Pancuronium

Generic name
Pancuronium
Brand name
ATC Code
M03AC01
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Pancuronium

Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

The volume of distribution is greater in neonates than in older children. For the same dose in neonates and in older children, the concentration at the myoneural junction will be lower in neonates.
Most non-depolarizing muscle relaxants are cleared by the kidneys; the relatively immature renal function can lead to a prolonged elimination time in children.

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Neuromuscular blockade
  • Intravenous
    • 1 month up to 18 years
      • Initial dose: 0.1 mg/kg/dose, once only. (When pancuronium is used only for intubation, the starting dose is sufficient).
      • Maintenance dose: 0.01 mg/kg/dose, bolus. Repeat doses if indicated based on the Train of Four (ToF) test..
    • Term neonate
      • Initial dose: 0.1 mg/kg/dose, once only. (When pancuronium is used only for intubation, the starting dose is sufficient).
      • Maintenance dose: 0.01 mg/kg/dose, bolus. Repeat doses if indicated based on the Train of Four (ToF) test..

      • Due to the variable sensitivity to non-depolarizing neuromuscular blockers, it is recommended that an initial test dose of 0.01 to 0.02 mg/kg should be used in new-borns

Renal impaiment in children > 3 months

No information available on dose adjustment in renal impairment.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Tachycardia, particularly in young children.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications

No information available on specific contra indications in children.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Monitor neuromuscular function. The duration of action for muscle relaxants is so variable that relaxation measurement should be considered before extubation and to antagonize if necessary.

Cross hypersensitivity - including from other groups - is possible. This may be based on the excipients but also on the active substance. Advice is to consult a pediatric allergist in case of a suspected allergic reaction to a muscle relaxant and with the request to also test for safety of alternative muscle relaxants.

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

Choline derivatives
M03AB01
Other quaternary ammonium compounds
M03AC04
M03AC11
M03AC10
M03AC09
M03AC03
Other muscle relaxants, peripherally acting agents
M03AX01

References

  1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
  2. NV Organon, SPC Pavulon (RVG 05804), www.cbg-meb.nl, Geraadpleegd 02 juli 2010, http://db.cbg-meb.nl/IB-teksten/h05804.pdf

Changes

Therapeutic Drug Monitoring


Overdose