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Pancuronium Bromide(BAN, USAN, Rinn)

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Pancuronium Bromide(BAN, USAN, Rinn) Doxacurium Chloride/Pancuronium Bromide 1907 product information recommends that such patients should be ma or cardiovascular disease, or those who are sensi- Preparations given a test dose of 15 to 20 micrograms/kg with subsequent tive to falls in arterial blood pressure, it should be given dosage adjustments being guided by monitoring of the block. Proprietary Preparations (details are given in Part 3) over 60 seconds. To give a dose of 250 micrograms/kg Arg.: Mivacron; Austral.: Mivacron; Austria: Mivacron; Novacrium; Belg.: Neuromuscular disorders. Neuromuscular blockade was for tracheal intubation, an injection of Mivacron; Braz.: Mivacron†; Canad.: Mivacron†; Chile: Mivacron; Cz.: successfully achieved with mivacurium in an obese elderly pa- Mivacron; Denm.: Mivacron; Fin.: Mivacron; Fr.: Mivacron; Ger.: Mivacron; tient with myasthenia gravis requiring surgery.1 Only about half 150 micrograms/kg may be followed 30 seconds later Gr.: Mivacron; Hong Kong: Mivacron; Hung.: Mivacron; Irl.: Mivacron; by an injection of 100 micrograms/kg. Maintenance Israel: Mivacron†; Ital.: Mivacron; Malaysia: Mivacron; Neth.: Mivacron; the usual dose was required and even then recovery was delayed. Norw.: Mivacron; NZ: Mivacron; Pol.: Mivacron; Port.: Mivacron; Rus.: See Atracurium, p.1903 for a discussion of the use of competi- doses of 100 micrograms/kg may be given at intervals Mivacron (Мивакрон); S.Afr.: Mivacron; Singapore: Mivacron; Spain: Mi- tive neuromuscular blockers in patients with neuromuscular dis- of 15 minutes. In children aged 2 to 6 months an initial vacron; Swed.: Mivacron; Switz.: Mivacron; Turk.: Mivacron; UK: Miva- orders. dose of 150 micrograms/kg has been given; in children cron; USA: Mivacron†. 1. Seigne RD, Scott RPF. Mivacurium chloride and myasthenia gravis. Br J Anaesth 1994; 72: 468–9. aged 7 months to 12 years, an initial dose of 200 micrograms/kg has been given. A maintenance Plasma cholinesterase deficiency. There have been reports (BAN, USAN, rINN) of prolonged neuromuscular block produced by mivacurium in dose of 100 micrograms/kg may be given every 6 to 9 Pancuronium Bromide patients with plasma cholinesterase deficiency.1-4 Time to full re- minutes for children aged 2 months to 12 years. Bromuro de pancuronio; NA-97; Org-NA-97; Pancuronii bromi- covery varied; one patient required up to 8 hours. Mivacurium chloride may also be given by continuous dum; Pancuronium, bromure de; Pankuronio bromidas; Pankuro- 1. Goudsouzian NG, et al. Prolonged neuromuscular block from intravenous infusion for maintenance of block. For niowy bromek; Pankuroniumbromid; Pankuronium-bromid; Pan- mivacurium in two patients with cholinesterase deficiency. An- esth Analg 1993; 77: 183–5. adults the initial rate is 8 to 10 micrograms/kg per kuroniumbromidi; Pankuronyum Bromür. 1,1′-(3α,17β-Diace- 2. Sockalingam I, Green DW. Mivacurium-induced prolonged neu- minute adjusted every 3 minutes if necessary by incre- toxy-5α-androstan-2β,16β-ylene)bis(1-methylpiperidinium) di- romuscular block. Br J Anaesth 1995; 74: 234–6. ments of 1 microgram/kg per minute to a usual rate of bromide. 3. Fox MH, Hunt PCW. Prolonged neuromuscular block associated with mivacurium. Br J Anaesth 1995; 74: 237–8. 6 to 7 micrograms/kg per minute; in children aged 2 Панкурония Бромид 4. Zimmer S. Mivacurium and prolonged neuromuscular block. Br months to 12 years the usual dose is 11 to C35H60Br2N2O4 = 732.7. J Anaesth 1995; 75: 823. 14 micrograms/kg per minute. CAS — 15500-66-0. Tourniquets. Mivacurium might be unsuitable for neuromus- Reduced doses may be required in the elderly and in ATC — M03AC01. cular blockade of a limb which has been isolated with a tourni- patients with hepatic or renal impairment (see below). ATC Vet — QM03AC01. quet in order to provide a bloodless field for surgery.1 It is largely inactivated by the enzymatic action of plasma cholinesterase and ◊ Reviews. would therefore continue to degrade locally leading to a loss of 1. Mirakhur RK. Newer neuromuscular blocking drugs: an over- blockade in the limb, which could not be corrected by further view of their clinical pharmacology and therapeutic use. Drugs O doses unless the tourniquet was deflated. However, as for other 1992; 44: 182–99. competitive neuromuscular blockers, the use of mivacurium to 2. Frampton JE, McTavish