Dosing and uses of Pavulon (pancuronium)
Adult dosage forms and strengths
injectable solution
- 1mg/mL
- 2mg/mL
General Anesthesia Adjunct/Cesarean Section
Load: 0.04-0.1 mg/kg IV
Maintenance: 0.015-0.1 mg/kg IV q30-60min Or
Continuous infusion: 0.1 mg/kg/hr IV
Dose should be calculated based on ideal body weight
Monitoring of muscle twitch response to a peripheral nerve stimulator is advised
Endotracheal Intubation
Bolus dose 0.06-0.1 mg/kg
Usually effective with in 2-3 minutes
Other Indications & Uses
Skeletal muscle relaxation during surgery, endotracheal intubation, mechanical ventilation
Pediatric dosage forms and strengths
injectable solution
- 1mg/mL
- 2mg/mL
Neonates (<28 Days Old)
Load: 0.02 mg/kg IV
Maintenance: 0.05-0.1 mg/kg IV q0.5-4hr PRn
>1 Month Old
Load: 0.04-0.1 mg/kg IV
Maintenance: 0.015-0.1 mg/kg IV q30-60min Or
Continual infusion: 0.1 mg/kg/hr IV
Pavulon (pancuronium) adverse (side) effects
Frequency not defined
Slight elevation in pulse rate
Elevations in blood pressure
Excessive salivation
Excessive sweating (in children)
Transient rashes
Wheezing
Dose-related tachycardia
Histamine release (bronchospasm/hypotension)
CAUTION: adequate ventilatory support mandatory, may experience resistance with >25% TBSA burns, may experience incr sensitivity w/electrolyte disorders (hyperMg, hypoK, hypoCa)
Warnings
Black box warnings
The drug should be administered only by adequately trained individuals familiar with its actions, characteristics, and hazards
Contraindications
Lack of ventilatory support, neuromuscular disease
Hypersensitive to drug &/or bromides
Cautions
Additive/synergistic effects if administered with or following an opioid, sedative or anesthetic agent
In pts with poor renal perfusion or severe renal disease, preexisting tachycardia
Severe anaphylactic reactions to neuromuscular blocking agents have been reported; these reactions have, in some cases, been life threatening and fatal; because of the potential severity of these reactions, the necessary precautions, such as the immediate availability of appropriate emergency treatment, should be taken
Pregnancy and lactation
Pregnancy category: C
Lactation: not known if excreted in breast milk; effect on nursing infant not known
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Pavulon (pancuronium)
Half-Life:
2 hr (terminal phase)
Renal dysfunction may incr half-life 50%
Other Information
Onset: 1-2 min
Duration: 60 min
Protein Bound: 87% (range: 77-91%)
Metabolism: primarily none, some hepatic transformation to weakly active metabolite
Excretion: unchanged in urine
Little effect on intraocular/intracranial pressure
Very rarely causes release of histamine (and hypotension, bronchospasm, flushing); more commonly causes dose-related tachycardia by blocking cardiac ACh receptors
Mechanism of action
Non-depolarizing skeletal muscle relaxant; cholinergic receptor antagonist
Administration
IV Compatibilities
Additive: ciprofloxacin, verapamiL
Syringe: caffeine, heparin
Y-site: aminophylline, cefazolin, cefuroxime, cimetidine, dobutamine, dopamine, epinephrine, esmolol, etomidate, fenoldopam, fentanyl, fluconazole, gentamicin, heparin, Hextend, hydrocortisone, isoproterenol, levofloxacin, lorazepam, midazolam, milrinone, morphine, nitroglycerin, propofol (1 mg/mL), ranitidine, Na nitroprusside, trimethoprim/sulfamethoxazole, vancomycin
IV Incompatibilities
Y-site: diazepam, thiopentaL
IV Preparation
Solution: add to an empty Viaflex bag & infuse undiluted (2 mg/mL); however, if necessary, may be diluted in D5W, NS, or Lr
Continuous infusions may be given by using undiluted drug
IV Administration
Use controlled microinfusion device
Storage
Store at 2-8 C; stable at RT x 6mth
