, April 13, May 18, June 9 and 22, July 2 and 30, August 12, September 4 and 21, October 14, November 3, December 1 and 14, 2009; January 8, February 5 and 24, March 11, April 6 and 13, May 6 and 28, July 12, 22, and 30, September 1, October 7 and 21, November 4, December 17, 2010; January 13, February 10 and 23, March 10, April 4, 11, and 18, May 13 and 25, June 29, July 28, August 25, September 29, October 26, December 1, 2011; January 10 and 11, March 1, April 5, 13, and 30, May 11, June 5, July 3, August 21, October 10 and 11, December 17, 2012; February 20, April 15, May 6, June 28, July 23, September 9, October 21, December 17, 2013; January 3 and 22, March 26, April 28, June 2, 16, and 25, and July 31, 2014.
    8. Sun Pharma, Customer Service (personal communications). February 5 and 26, March 11, April 6, May 7 and 28, July 12 and 30, August 30, October 6 and 19, November 2, December 15, 2010; January 10, February 10, March 11, April 1 and 13, May 25, June 29, July 28, September 2 and 29, October 26, December 2 and 12, 2011; January 10 and 24, March 15, April 30, June 5, July 3, August 21, October 10, December 3 and 19, 2012; February 20, April 15, May 14, July 3, September 13, October 23, 2013; January 3, March 26, May 1, June 19, July 8, August 28, September 9 and 23, October 13, November 5, December 29, 2014; January 8, February 2 and 23, March 9 and 23, April 6, May 11, July 7, September 11, November 12, 2015; January 8, March 4, 2016; January 7, April 4, June 11, August 9, December 7, 2018; April 23, and August 21, 2019.
    9. Sagent, Customer Service (personal communications). August 24, September 7 and 29, October 26, November 2, December 1, 2011; January 10 and 24, March 15 and 28, April 24, June 5, July 3, August 20, October 10, December 3 and 18, 2012; February 11, April 15, May 9, July 1 and 23, September 12, October 9, December 19, 2013; January 9, February 3, March 26, April 28, June 2 and 13, July 3 and 31, September 19, October 10, December 29, 2014; February 19, March 5 and 19, April 2, May 7, July 2, September 10, November 12, 2015; January 7, and March 3 and 10, 2016.
    10. Fresenius Kabi, Customer Service (personal communications). August 10 and 16, November 10, 2017; January 7, February 5, March 23 and 29, April 13, May 10 and 19, June 7, August 17, October 5, December 9, 2018; February 7, April 19, May 24, August 16, October 18, and November 1, 2019.
    11. Hospira. Vecuronium bromide Injection product label. Lake Forest, IL; Hospira; September, 2010.
    12. Baughman VL, Golembiewski J, Gonzales JP, Alvarez, W, eds. Anesthesiology and Critical Care Drug Handbook. 9th ed. Hudson, OH: Lexi-Comp; 2010.
    13. 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.
    14. 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.
    15. American Society of Health-System Pharmacists. Drug Shortage Resource Center. Accessed on December 14, 2011.

Updated

Updated November 7, 2019 by Michelle Wheeler, PharmD, Drug Information Specialist. Created September 15, 2015 by Michelle Wheeler, PharmD, Drug Information Specialist. © 2019, Drug Information Service, University of Utah, Salt Lake City, UT.

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