Products Affected - Description

• • Vecuronium Bromide lyophilized powder for injection, Eugia US, 10 mg, vial, 10 count, NDC 55150-0235-10
  • Vecuronium Bromide lyophilized powder for injection, Eugia US, 20 mg, vial, 10 count, NDC 55150-0236-20
  • Vecuronium Bromide lyophilized powder for injection, Fresenius Kabi, 10 mg, vial, 10 count, NDC 63323-0781-10 - discontinued
  • Vecuronium Bromide lyophilized powder for injection, Fresenius Kabi, 20 mg, vial, 10 count, NDC 63323-0782-20 - discontinued
  • Vecuronium Bromide lyophilized powder for injection, Hikma, 10 mg, vial, 10 count, NDC 00143-9234-10
  • Vecuronium Bromide lyophilized powder for injection, Hikma, 20 mg, vial, 10 count, NDC 00143-9232-10
  • Vecuronium Bromide, Pfizer, 10 mg, vial, 10 count, NDC 00409-1632-01 - discontinued

Reason for the Shortage

• • Eugia has vecuronium on shortage due to increased demand.[1]
  • Fresenius Kabi discontinued vecuronium in March 2024.[2]
  • Hikma did not provide a reason for the shortage.[3]
  • Mylan Institutional (Viatris) has vecuronium available.[4]
  • Pfizer discontinued vecuronium in early-2024.[5]
  • Sun Pharma has vecuronium injection available.[6]
  • Teva discontinued vecuronium in 2022.[7]

Available Products

• • Vecuronium Bromide lyophilized powder for solution for injection, Mylan Institutional (Viatris), 10 mg, vial, 10 count, NDC 67457-0438-10
  • Vecuronium Bromide lyophilized powder for solution for injection, Mylan Institutional (Viatris), 20 mg, vial, 10 count, NDC 67457-0475-20
  • 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

• • Eugia has vecuronium 10 mg and 20 mg vials on intermittent back order and the company is releasing product as it becomes available.[1]
  • Hikma has vecuronium 10 mg and 20 mg vials on back order and the company cannot estimate a release date.[3]

• • 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.[8]

• • 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 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.[9-11]
  • 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.[9-11]
  • Some presentations of alternative agents including pancuronium, rocuronium, and atracurium may be in short supply.[12]

  Table 1. Characteristics of NMBAs9-11

  NMBA	Type of NMBA	Onset 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.9-11
  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 (depending on initial bolus dose)
  Succinylcholine	Depolarizing	0.5 - 1	4 - 6*
  Vecuronium	Nondepolarizing	2.5 - 3	20 - 40

  
  

• 1. Eugia (personal communications). October 23, 2019; January 6, April 28, June 8, August 11, November 11, 2020; February 17, April 12, July 16, November 5, 2021; January 24, March 18, July 22, October 14, 2022; January 20, March 16, June 9, July 21, August 4, October 27, December 19, 2023; and February 14, 2024.
  2. 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, November 1, 2019; January 10, March 13, April 24, May 1 and 29, August 7, September 25, November 6, December 11, 2020; February 12, March 26, April 16 and 30, July 30, November 19, December 10, 2021; January 21, March 4, 11, and 18, April 8 and 29, June 3, August 19, October 21, December 29, 2022; January 20, March 17, May 26, June 9, July 27, August 3 and 31, November 16, December 21, 2023; January 25, February 22, and April 4, 2024.
  3. Hikma, Customer Service (personal communication). November 4, December 23, 2020; February 10, March 31, April 14 and 28, July 28, November 17, December 1 and 15, 2021; January 26, March 2 and 17, April 13, May 4, June 1, and August 17, October 18, 2022; January 4 and 25, March 16, May 25, June 8, July 26, August 30, November 15, December 27, 2023; January 24, February 21, and April 3, 2024.
  4. Mylan Institutional (Viatris), 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, October 22, 2019; March 16, April 27, August 11, November 9, 2020; February 17, April 16, June 25, November 10 and 30, December 15, 2021; January 20, March 9, 22, and 29, April 22, May 25, August 25, October 12, December 20, 2022; January 26, March 21, June 12, November 21, 2023; and February 16, 2024.
  5. Pfizer, Customer Service (personal communications or website). 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, November 7, 2019; January 7, March 16, April 24, May 5 and 29, July 16, August 7, September 25, November 6, December 11 and 15, 2020; February 16, April 1, 16, and 30, July 30, November 22, December 15, 2021; January 26, March 4, 11, and 18, April 8, May 3, June 3, August 24, October 21, 2022; January 4 and 25, March 21, May 30, June 9, August 1 and 31, November 18, 2023; January 25, February 23, and April 5, 2024.
  6. 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, August 21, 2019; March 17, April 28, August 10, December 16, 2020; March 22, November 20, 2021; January 11, March 1, April 14, August 15, October 3, December 13, 2022; February 27, May 3, July 26, 2023; January 26, February 21, and April 9, 2024.
  7. 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, October 18, 2019; January 10, March 16, April 27, May 4 and 29, July 10 and 31, September 25, November 6, December 11, 2020; February 12, March 26, April 16 and 30, July 30, November 19, December 10, 2021; January 21, March 4 and 11, April 8 and 29, and October 21, 2022.
  8. Hospira. Vecuronium bromide Injection product label. Lake Forest, IL; Hospira; September, 2010.
  9. Baughman VL, Golembiewski J, Gonzales JP, Alvarez, W, eds. Anesthesiology and Critical Care Drug Handbook. 9th ed. Hudson, OH: Lexi-Comp; 2010.
  10. 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.
  11. 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.
  12. American Society of Health-System Pharmacists. Drug Shortage Resource Center. Accessed on December 14, 2011.