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Action/Kinetics:
Five times as potent as d-tubocurarine. Anticholinesterase agents will reverse effects. Possesses vagolytic activity although it is not likely to cause histamine release.
Onset: Within 45 sec.
Time to peak effect: 3-4.5 min (depending on the dose).
Duration: 35-45 min (increased with multiple doses).
t
1/2, elimination: 89-161 min. Forty percent is excreted through the urine either unchanged or as metabolites; 10% is excreted through the bile. In clients with renal failure, the t
1/2 is doubled. Significantly bound to plasma protein.
Uses:
Adjunct to anesthesia to produce relaxation of skeletal muscle. Facilitate ET intubation. Facilitate management of clients undergoing mechanical ventilation.
Special Concerns:
Children up to 1 month of age may be more sensitive to the effects of atracurium. Clients with myasthenia gravis or Eaton-Lambert syndrome may have profound effects from small doses.
Additional Side Effects:
Respiratory:
Apnea, respiratory insufficiency.
CV: Increased HR and MAP.
Miscellaneous: Salivation, skin rashes,
hypersensitivity reactions (e.g., bronchospasm flushing, hypotension, redness, tachycardia).
Additional Drug Interactions:
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Azathioprine / Reverses effects of pancuronium
-
Bacitracin / Additive muscle relaxation
-
Enflurane /
Muscle relaxation
-
Isoflurane /
Muscle relaxation
-
Metocurine /
Muscle relaxation but duration is not prolonged
-
Quinine /
Effect of pancuronium
-
Sodium colistimethate /
Muscle relaxation
-
Succinylcholine /
Intensity and duration of action of pancuronium
-
Tetracyclines / Additive muscle relaxation
-
Theophyllines /
Effects of pancuronium; also, possible cardiac arrhythmias
-
Tricyclic antidepressants with halothane / Administration of pancuronium may cause severe arrhythmias
-
Tubocurarine /
Muscle relaxation but duration is not prolonged
How Supplied:
Injection: 1 mg/mL, 2 mg/mL
Dosage
?IV Only
Muscle relaxation during anesthesia.
Adults and children over 1 month of age, initial: 0.04-0.1 mg/kg. Additional doses of 0.01 mg/kg may be administered as required (usually q 20-60 min).
Neonates: Administer a test dose of 0.02 mg/kg first to determine responsiveness.
ET intubation.
0.06-0.1 mg/kg as a bolus dose. Can undertake intubation in 2 to 3 min.
