PANCURONIUM 4mg/2ml Injection/Solution for

What is PANCURONIUM 4mg/2ml

PANCURONIUM 4mg/2ml is a sterile injectable solution containing pancuronium bromide, a non-depolarizing neuromuscular blocking agent. It is typically administered intravenously in hospital settings to facilitate muscle relaxation during surgical procedures, endotracheal intubation, or mechanical ventilation.

• Formulation: Each ampoule contains 4mg of pancuronium bromide in 2ml of solution. It is available in packs of 5 ampoules.
• Drug class: Neuromuscular blocking agent (non-depolarizing type).
• Mechanism: It acts by blocking the transmission of nerve impulses to the skeletal muscles, causing temporary paralysis.
• Clinical Use: It is commonly used during anesthesia to induce skeletal muscle relaxation, particularly for abdominal and thoracic surgeries.
• Prescription status: This medication is restricted to use under the supervision of qualified healthcare professionals in clinical settings.

How to use PANCURONIUM 4mg/2ml

PANCURONIUM should only be administered by trained medical personnel, typically anesthesiologists or intensivists, who are skilled in airway management and life support.

• Route of administration: Intravenous (IV) injection or infusion.
• Pre-use assessment: Ensure baseline monitoring of respiratory function, cardiac activity, and neuromuscular response.
• Initial dosing: Administer the recommended dose over 1–2 minutes to avoid rapid onset of paralysis before adequate airway management is in place.
• Monitoring: Continuous monitoring using peripheral nerve stimulators is essential to assess the degree of muscle relaxation and adjust dosage accordingly.
• Ventilation support: Patients must be mechanically ventilated, as pancuronium induces respiratory paralysis.
• Reversal: Neuromuscular blockade can be reversed post-surgery using agents such as neostigmine in combination with atropine or glycopyrrolate.

Mode of Action PANCURONIUM 4mg/2ml

Pancuronium bromide works by competitively blocking acetylcholine receptors at the neuromuscular junction, resulting in muscle paralysis.

• Competitive antagonist: Pancuronium binds to nicotinic receptors on the motor endplate of skeletal muscle, preventing acetylcholine from activating these receptors.
• Non-depolarizing action: Unlike depolarizing agents like succinylcholine, pancuronium does not cause muscle fasciculations.
• Onset and duration: Onset of action is typically within 2–3 minutes, with a duration of 60–100 minutes depending on the dose and patient metabolism.
• Reversal potential: Its effects are reversible with acetylcholinesterase inhibitors that increase acetylcholine levels at the neuromuscular junction.
• No analgesic or sedative properties: Pancuronium does not induce unconsciousness or pain relief and must be used with appropriate anesthetics.

PANCURONIUM 4mg/2ml Interactions PANCURONIUM 4mg/2ml

Pancuronium can interact with several drugs and substances that either potentiate or reduce its neuromuscular blocking activity.

• Potentiating agents:
  • Inhalational anesthetics like halothane, isoflurane, and sevoflurane can enhance its effects.
  • Aminoglycoside antibiotics (e.g., gentamicin, tobramycin) and tetracyclines increase the risk of prolonged paralysis.
  • Magnesium sulfate and lithium may potentiate neuromuscular blockade.
• Antagonistic agents:
  • Cholinesterase inhibitors (e.g., neostigmine, pyridostigmine) reverse its action and are used postoperatively.
  • Carbamazepine and phenytoin may reduce its efficacy by increasing metabolism or resistance at the neuromuscular junction.
• Caution with corticosteroids: Concurrent long-term use with corticosteroids may increase the risk of prolonged muscle weakness or myopathy.
• Other considerations: Ensure compatibility before mixing with other IV drugs or fluids.

Dosage of PANCURONIUM 4mg/2ml

The dosage of pancuronium must be individualized based on the patient's weight, clinical condition, and response to the drug. Close monitoring is mandatory during administration.

• Adults (intubation/surgery): Initial dose of 0.04–0.1 mg/kg IV, with maintenance doses of 0.01 mg/kg every 20–40 minutes as needed.
• Pediatric patients: Similar initial dosing of 0.04–0.1 mg/kg IV; titrated carefully under close observation.
• ICU use (mechanical ventilation): Lower continuous infusion doses may be used (e.g., 0.02–0.05 mg/kg/hour).
• Renal or hepatic impairment: Dose reduction may be necessary due to prolonged elimination.
• Reversal timing: Administer reversal agents once spontaneous recovery of neuromuscular function is evident.
• Monitoring: Always assess neuromuscular function with peripheral nerve stimulation (e.g., train-of-four technique).

Possible side effects of PANCURONIUM 4mg/2ml

While effective, pancuronium can cause a range of side effects that require close monitoring and intervention in some cases.

• Common side effects:
  • Increased heart rate (tachycardia)
  • Elevated blood pressure (hypertension)
  • Skin flushing or erythema
• Serious adverse effects:
  • Prolonged neuromuscular blockade
  • Respiratory paralysis (requires mechanical ventilation)
  • Anaphylactic reactions, though rare
  • Cardiac arrhythmias, especially in patients with electrolyte imbalances
• Long-term use risks (ICU settings):
  • Critical illness myopathy or neuropathy
  • Muscle wasting with prolonged paralysis
• Allergic manifestations: Rash, bronchospasm, or hypotension, though uncommon, require immediate intervention.

PANCURONIUM 4mg/2ml Contraindications PANCURONIUM 4mg/2ml

Pancuronium should not be used in certain clinical situations due to the risk of severe adverse effects or lack of benefit.

• Known hypersensitivity: Allergy to pancuronium bromide or other neuromuscular blocking agents.
• Myasthenia gravis: Profound and prolonged paralysis can occur in patients with neuromuscular transmission disorders.
• Severe renal or hepatic dysfunction: Accumulation of the drug may lead to prolonged neuromuscular blockade.
• Neonates and premature infants: Use with caution due to immature neuromuscular systems.
• Bradycardia-prone patients: Pancuronium may cause vagal blockade leading to tachycardia, but patients with underlying arrhythmias should be closely monitored.

Storage of PANCURONIUM 4mg/2ml

Proper storage of pancuronium is essential to maintain its efficacy and safety before administration.

• Temperature: Store below 25°C. Do not freeze.
• Protect from light: Keep ampoules in the original packaging until use to avoid degradation from UV exposure.
• Shelf life: Refer to the expiry date printed on the ampoule or carton. Do not use expired products.
• Handling: Inspect ampoules before use. Discard if solution is discolored or contains particulates.
• Post-opening: Once opened, unused portions should be discarded and not stored for future use.
• Keep out of reach of children: Though used only in hospitals, ensure secure storage in clinical settings.