pancuronium bromide

CLINICAL USE

Non-depolarising muscle relaxant of long duration

DOSE IN NORMAL RENAL FUNCTION

Initial dose: 50–100 micrograms/kgIncremental dose:

10 to 20 : micrograms/kg

PHARMACOKINETICS

Molecular weight :732.7

%Protein binding :80–90

%Excreted unchanged in urine : 40–60

Volume of distribution (L/kg) :0.15–0.38

half-life – normal/ESRD (hrs) :2/4.3–8.2

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Initial dose: 25–50 micrograms/kg Incremental dose: 5–10 micrograms/kg

<10 : Initial dose: 10–25 micrograms/kg Incremental dose: 2.5–5 micrograms/kg

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in GFR <10 mL/min

HD :Unknown dialysability. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced muscle relaxant effect

Anti-arrhythmics: procainamide enhances muscle relaxant effect

Antibacterials: effect enhanced by aminoglycosides, clindamycin, polymyxins and piperacillinBotulinum toxin: neuromuscular block enhanced (risk of toxicity)

ADMINISTRATION

Reconstition

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Route

Rate of Administration

Bolus

Comments

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OTHER INFORMATION

Active metabolites accumulate in CKD 5; duration of action prolonged

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