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Pancuronium Injection

Last Updated: May 26, 2016
Status: Resolved

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
    NMBA TYPE OF NMBA ONSET 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
    Atracurium Nondepolarizing 2 to 3 20 to 35
    Cisatracurium Nondepolarizing 1.5 to 2 20 to 35
    Pancuronium Nondepolarizing 2 to 3 60 to 100
    Rocuronium Nondepolarizing 1 to 2 22 to 67 (depending on initial bolus dose)
    Succinylcholine Depolarizing 0.5 to 1 4 to 6 a
    Vecuronium Nondepolarizing 2.5 to 3 20 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.

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