Intravenous Facilitate endotracheal intubation, Muscle relaxant in general anaesthesia
Adult: Initially, 50-100 mcg/kg by inj, may reduce to 20-60 mcg/kg if given after suxamethonium. Maintenance: 10-20 mcg/kg. Child: 0-30 days Initially, 30-40 mcg/kg. Maintenance: 10-20 mcg/kg; >1 mth Same as adult dose.
Intravenous Facilitate mechanical ventilation in intensive care
Adult: 60 mcg/kg every 1-1.5 hr or less frequently.
Special Patient Group
Obese patient: Adjust dose based on ideal body wt.
Renal Impairment
Haemodialysis/peritoneal dialysis patient: Avoid use. Continuous renal replacement therapy: 50% of normal dose.
CrCl (m/min)
Dosage
<10
Avoid use.
10-50
50% of normal dose.
Incompatibility
Y-site: Diazepam, pantoprazole, thiopental.
Special Precautions
Patient w/ burn injury, biliary tract disease, pulmonary disease, muscular dystrophies, myasthenia gravis, myasthenic syndrome, electrolyte disturbance, altered pH, dehydration, CV disease, oedema, raised catecholamine concentration and those at risk of HTN. Renal and hepatic impairment. Childn. Pregnancy and lactation.
Adverse Reactions
Tachycardia, HTN, bradycardia, bronchospasm, hypotension, CV collapse, excessive salivation; pain or local skin reactions at inj site. Rarely, hypersensitivity reactions. Potentially Fatal: Anaphylaxis.
Symptoms: Prolonged apnoea, resp depression and/or muscle weakness. Death may follow acute resp failure. Management: May administer neostigmine 2.5 mg and atropine 1.2 mg to reverse neuromuscular block while ventilation is continued. When admin of the anticholinesterase agent fails to reverse neuromuscular blockade, continue ventilation until spontaneous breathing is restored.
Drug Interactions
Increased effect w/ inhalational anaesth, other non-depolarising muscle relaxants, antibiotics (polypeptide and aminoglycoside group), diazepam, propranolol, thiamine (high dose), MAOIs, quinidine, Mg sulfate, protamine, nitroglycerin, narcotic analgesics, diuretics, phenytoin, α and β adrenergic blockers, imidazoles, norepinephrine and epinephrine and prior suxamethonium. Decreased effect w/ neostigmine, edrophonium, corticosteroids (high dose); KCl, Ca chloride and NaCl; heparin (temporary decrease), azathioprine, theophylline, pyridostigmine, neurolept analgesia and propanidid.
Action
Description: Mechanism of Action: Pancuronium blocks neural transmission by competing w/ acetylcholine for cholinergic receptors at the motor end-plate, resulting to skeletal muscles relaxation. Onset: Approx 1.5-2 min. Duration: Approx 45-60 min. Pharmacokinetics: Distribution: Rapidly distributed into body tissues; crosses the placenta (small amounts). Plasma protein binding: Approx 80%. Metabolism: Undergoes hepatic metabolism, converted to 3-hydroxypancuronium (active metabolite). Excretion: Via urine as unchanged drug and metabolites; bile (small amounts). Elimination half-life: Approx 2 hr.
Chemical Structure
Pancuronium bromide Source: National Center for Biotechnology Information. PubChem Database. Pancuronium bromide, CID=27350, https://pubchem.ncbi.nlm.nih.gov/compound/Pancuronium-bromide (accessed on Jan. 22, 2020)
Storage
Store between 2-8°C; may be stored below 25°C (stable for 6 mth).
M03AC01 - pancuronium ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.
References
Anon. Pancuronium. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 25/08/2015.Buckingham R (ed). Pancuronium Bromide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 25/08/2015.McEvoy GK, Snow EK, Miller J et al (eds). Pancuronium Bromide. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 25/08/2015.Pancuronium Bromide Injection, Solution (Hospira, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 25/08/2015.
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