Last Updated: May 19, 2015
Products Affected - Description
2 mg/mL, 10 mL vial, package of 10 (NDC 00781-3152-95)
Reason for the Shortage
- Sandoz could not provide a reason for the shortage.1
- Nimbex injection was on shortage due to increased demand.2
2 mg/mL, 5 mL vial, package of 10 (NDC 00781-3150-95)
2 mg/mL, 5 mL vial, package of 10 (NDC 00074-4378-05)
10 mg/mL, 20 mL vial, package of 10 (NDC 00074-4382-20)
Estimated Resupply Dates
Sandoz has cisatracurium 2 mg/mL 10 mL vials on back order and the company estimates a release date in mid-February 2015.1
Implications for Patient Care
Cisatracurium 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.3
Clinicians must use extreme caution to prevent dosing errors when switching between the various vial sizes (eg, if 20 mL vials are used in place of 10 mL 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.4-6
- 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.4-6
- Some presentations of alternative agents including pancuronium, rocuronium, and vecuronium may be in short supply.7
Characteristics of NMBAs4-6
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 – 6d
2.5 – 3
20 – 40
- Oseltamivir Phosphate Oral Suspension — Resolved
- Pancuronium Injection — No Commercially Available Preparations
- Sandoz (personal communication). January 22 and 30, February 24, March 7, April 21, May 5, 12, and 19, June 16, July 14, September 3, October 7, November 11, and December 1, 2014; and January 14, 2015.
- AbbVie, Customer Service (personal communication). January 22, February 4, 11, and 24, April 21, May 12, June 16, July, September 3, October 7, November 11 and 21, and December 1, 2014; and January 14, 2015.
- Abbott. Nimbex (cisatracurium besylate) Injection product label. North Chicago, IL; Abbott; May 2008.
- Baughman VL, Golembiewski J, Gonzales JP, Alvarez, W, eds. Anesthesiology and Critical Care Drug Handbook. 9th ed. Hudson, OH: Lexi-Comp; 2010.
- Muscle Relaxants – Adjuncts to Anesthesia. In: Wickersham RM, Novack KK et al., Eds. (2011). Drug Facts and Comparisons (eFacts). St. Louis, MO: Facts and Comparisons.
- 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.
- American Society of Health-System Pharmacists. Drug Shortage Resource Center. Accessed on January 22, 2014.
Updated January 14, 2015 by Jane Chandramouli, PharmD, Drug Information Specialist, Drug Information Service. Created April 11, 2002 by Jane Chandramouli, PharmD, Drug Information Specialist, and Erin R. Fox, PharmD, Drug Information Specialist. Copyright 2015, Drug Information Service, University of Utah, Salt Lake City, UT.