PANCURONIUM 4mg/2ml Injection/Solution for

What is PANCURONIUM 4mg/2ml

PANCURONIUM 4mg/2ml is a prescription-only injectable neuromuscular blocking agent containing pancuronium bromide. It is used to produce skeletal muscle relaxation during surgery or mechanical ventilation. Pancuronium belongs to a class of drugs known as non-depolarizing neuromuscular blockers, which block nerve signals to the muscles without causing initial muscle contractions.

• Generic Name: Pancuronium bromide
• Form: Solution for Injection
• Strength: 4mg per 2ml ampoule
• Packaging: Box of 50 ampoules (2ml each)
• Clinical Use:
• Facilitates endotracheal intubation
• Maintains skeletal muscle relaxation during surgery
• Aids mechanical ventilation in intensive care

Pancuronium has no sedative or analgesic properties. It must be used alongside anesthesia and analgesia in surgical procedures. The drug is typically administered in controlled medical environments by trained healthcare providers.

How to use PANCURONIUM 4mg/2ml

PANCURONIUM 4mg/2ml should only be administered by qualified healthcare professionals experienced in the use of neuromuscular blockers. It is administered intravenously, with careful monitoring of the patient's neuromuscular function, respiratory status, and overall clinical condition.

• Route: Intravenous (IV) injection or continuous infusion
• Environment: Used only in surgical theaters or ICUs with life-support facilities
• Pre-administration Check:
• Verify patient weight and renal/hepatic function
• Ensure neuromuscular monitoring equipment is available
• Check for potential drug interactions or contraindications
• Monitoring Required:
• Train-of-four (TOF) stimulation to assess depth of blockade
• Continuous ECG, oxygen saturation, and end-tidal CO₂

The medication is typically given as a single bolus dose followed by maintenance doses or a continuous infusion, depending on the duration of the procedure. Reversal agents such as neostigmine or sugammadex may be administered post-operatively to hasten recovery from paralysis.

Mode of Action PANCURONIUM 4mg/2ml

Pancuronium bromide acts by inhibiting transmission of nerve impulses at the neuromuscular junction, resulting in muscle relaxation. It is classified as a non-depolarizing neuromuscular blocker.

• Mechanism: Competitive antagonist at nicotinic acetylcholine receptors
• Effect: Prevents acetylcholine from activating receptors, thus stopping depolarization and muscle contraction
• Onset: Within 2–3 minutes after IV administration
• Duration: Long-acting; effects may last up to 100 minutes

Pancuronium does not cause initial fasciculations or muscle twitches, unlike depolarizing agents such as succinylcholine. Instead, it causes a smooth and sustained muscle paralysis. Pancuronium is primarily metabolized in the liver and excreted through the kidneys, so renal and hepatic function affect its duration and clearance.

Because it does not affect consciousness or pain perception, it must be used in combination with general anesthesia and analgesia.

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

PANCURONIUM may interact with various medications, which can alter its efficacy or increase the risk of complications. These interactions should be carefully considered before and during treatment.

• Drugs that enhance pancuronium’s effects:
• Inhalation anesthetics (e.g., isoflurane, enflurane, halothane)
• Aminoglycosides (e.g., gentamicin, amikacin)
• Magnesium sulfate
• Calcium channel blockers
• Loop diuretics (e.g., furosemide)
• Drugs that reduce pancuronium’s effects:
• Cholinesterase inhibitors (e.g., neostigmine, pyridostigmine)
• High-dose corticosteroids (may antagonize neuromuscular blockade)

Concurrent use of other neuromuscular blockers may result in additive or unpredictable effects. Careful dose adjustment and continuous neuromuscular monitoring are necessary to manage interactions safely.

Dosage of PANCURONIUM 4mg/2ml

Dosage must be tailored to individual patient requirements based on factors like age, body weight, renal/hepatic function, and the desired duration of paralysis. Neuromuscular monitoring guides safe and effective dosing.

• Adult Initial Dose: 0.04–0.1 mg/kg IV bolus
• Maintenance Doses: 0.01 mg/kg every 20–40 minutes as needed
• Continuous Infusion: May be titrated between 1–2 mcg/kg/min
• Children: Slightly higher doses may be needed on a weight basis
• Geriatric and Renal Impairment: May require lower doses and longer monitoring due to prolonged drug action

Always individualize dosage based on neuromuscular response. Use a peripheral nerve stimulator to assess the depth of blockade (e.g., train-of-four ratio). Reversal agents may be administered at the end of the procedure to expedite recovery.

Possible side effects of PANCURONIUM 4mg/2ml

Side effects of pancuronium are primarily related to its action on the neuromuscular junction and autonomic system. While generally well-tolerated under proper supervision, adverse reactions can occur.

• Common Side Effects:
• Increased heart rate (tachycardia)
• Elevated blood pressure
• Delayed recovery from muscle paralysis
• Serious or Rare Reactions:
• Bronchospasm or laryngospasm
• Anaphylaxis (rare but life-threatening)
• Respiratory muscle paralysis if not adequately ventilated
• Increased salivation or bronchial secretions
• Prolonged weakness in patients with underlying neuromuscular disease

Most adverse effects are manageable in a controlled clinical setting. Proper monitoring and readiness to provide airway support are critical in minimizing risk.

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

PANCURONIUM should not be used in patients with known hypersensitivity to the drug or in those with certain pre-existing conditions that may increase the risk of complications.

• Absolute Contraindications:
• Known allergy to pancuronium or other bromide compounds
• History of severe anaphylaxis to neuromuscular blocking agents
• Relative Contraindications / Use with Caution:
• Myasthenia gravis or similar neuromuscular disorders
• Electrolyte disturbances (e.g., hypokalemia, hypermagnesemia)
• Severe renal or hepatic dysfunction
• Cardiac arrhythmias or unstable cardiovascular status
• Pregnancy (only if clearly needed)

Pancuronium should always be administered by trained personnel in environments equipped to handle airway management and emergency resuscitation.

Storage of PANCURONIUM 4mg/2ml

Proper storage conditions are essential to ensure the safety and effectiveness of PANCURONIUM 4mg/2ml injection. The product should be handled according to pharmaceutical standards.

• Storage Temperature: 2°C to 8°C (Refrigerated)
• Do Not Freeze: Freezing can degrade the solution
• Light Protection: Store in original box away from direct sunlight
• After Opening: Use immediately; discard unused portion
• Shelf Life: Refer to expiration date on packaging
• Disposal: Discard according to hospital protocol or hazardous waste guidelines

Only use ampoules that are clear, without particles or discoloration. Always verify labeling and expiration before use. Keep out of reach of unauthorized personnel and store in a secure medical facility.