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Pancuronium information from DrugsUpdate  

See Available Brands of Pancuronium in India

P - Caution when used during pregnancy
L - Contraindicated in lactation

Pancuronium is a chemical compound, used in medicine as the bromide salt pancuronium bromide. It has the brand name Pavulon (Organon International). It is a muscle relaxant with various purposes. It is one of the drugs administered during a lethal injection in the United States.

Pharmacodynamics

Pharmacokinetics

Pancuronium bromide is a non-depolarising neuromuscular blocking agent with curarimimetic action through competitive blockade at the myoneural junction by binding with cholinergic receptor sites.

Onset
Peak effect after IV administration: 2-3 min.

Duration
(dose dependant) 60-100 min. Recovery time is often much slower in renal and hepatic impairment.

Distribution
Volume of distribution is increased 50% in hepatic impairment. Protein-binding: 80%.

Metabolism
Hepatic (30-45%); active metabolite 3-hydroxypancuronium (30-50% activity of drug).

Excretion
Half life elimination: 10 min (doubled in hepatic and renal impairment). Excreted via urine (55-70% as unchanged drug). Plasma clearance reduced in hepatic and renal impairment.

Pancuronium Indications / Pancuronium Uses

Information Not Available

Pancuronium Adverse Reactions / Pancuronium Side Effects

Tachycardia may occur due to vagal blockade and especially during light anaesthesia. May decrease intra-ocular pressure and induce miosis; excessive salivation; transient rashes and itching; wheezing; elevation in pulse rate, BP, cardiac output; erythema; burning sensation along vein; profound muscle weakness; bronchospasm; hypersensitivity reaction; acute quadriplegic myopathy syndrome, myositis ossificans.

Potentially Fatal: Rare anaphylactoid reactions; bradycardia, bronchospasm, hypotension and CV collapse; respiratory depression.

Precautions

Although Pancuronium Bromide Injection has been used successfully in many patients with pre-existing pulmonary, hepatic, or renal disease, caution should be exercised in these situations.

Renal Failure

A major portion of Pancuronium, as well as an active metabolite, are recovered in urine. The elimination half-life is doubled and the plasma clearance is reduced in patients with renal failure; at the same time, the rate of recovery of neuromuscular blockade is variable and sometimes very much slower than normal. This information should be taken into consideration if Pancuronium is selected, for other reasons, to be used in a patient with renal failure.

Altered Circulation Time

Conditions associated with slower circulation time in cardiovascular disease, old age, edematous states resulting in increased volume of distribution may contribute to a delay in onset time; therefore, dosage should not be increased.

Hepatic and/or Biliary Tract Disease

The doubled elimination half-life and reduced plasma clearance determined in patients with hepatic and/or biliary tract disease, as well as limited data showing that recovery time is prolonged an average of 65% in patients with biliary tract obstruction, suggests that prolongation of neuromuscular blockade may occur. At the same time, these conditions are characterized by an approximately 50% increase in volume of distribution of Pancuronium, suggesting that the total initial dose to achieve adequate relaxation may in some cases be high. The possibility of slower onset, higher total dosage and prolongation of neuromuscular blockade must be taken into consideration when Pancuronium is used in these patients. (See also Pharmacokinetics).

Long-term Use in I.C.U.

In the intensive care unit, in rare cases, long-term use of neuromuscular blocking drugs to facilitate mechanical ventilation may be associated with prolonged paralysis and/or skeletal muscle weakness that may be first noted during attempts to wean such patients from the ventilator. Typically, such patients receive other drugs such as broad spectrum antibiotics, narcotics and/or steroids and may have electrolyte imbalance and diseases which lead to electrolyte imbalance, hypoxic episodes of varying duration, acid-base imbalance, and extreme debilitation, any of which may enhance the actions of a neuromuscular blocking agent. Additionally, patients immobilized for extended periods frequently develop symptoms consistent with disuse muscle atrophy. Therefore, when there is a need for long-term mechanical ventilation, the benefits-to-risk ratio of neuromuscular blockade must be considered.

Continuous infusion or intermittent bolus dosing to support mechanical ventilation has not been studied sufficiently to support dosage recommendations.

Severe Obesity or Neuromuscular Disease

Patients with severe obesity or neuromuscular disease may pose airway and/or ventilatory problems requiring special care before, during, and after the use of neuromuscular blocking agents such as Pancuronium bromide.

CNS

Pancuronium bromide has no known effect on consciousness, the pain threshold or cerebration. Administration should be accompanied by adequate anesthesia or sedation.

