Search
pancuronium (Pavulon)
Tradename: Pavulon. (pancuronium bromide)
Indications:
- relaxation of skeletal muscles during surgery under general anesthesia
- relaxation of skeletal muscles during endotracheal intubation
- increase pulmonary compliance during mechanical ventilation
- status asthmaticus resistant to other therapy
- neuromuscular blocking agent of choice in most critically ill patients WITHOUT significant cardiac disease or hemodynamic instability
Dosage:
1) ALWAYS use with sedative, i.e. lorazepam (Ativan)
2) should be used with analgesic if needed
3) start: 0.06-0.1 mg/kg/hr (4-5 mg) maintenance: 0.02-0.03 mg/kg (1-2 mg/hr)
4) 0.04 mg/kg followed by 0.02-0.1 mg/kg every 30-60 min PRN
5) titrate dose to patient's needs
Injection: 1 mg/mL (10 mL), 2 mg/mL (2 mL, 5 mL).
Dosage adjustment in renal failure:
creatinine clearance dosage
10-50 mL/min 50% of normal dose
< 10 mL/min do NOT use
Phamacokinetics:
1) rapid onset of action (4 minutes)
2) onset & duration of action are dose-dependent
3) 1/2life is 2 hours
4) duration 45-90 min
5) metabolized in liver 30-40% to several compounds, some which are active
6) eliminated mainly in the urine (55-70% as unchanged drug)
7) 1/2life is prolonged in patients with hepatic or renal impairment
Adverse effects:
1) not common (1-10%)
- rash, excessive salivation, itching, tachycardia, hypertension (secondary to vagolytic effect)
2) uncommon (< 1%)
- skin flushing, erythema, edema, circulatory collapse, bronchospasm, hypersensitivity, burning sensation along the vein, profound muscle weakness, wheezing
3) other
- mast cell degranulation & histamine release
- allergic-type reaction
- rash
- increased risk of deep vein thrombosis (DVT)
- prolonged paralysis*
- exacerbation of adverse effects with hyperkalemia or hypokalemia
* Cholinesterase inhibitors (neostigmine, pyridostigmine, edrophonium) are used with atropine to REVERSE neuromuscular blockade
Drug interactions:
1) aminoglycosides, tetracyclines, clindamycin, K+-depleting agents (loop diuretics, thiazides, amphotericin B, corticosteroids) in combination increase & prolong neuromuscular blockade
2) corticosteroids in combination prolong muscle weakness
3) quinidine
4) magnesium sulfate
5) verapamil
Laboratory:
1) specimen:
a) plasma
b) stable for 20 hours at 23 degrees C, pH 5.4
c) unstable at room temperature, pH 7.4
2) methods: fluorometry, GC
3) labs with Loincs
- pancuronium in tissue
- pancuronium in blood
- pancuronium in serum/plasma
- pancuronium in urine
Mechanism of action:
1) non-depolarizing neuromuscular blocking agent
2) diminishes response to acetylcholine at the motor endplate
Interactions
drug interactions
General
neuromuscular blocker (paralyzing agent)
steroid
Properties
MISC-INFO: elimination route LIVER
KIDNEY
1/2life 2 HOURS
therapeutic-range >0.2 UG/ML
protein-binding 7-29%
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- Goodman and Gilman's The Pharmacological Basis of
Therapeutics, 8th ed. Gilman et al, eds.
Permagon Press/McGraw Hill, 1990, pg 169
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998 - not on National VA formulary
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed.,
W.B. Saunders, 1995
- Deprecated Reference