Home Drug Guide Pancuronium Bromide

Drug Guide

Generic Name

Pancuronium Bromide

Brand Names Pavulon

Classification

Therapeutic: Neuromuscular Blocking Agent

Pharmacological: Non-depolarizing Muscle Relaxant

FDA Approved Indications

Adjunct to general anesthesia to facilitate endotracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation.

Mechanism of Action

Pancuronium Bromide is a non-depolarizing neuromuscular blocker that antagonizes acetylcholine at the neuromuscular junction, preventing depolarization and leading to muscle paralysis.

Dosage and Administration

Adult: Иnitial dose of 0.08 to 0.1 mg/kg IV, with additional doses of 0.02 mg/kg as needed. Maintenance dosages depend on clinical response.

Pediatric: Dose varies; typically 0.04 to 0.1 mg/kg IV, with supplementary doses based on response.

Geriatric: Reduced doses may be necessary, starting at lower end of dosing range.

Renal Impairment: Adjust doses as accumulation may occur due to impaired excretion.

Hepatic Impairment: No specific adjustments; monitor closely.

Pharmacokinetics

Absorption: Not applicable (administered IV).

Distribution: Widely distributed; crosses the placenta.

Metabolism: Primarily excreted unchanged; minimal metabolism.

Excretion: Renal and biliary routes.

Half Life: Approximately 2-3 hours in healthy individuals, prolonged in renal impairment.

Contraindications

Known hypersensitivity to pancuronium or other neuromuscular blockers.

Precautions

Use with caution in myasthenia gravis, hepatic or renal impairment, or severe electrolyte imbalances. Monitor closely in these populations.

Adverse Reactions - Common

Prolonged paralysis (Rare)
Tachycardia (Common)
Hypotension or hypertension (Uncommon)

Adverse Reactions - Serious

Anaphylaxis (Rare)
Malignant hyperthermia (less common) (Rare)

Drug-Drug Interactions

Increased neuromuscular blockade with other neuromuscular blockers or aminoglycosides.
Decreased blockade effect with cholinesterase inhibitors.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor ventilatory status, neuromuscular function (e.g., peripheral nerve stimulator), and vital signs.

Diagnoses:

Risk for impaired gas exchange.
Impaired airway clearance.

Implementation: Administer dosage as prescribed, monitor for adequate paralysis and recovery, and provide appropriate ventilatory support.

Evaluation: Assess neuromuscular function regularly; ensure patient has resumed adequate spontaneous respirations and muscle strength.

Patient/Family Teaching

Explain the purpose of muscle paralysis and ventilatory support.
Inform about possible side effects and signs to report.
Reassure that paralysis is reversible and monitored closely.

Special Considerations

Black Box Warnings:

Use with caution in patients with known hypersensitivity; potential for prolonged paralysis.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Complete paralysis, respiratory depression, circulatory collapse.

Treatment: Provide supportive care, including mechanical ventilation; consider administration of cholinesterase inhibitors (e.g., neostigmine) to reverse paralysis if appropriate.

Storage and Handling

Storage: Store in a cool, dry place, protected from light.

Stability: Stable under recommended storage conditions.