Parenteral Manual

Pancuronium bromide

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
PAVULON®
Classification: 
Nondepolarizing neuromuscular blocking agent
Original Date: 
August 2005
Revised Date: 
September 2011
Indications: 
  • An adjunct to general anesthesia to induce skeletal muscle relaxation                                       
  • Infants requiring mechanical ventilation who continue to have inadequate oxygenation despite optimal supportive care (increases pulmonary compliance)
  • To facilitate endotracheal intubation
Reconstitution and Stability: 
  • Available as 1 mg/mL solution
  • Ampoules & vials should be refrigerated but are stable for 6 months at room temperature         
  • Diluted solutions stable for 48 hours
  • Diluted solutions do not undergo significant sorption to glass or plastic during short-term (48 hour) storage
Compatibility: 

- Solutions Compatible: D5W, NS, D5NS, ringer's lactate, ringer's solution

- Additive/Above Cassette Compatible: no information

- Y-site Compatible: aminophylline, cefazolin, cefuroxime, dobutamine, dopamine, epinephrine, fentanyl, fluconazole, gentamicin, heparin, hydrocortisone, insulin, isoproterenol, lidocaine, lorazepam, midazolam, morphine, nitroglycerin, nitroprusside, ranitidine, vancomycin

- Incompatible: a precipitate may form when mixed with barbiturates, diazepam, thiopental 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

YES, ventilator support; cardiac monitoring
Usual dilution: 1 mg/mL (undiluted)
Infusion time: 1 minute
IV Intermittent Infusion NO
IV Continuous Infusion YES, ventilator support; cardiac monitoring
Usual dilution: 0.01-0.8 mg/mL
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • Dosage must be individualized

Pediatric:

  • Initial: 0.04-0.1 mg/kg IV
  • Maintenance: subsequent doses of 0.01 mg/kg IV every 20-40 min as needed or
  • Continuous IV Infusion: 0.03-0.1 mg/kg/hour 
  • Maximum: 0.1 mg/kg/dose           

Adolescent/Adult:

  • Initial: 0.04-0.1 mg/kg IV; later incremental doses starting at 0.01 mg/kg may be used at 25-60 minute intervals,  or
  • Continuous IV Infusion: 0.02-0.04 mg/kg/hour

DOSAGE ADJUSTMENT IN RENAL IMPAIRMENT:

  • CrCl 10-50 mL/minute: Administer 50% of normal dose
  • CrCl <10 mL/minutes: Do not use
Potential hazards of parenteral administration: 
  • Transient rise in blood pressure and arrhythmias             
  • Tachycardia                                               
  • Burning sensation on injection            
  • Increased salivation                  
  • Hypersensitivity reactions
  • Prolonged muscle weakness                                                           
Notes: 
  • Oxygen and resuscitative equipment must be readily available (ventilation must be supported during neuromuscular blockade)
  • Monitor heart rate, blood pressure and respiratory status                             
  • Effects may be reversed with neostigmine
  • Caution in patients with neuromuscular disease and renal impairment 
  • Should be used in conjunction with analgesia and/or sedation
  • Electrolyte abnormalities (hypokalemia, hyponatremia, hypocalcemia, hypermagnesemia) potentiate the effect of pancuronium
  • Many potential drug interactions - Contact Pharmacy
  • Onset: 2-3 minutes; Duration: 40-60 minutes
References: 

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