Pancuronium bromide


Full Prescribing Info
Dosage/Direction for Use

Intravenous
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.
Renal impairment: Haemodialysis/peritoneal dialysis patient: Avoid use. Continuous renal replacement therapy: 50% of normal dose.
CrCl (ml/min)Dosage Recommendation
<10Avoid use.
10-5050% of normal dose.

Incompatibility:
Y-site: Diazepam, pantoprazole, thiopental.

Intravenous
Facilitate endotracheal intubation
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.
Renal impairment: Haemodialysis/peritoneal dialysis patient: Avoid use. Continuous renal replacement therapy: 50% of normal dose.
CrCl (ml/min)Dosage Recommendation
<10Avoid use.
10-5050% of normal dose.

Incompatibility:
Y-site: Diazepam, pantoprazole, thiopental.

Intravenous
Facilitate mechanical ventilation in intensive care
Adult: 60 mcg/kg every 1-1.5 hr or less frequently.
Renal impairment: Haemodialysis/peritoneal dialysis patient: Avoid use. Continuous renal replacement therapy: 50% of normal dose.
CrCl (ml/min)Dosage Recommendation
<10Avoid use.
10-5050% of normal dose.

Incompatibility:
Y-site: Diazepam, pantoprazole, thiopental.

Special Populations:
Obese patient: Adjust dose based on ideal body wt.
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. Patient Counselling Not recommended to drive or operate machinery w/in 24 hr after full recovery from neuromuscular effects. Monitoring Parameters Monitor heart rate, BP, assisted ventilation status.
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.
Overdosage
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
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.
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.
Storage
Intravenous: Store between 2-8°C; may be stored below 25°C (stable for 6 mth).
CIMS Class
Disclaimer: This information is independently developed by CIMS based on pancuronium bromide from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 CIMS. All rights reserved. Powered by CIMSAsia.com
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