Drug information of Pancuronium

Pancuronium

Drug group:

Pancuronium Bromide is a nondepolarizing neuromuscular blocking agent.

Mechanism of effect

It acts by competing for cholinergic receptors at the motor end-plate. The antagonism to acetylcholine is inhibited; and neuromuscular block is reversed by anticholinesterase agents such as pyridostigmine, neostigmine, and edrophonium.

Pharmacodynamic

Produces skeletal muscle relaxation by causing a decreased response to acetylcholine (ACh) at the myoneural (neuromuscular) junction of skeletal muscle. Blocks the effects of both the small quantities of ACh that maintain muscle tone and the large quantities of ACh that produce voluntary skeletal muscle contraction; does not alter the resting electrical potential of the motor end-plate or cause muscular contractions.

Pharmacokinetics

Pancuronium Bromide Injection , USP is for intravenous use only. Onset of paralysis is dose related. Following IV administration of 0.06 mg/kg, clinically sufficient neuromuscular blockade occurs within 2–3 minutes.
• Duration of paralysis is dose related. Duration of clinically sufficient neuromuscular blockade induced by 0.06 mg/kg is about 35–45 minutes.
• Supplemental doses may increase magnitude and duration of neuromuscular blockade. Crosses the placenta in small amounts.
• Plasma Protein Binding is Approximately 87%. Undergoes limited biotransformation. Excreted principally in urine as unchanged drug and to a lesser extent in bile.
• Half-life is Triphasic ; terminal half-life is approximately 2 hours.

Dosage

In adults under balanced anesthesia the initial intravenous dosage range is 0.04 to 0.1 mg/kg. Later incremental doses starting at 0.01 mg/kg may be used. These increments slightly increase the magnitude of the blockade and significantly increase the duration of blockade because a significant number of myoneural junctions are still blocked when there is clinical need for more drug.
If Pancuronium Bromide Injection , USP is used to provide skeletal muscle relaxation for endotracheal intubation, a bolus dose of 0.06 to 0.1 mg/kg is recommended. Conditions satisfactory for intubation are usually present within 2 to 3 minutes .
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 Injection , USP, 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.

Drug contraindications

severe hypersensitivity reactions

Side effects

redness

Alerts

• Potential for severely compromised respiratory function and respiratory paralysis.
• Should be used only by individuals experienced in the use of neuromuscular blocking agents and in the maintenance of an adequate airway and respiratory support. Facilities and personnel necessary for intubation, administration of oxygen, and assisted or controlled respiration should be immediately available.
• IV cholinesterase inhibitor (e.g., neostigmine, pyridostigmine, edrophonium) should be readily available.
• Use with caution in patients with pulmonary impairment or respiratory depression.
• Possible profound neuromuscular blockade in patients with neuromuscular disease (e.g., myasthenia gravis, Eaton-Lambert syndrome).
• Reduce initial dosage; monitor response carefully with a peripheral nerve stimulator.
• Hypersensitivity reactions (bronchospasm, flushing, redness, hypotension, tachycardia) reported rarely.
• Resistance to therapy with neuromuscular blocking agents can develop in burn patients, particularly those with burns over 25–30% or more of body surface area.
• Use not recommended in patients with preexisting tachycardia or in patients in whom minor elevation in heart rate is undesirable.
• Possible delayed onset of action in patients with impaired circulation (e.g., cardiovascular disease, edema); however, larger than usual doses are not recommended.
• Possible increased or decreased neuromuscular blockade in patients with electrolyte distrubances (e.g., adrenocortical insufficiency) or acid/base imbalances.
• Malignant hyperthermia is rarely associated with use of neuromuscular blocking agents and/or potent inhalation anesthetics.
• Possible airway or ventilatory problems in patients with severe obesity.Use with caution.

Points of recommendation

To make sure this medicine is safe for you, tell your doctor if you have :
• If you have an allergy to this medicine or any other part of it.
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
Very bad and sometimes deadly allergic side effects have rarely happened. Talk with your doctor.
Long-term paralysis and muscle weakness have happened when pancuronium was given for a long time. Talk with the doctor.
This medicine has benzyl alcohol in it. Benzyl alcohol may cause very bad and sometimes deadly side effects in newborns or infants. This medicine is not approved for use in children. Talk with the doctor.
Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this medicine while you are pregnant.
Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

Pregnancy level

C


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