Pancuronium Injection 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]

• • 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.