Pancuronium Intravenous for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

To be used by anaesthetists only
Anaphylactic reactions have been documented, as has cross-reactivity with other neuromuscular-blocking agents
Dose obese patients based on Ideal Body Weight (Patient is obese if actual body weight is 20% or more above ideal body weight or BMI > 30 ) ^{(ref 1,4)}
See under 'Dose' for adjustments required in renal or hepatic impairment

Pancuronium bromide 4mg per 2mL ampoule

Already in solution

Draw up using a 5 micron filter needle

Bolus intravenous injection

Intubation

Initial dose: 50 to 80 microgram/kg (intubation accomplished within 150-120 seconds), or 80 to 100 micrograms/kg (intubation accomplished within 120-90 seconds)
Incremental doses of 10 to 20 microgram/kg may be needed
Reduce initial dose to 20 to 60 microgram/kg in patients who have recently received suxamethonium
See under 'Further information' for use in ICU

Obesity

To avoid excessive dosage in obese patients, dose should be calculated on the basis of Ideal Body Weight (IBW)- see further information ^{(ref 1)}
In obese patients, doses based on a mg/kg of actual body weight may lead to overdose

Renal impairment

Prolonged elimination likely as pancuronium is predominantly cleared by the kidneys
Patients with chronic renal failure may require a larger initial dose of pancuronium. A 45% increase in dose requirement has been reported in patients with end-stage renal failure (this is because of an increased volume of distribution) ^{(ref 3)}
Recovery from neuromuscular blockade may be prolonged

Hepatic disease or biliary tract disease

The duration of action may be prolonged. Also, resistance to neuromuscular blockade may occur because of the increased volume of distribution of the drug
In such conditions, the drug has a slower onset, and coupled with increased dosage requirements, there may be a prolongation of blockade and recovery time in these patients

Not used for maintenance in ICU, however doses of 60 microgram/kg up to every 60 to 90 minutes, or even less frequently, are usually adequate ^{(ref 2)}
Licensed for administration by bolus intravenous injection only. However, it may be diluted in Sodium chloride 0.9% or Glucose 5% and administered as an infusion if required (unlicensed) ^{(also ref 2)}
Patient is obese if actual body weight is 20% or more above ideal body weight or BMI > 30 ^{(ref 4)}Ideal body weight (IBW) calculations
Male 50kg + (2.3 x inches over 5 feet) or 50kg + (0.9 x cm over 152 cm)
Female 45.5kg + (2.3 x inches over 5 feet) or 45.5kg + (0.9 x cm over 152 cm)

Store between 2 and 8⁰C

SPC December 2020, SPC UK March 2021 (Hospira)

1: BNF 82

2: Injectable Medicines Administration Guide UCL Hospitals 3rd edition

3: Martindale - accessed online 08/11/2021

4: Sanford guide to antimicrobial therapy (information on obesity extrapolated from data on antimicrobials)- accessed online 16/11/2021

Muscle relaxant