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The most frequent adverse reaction to nondepolarizing blocking agents as a class consists of an extension of drug's pharmacological action beyond the time period needed. This may vary from skeletal muscle weakness to profound and prolonged skeletal muscle paralysis resulting in respiratory insufficiency or apnea.
Inadequate reversal of the neuromuscular blockade is possible with PAVULON® (pancuronium bromide injection) as with all curariform drugs. These adverse experiences are managed by manual or mechanical ventilation until recovery is judged adequate.
Prolonged paralysis and/or skeletal muscle weakness have been reported after long-term use to support mechanical ventilation in the intensive care unit.
See discussion of circulatory effects in CLINICAL PHARMACOLOGY.
Salivation is sometimes noted during very light anesthesia, especially if no anticholinergic premedication is used.
An occasional transient rash is noted accompanying the use of PAVULON® (pancuronium bromide injection) .
Although histamine release is not a characteristic action of PAVULON® (pancuronium bromide injection) , rare hypersensitivity reactions such as bronchospasm, flushing, redness, hypotension, tachycardia, and other reactions possibly mediated by histamine release have been reported.
There have been post-marketing reports of severe allergic reactions (anaphylactic and anaphylactoid reactions) associated with the use of neuromuscular blocking agents, including PAVULON® (pancuronium bromide injection) . These reactions, in some cases, have been life-threatening and fatal. Because these reactions were reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency (see WARNINGS AND PRECAUTIONS).
Read the Pavulon (pancuronium bromide injection) Side Effects Center for a complete guide to possible side effects
Prior administration of succinylcholine may enhance the neuromuscular blocking effect of PAVULON® (pancuronium bromide injection) and increase its duration of action. If succinylcholine is used before PAVULON® (pancuronium bromide injection) the administration of PAVULON® (pancuronium bromide injection) should be delayed until the patient starts recovering from succinylcholine-induced neuromuscular blockade.
If a small dose of PAVULON® (pancuronium bromide injection) is given at least 3 minutes prior to the administration of succinylcholine, in order to reduce the incidence and intensity of succinylcholine-induced fasciculations, this dose may induce a degree of neuromuscular block sufficient to cause respiratory depression in some patients.
Other nondepolarizing neuromuscular blocking agents (vecuronium, atracurium, d-tubocurarine, metocurine, and gallamine) behave in a clinically similar fashion to PAVULON® (pancuronium bromide injection) . The combinations of PAVULON® (pancuronium bromide injection) -metocurine and PAVULON® (pancuronium bromide injection) -d-tubocurarine are significantly more potent than the additive effects of each of the individual drugs given alone; however, the duration of blockade of these combinations is not prolonged. There are insufficient data to support concomitant use of pancuronium and the other three above mentioned muscle relaxants in the same patients.
Use of volatile inhalational anesthetics such as enflurane, isoflurane, and halothane with PAVULON® (pancuronium bromide injection) will enhance neuromuscular blockade. Potentiation is most prominent with use of enflurane and isoflurane.
With the above agents, the intubating dose of PAVULON® (pancuronium bromide injection) may be the same as with balanced anesthesia unless the inhalational anesthetic has been administered for a sufficient time at a sufficient dose to have reached clinical equilibrium. The relatively long duration of action of pancuronium should be taken into consideration when the drug is selected for intubation in these circumstances.
Clinical experience and animal experiments suggest that pancuronium should be given with caution to patients receiving chronic tricyclic antidepressant therapy who are anesthetized with halothane because severe ventricular arrhythmias may result from this combination. The severity of the arrhythmias appears in part related to the dose of pancuronium.
Parenteral/intraperitoneal administration of high doses of certain antibiotics may intensify or produce neuromuscular block on their own. The following antibiotics have been associated with various degrees of paralysis: aminoglycosides (such as neomycin, streptomycin, kanamycin, gentamicin, and dihydrostreptomycin); tetracyclines; bacitracin; polymyxin B; colistin; and sodium colistimethate. If these or other newly introduced antibiotics are used preoperatively or in conjunction with PAVULON® (pancuronium bromide injection) , unexpected prolongation of neuromuscular block should be considered a possibility.
Experience concerning injection of quinidine during recovery from use of other muscle relaxants suggests that recurrent paralysis may occur. This possibility must also be considered for PAVULON® (pancuronium bromide) injection.
Electrolyte imbalance and diseases which lead to electrolyte imbalance, such as adrenal cortical insufficiency, have been shown to alter neuromuscular blockade. Depending on the nature of the imbalance, either enhancement or inhibition may be expected. Magnesium salts, administered for the management of toxemia of pregnancy, may enhance the neuromuscular blockade.
Drug/laboratory test interactions
None known.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 1/11/2011
Additional Pavulon Information
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