Generic
Pancuronium Bromide
1 brands available in the market
At a glance
Pancuronium Bromide is a non-depolarizing neuromuscular blocking agent used for skeletal muscle relaxation during surgery and to facilitate endotracheal intubation.
Description
Pancuronium is a typical non-depolarising curare-mimetic muscle relaxant. It acts as a competitive acetylcholine antagonist on neuromuscular junctions, displacing acetylcholine from its post-synaptic nicotinic acetylcholine receptors. Unlike suxamethonium, it causes no muscle fasciculations upon administration.
Indications
- Adjunct to general anesthesia
- Facilitating endotracheal intubation
- Skeletal muscle relaxation during medium and long duration surgical procedures
Therapeutic class
Non-depolarizing Muscle Relaxants
Pharmacological class
Competitive Neuromuscular Blocker
Pharmacology
Pancuronium competitively binds to nicotinic receptors at the neuromuscular junction to block acetylcholine action, preventing muscle contraction and causing skeletal muscle relaxation.
Mechanism of action
Provides muscle relaxation during surgery by blocking neuromuscular transmission.
Dosage
Adult Dose (IV):
- Intubation/Initial: 0.04-0.1 mg/kg
- Maintenance: 0.015-0.1 mg/kg q30-60min OR 0.1 mg/kg/hr continuous infusion
- After suxamethonium: 0.02-0.06 mg/kg
- Dose based on ideal body weight
Pediatric Dose (IV):
- Neonates (0-30 days): 0.03-0.04 mg/kg (initial); 0.01-0.02 mg/kg (maintenance)
- >1 month: Same as adult
Administration
- Administered by doctor or nurse IV
- Monitor muscle response with peripheral nerve stimulator
Missed dose
Not generally applicable (scheduled administration); consult doctor if needed.
Side effects
Common Side Effects:
- Tachycardia
- Hypertension
- Bradycardia
- Bronchospasm
- Hypotension
- Pain or local skin reactions at injection site
- Excessive salivation
Precautions & warnings
- Caution in burn injury, biliary tract disease, pulmonary disease, muscular dystrophies, myasthenia gravis, electrolyte disturbance, dehydration, CV disease, edema, renal and hepatic impairment
- Obese patients: Dose based on ideal body weight
Contraindications
- Hypersensitivity
- Anuria
- Reduced airway control (relative)
- Lactation
Drug interactions
- Increased effect with inhalational anaesthetics, other non-depolarising muscle relaxants, aminoglycoside antibiotics, diazepam, propranolol, quinidine, Mg sulfate
- Decreased effect with neostigmine, edrophonium, corticosteroids
- Risk of serious cardiac arrhythmias with digoxin
Food interactions
Caution with alcohol; consult doctor.
Use in pregnancy
Use in Pregnancy: Pancuronium may be unsafe during pregnancy (Category C); animal studies show adverse effects.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Pancuronium is probably safe during breastfeeding; no significant risk to baby.
Pediatric use
Dose established for children (neonates and >1 month).
Geriatric use
Elderly may require dose adjustment.
Renal / hepatic impairment
Renal Impairment: CrCl <10: Avoid use; CrCl 10-50: 50% of normal dose; Continuous renal replacement therapy: 50% of normal dose.
Hepatic Impairment: Caution in liver disease; dose adjustment may be needed.
Overdose effects
Overdose: Prolonged apnea, respiratory depression and muscle weakness; reverse with neostigmine and atropine; respiratory support.
Storage conditions
Store in a cool and dry place, away from light; keep out of reach of children.
Chemical structure
Pancuronium Bromide