Special Precautions

Myasthenia gravis; severe electrolyte disorders; severe CV disease; pregnancy. Hepatic and renal function impairment. Hypothermia; jaundice; hypermagnesaemia, hypocalcaemia, hypokalaemia, hypoproteinaemia, acidosis, alkalosis, hypercalcemia. In obese patients, dose should be based on ideal body wt. Elderly; previous anaphylactic reactions to other neuromuscular-blocking agents. Burn patients (>30% of body) may be resistant to action for 5-70 days after injury. Demyelinating lesions, peripheral neuropathies, denervation, infection, muscle trauma, and DM may antagonise the neuromuscular blockade effects of drug. Neuromuscular diseases, acute intermittent porphyria, Eaton-Lambert syndrome. Maintain adequate airway and respiratory support during use.

Other Drug Interactions

Neuroleptanalgaesia may decrease neuromuscular activity. Action may be prolonged and/or potentiated by aminoglycoside antibiotics, lithium, diazepam, lidocaine (high dose), quinidine, tetracyclines, propranolol, thiamine (high dose), parenteral magnesium sulphate, MAOIs, quinine, protamine, carbamazepine, donepezil and phenytoin (if pancuronium is given concurrently for <1 wk). Action may be decreased by neostigmine, edrophonium, high-dose or long term corticosteroids, adrenaline (may also potentiate effect), azathioprine, theophylline (high doses), clindamycin, nifedipine, piperacillin, polymixins, verapamil, procainamide. Furosemide may increase or decrease effects. TCAs may increase risk of arrhythmias and hypotension during anaesthesia.

Potentially Fatal: Potentiated by volatile anaesthetics (isoflurane and enflurane) and local anaesthetics. Prior admin of suxamethonium can increase the intensity of neuromuscular block. Concomitant use with digoxin may increase risk of serious cardiac arrhythmias.

Other Interactions

Information Not Available

Dosage

Intravenous
Facilitate endotracheal intubation
Adult: Initially, 50-100 mcg/kg. Maintenance: 10-20 mcg/kg. Can be administered undiluted by rapid IV inj.
Child: Neonate:30-40 mcg/kg. Maintenance: 10-20 mcg/kg 4-6 hrly as necessary. 1 mth-18 yr: initially 60-100 mcg/kg, then 10-20 mcg/kg repeated as recquired.
CrCl (ml/min)    Dosage Recommendation
10-50    50% normal dose
<10    avoid
Hepatic impairment: Hepatic impairment may results in a slower onset of action, higher initial dosage and longer neuromuscular blockade.

Intravenous
Muscle relaxant in general anaesthesia
Adult: Initially, 50-100 mcg/kg. Maintenance: 10-20 mcg/kg. Can be administered undiluted by rapid IV inj.
Child: Neonate:30-40 mcg/kg. Maintenance: 10-20 mcg/kg 4-6 hrly as necessary. 1 mth-18 yr: initially 60-100 mcg/kg, then 10-20 mcg/kg repeated as recquired.
CrCl (ml/min)    Dosage Recommendation
10-50                      50% normal dose
<10                      avoid
Hepatic impairment: Hepatic impairment may results in a slower onset of action, higher initial dosage and longer neuromuscular blockade.

Intravenous
Facilitate mechanical ventilation in intensive care
Adult: 60 mcg/kg every 60-90 min. May be administered undiliuted by rapid IV inj.
CrCl (ml/min)    Dosage Recommendation
10-50                      50% dose
<10                       avoid
Hepatic impairment: Hepatic impairment may result in a slower onset of action, higher initial dosage and longer neuromuscular blockade.

Reconstitution

Can be diluted in 5% glucose or 0.9% sodium chloride.

Incompatibility
At the Y-site: diazepam and thiopental; variable compatibility with propofol. Do not mix other solutions in the same syringe as a change in pH can cause precipitation (normally pH 4).

Food(before/after)

Information Not Available

List of Contraindications

Pancuronium and Pregnancy

P - Caution when used during pregnancy.


Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Pancuronium and Lactation

L - Contraindicated in lactation

Pancuronium and Children

Dose response studies in children indicate that, with the exception of neonates, dosage requirements are the same as for adults. Neonates are especially sensitive to nondepolarizing neuromuscular blocking agents, such as Pancuronium bromide, during the first month of life. It is recommended that a test dose of 0.02 mg/kg be given first in this group to measure responsiveness.

Pancuronium and Geriatic

Information Not Available

Pancuronium and Other Contraindications

Anuria. Relatively contraindicated in conditions of reduced airway control. Lactation

Storage

Intravenous
Normally refrigerated, however stable at room temperature for 6 months

Lab interference

Intravenous
Normally refrigerated, however stable at room temperature for 6 months

Pancuronium brands in India:

Pancuronium Bromide Pavulon

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