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The possibility of iatrogenic overdosage can be minimized by carefully monitoring the muscle twitch response to peripheral nerve stimulation.
Excessive doses of PAVULON® (pancuronium bromide injection) produce enhanced pharmacological effects. Residual neuromuscular blockade beyond the time period needed may occur with PAVULON® (pancuronium bromide injection) as with other neuromuscular blockers. This may be manifested by skeletal muscle weakness, decreased respiratory reserve, low tidal volume, or apnea. A peripheral nerve stimulator may be used to assess the degree of residual neuromuscular blockade and help to differentiate residual neuromuscular blockade from other causes of decreased respiratory reserve.
Regonol® (pyridostigmine bromide) injection, neostigmine, or edrophonium, in conjunction with atropine or glycopyrrolate, will usually antagonize the skeletal muscle relaxant action of PAVULON® (pancuronium bromide injection) . Satisfactory reversal can be judged by adequacy of skeletal muscle tone and by adequacy of respiration. A peripheral nerve stimulator may also be used to monitor restoration of twitch response.
Failure of prompt reversal (within 30 minutes) may occur in the presence of extreme debilitation, carcinomatosis, and with concomitant use of certain broad spectrum antibiotics, or anesthetic agents and other drugs which enhance neuromuscular blockade or cause respiratory depression of their own. Under such circumstances, the management is the same as that of prolonged neuromuscular blockade. Ventilation must be supported by artificial means until the patient has resumed control of his respiration. Prior to the use of reversal agents, reference should be made to the specific package insert of the reversal agent.
PAVULON® (pancuronium bromide injection) is contraindicated in patients known to be hypersensitive to the drug. PAVULON® (pancuronium bromide injection) is contraindicated for use in neonates, including premature infants, because the formulation contains benzyl alcohol (see WARNINGS AND PRECAUTIONS: Pediatric Use).
Last reviewed on RxList: 1/11/2011
This monograph has been modified to include the generic and brand name in many instances.
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