Pancuronium Bromide

Registered South African indications:

• Muscle relaxation

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Coadministration with depolarising neuromuscular blockers e.g suxamethonium

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Hepatic impairment
• Elderly
• Pulmonary disease
• Muscular dystrophy
• Myasthenia gravis
• Myasthenic syndrome
• Neuromuscular disease
• Post poliomyelitis
• Electrolyte disturbances
• Dehydration
• Tendency to hypertension
• Cardiovascular disease
• Neonates
• Ill or cachetic patients
• Obstructive jaundice
• Hypothermic techniques
• Rapid sequence induction
• Hypoproteinaemia

Forms avail. in SA and covered in this monograph: inj

Endotracheal intubation

• IV: 40-100μg/kg

The muscle relaxant effect commences within 1-3 minutes and lasts for approximately 45 minutes

If administered after suxamethonium, a dosage reduction to 20-60μg/kg is recommended

Maintenance of muscle relaxation for surgical procedures

• IV: 10-20μg/kg

Paed. forms avail. in SA and covered in this monograph: inj

Endotracheal intubation

Younger than 28 days

• IV: 30-40μg/kg

If suxamethonium is used for intubation, administration should be delayed until the patient has clinically recovered from the neuromuscular block induced by suxamethonium

Older than 28 days

• See adult dosage

Maintenance of muscle relaxation for surgical procedures

• See adult dosage

Pregnancy

• FDA Pregnancy Category Not Rated (NR)

Breastfeeding

• Caution; no information available

Renal Impairment

• Caution; no dose adjustment recommended 

Hepatic Impairment

• Caution; no dose adjustment recommended

Elderly

• Caution; dose adjustment recommended

Cardiovascular Disorders

• Increased pulse rate
• Increased cardiac output
• Increased blood pressure
• Arrhythmias

Respiratory Disorders

• Bronchospasm

Gastrointestinal Disorders

• Salivation

Skin and Subcutaneous Tissue Disorders

• Transient rash
• Injection site reactions

Immune, Blood and Lymphatic System Disorders

• Severe anaphylactoid reactions

Sensory Disorders

• Decreased intraocular pressure
• Miosis

• Suxamethonium 
• Anaesthetics
• Other non-depolarising muscle relaxants
• Polypeptide antibiotics
• Aminoglycosides
• Diazepam
• Propranolol
• Thiamine
• Monoamine oxidase inhibitors
• Quinidine
• Magnesium sulphate
• Protamine
• Nitroglycerin
• Narcotic analgesics
• Diuretics
• Phenytoin
• Alpha and beta blockers
• Imidazoles
• Metronidazole
• Noradrenaline
• Adrenaline
• Neostigmine
• Edrophonium
• Corticosteriods 
• Potassium chloride
• Calcium chloride
• Sodium chloride
• Heparin
• Azathioprine
• Theophylline
• Pyridostigmine
• Neuroleptanalgesia
• Propanidid
• Mivacurium
• Morphine derivatives
• Tricyclic antidepressants
• Alkylating agents

Vital signs

Pancuronium bromide inhibits neuromuscular transmission by competing with acetylcholine to bind with cholinergic receptors of the motor end plate. This reduces the response of the end plate to acetylcholine.

Injection (per 2ml) 4mg

• Micro-Pancuronium Bromide (Micro)
• Pancuronium Bromide Fresenius (Bodene)
• Pavulon (Sanofi)