D. Mivacurium: a review of its pharma- H C O cology and therapeutic potential in general anaesthesia. Drugs 3 supplement regional anaesthesia has produced prolonged muscle H3C + 2 1993; 45: 1066–89. N weakness well beyond cuff deflation. This suggests that miva- 3. Feldman S. Mivacurium. Br J Hosp Med 1997; 57: 199–201. curium is not broken down in the ischaemic limb and that recov- CH3 HCH + 3 CH ery is not dependent on plasma concentrations of mivacurium. Action. Mivacurium has a shorter duration of action than most N 3 2 Br− other competitive neuromuscular blockers. Studies1-3 suggest See also Local Anaesthetics, under Interactions of Atracurium, HH p.1904, for a report of symptoms suggestive of local anaesthetic that it is a useful alternative to suxamethonium for the production of neuromuscular block of short duration and has the advantage O toxicity when prilocaine and mivacurium were used together. H 1. Shannon PF. Neuromuscular block and tourniquets. Br J Anaesth that its block can be reversed with an anticholinesterase. For a discussion of the choice of anticholinesterase for reversal of neu- 1994; 73: 726. O CH3 2. Torrance JM, et al. Low-dose mivacurium supplementation of romuscular block produced by short-acting blockers such as mi- prilocaine i.v. regional anaesthesia. Br J Anaesth 1997; 78: vacurium, see under Neostigmine, p.633. Although its onset of 222–3. action may be accelerated by giving a priming dose,4 mivacuri- um has a slower onset than suxamethonium and so may not be a Pharmacopoeias. In Eur. (see p.vii), Jpn, and US. Interactions suitable alternative5 when rapid intubation is required. For a gen- Ph. Eur. 6.2 (Pancuronium Bromide). White, yellowish-white, For interactions associated with competitive neu- eral review of neuromuscular blockers, see Anaesthesia, p.1900. or slightly pink, hygroscopic crystalline powder. Very soluble to 1. Brandom BW, et al. Comparison of mivacurium and suxametho- freely soluble in water; freely soluble in alcohol; very soluble in romuscular blockers, see Atracurium, p.1903. nium administered by bolus and infusion. Br J Anaesth 1989; 62: dichloromethane. Store in airtight containers. Protect from light. 488–93. Metoclopramide. Metoclopramide, an inhibitor of plasma USP 31 (Pancuronium Bromide). A white, yellowish-white, or 2. Caldwell JE, et al. Comparison of the neuromuscular block in- slightly pink, crystalline hygroscopic powder. Freely soluble in cholinesterase, was found to significantly prolong the duration of duced by mivacurium, suxamethonium or atracurium during ni- action of mivacurium in patients undergoing surgery, although in trous oxide-fentanyl anaesthesia. Br J Anaesth 1989; 63: 393–9. water, in alcohol, and in dichloromethane. Store in airtight con- this study only marginal inhibition of plasma cholinesterase by 3. Goldberg ME, et al. Comparison of tracheal intubating condi- tainers at a temperature of 15° to 25°. Protect from light. metoclopramide occurred.1 tions and neuromuscular blocking profiles after intubating doses 1. Skinner HJ, et al. Influence of metoclopramide on plasma of mivacurium chloride or succinylcholine in surgical outpa- Adverse Effects, Treatment, and Precau- cholinesterase and duration of action of mivacurium. Br J tients. Anesth Analg 1989; 69: 93–9. tions Anaesth 1999; 82: 542–5. 4. Haxby EJ, et al. Mivacurium priming intervals. Br J Anaesth 1994; 72: 485P. As for competitive neuromuscular blockers in general Pharmacokinetics 5. Anonymous. Mivacurium—a new neuromuscular blocker. Med (see Atracurium, p.1902). Lett Drugs Ther 1992; 34: 82. Pancuronium has vagolytic and sympathomimetic ac- Mivacurium is a mixture of 3 stereoisomers, 2 of which 1 Administration in the elderly. In a study comparing the ef- tion, which may cause tachycardia and hypertension, (cis-trans and trans-trans) are considered to account fects of mivacurium in elderly and young adults, the duration of for most of the neuromuscular blocking effect. All 3 neuromuscular effects was prolonged in elderly patients by about but does not produce ganglionic blockade. It has little isomers are inactivated by plasma cholinesterase. Re- 30%. The mean infusion requirement in elderly patients was histamine-releasing effect. Hypersensitivity reactions nal and hepatic mechanisms are involved in their elim- 3.67 micrograms/kg per minute compared with are relatively rare but bradycardia, bronchospasm, hy- ination with excretion in urine and bile. 5.5 micrograms/kg per minute in young adults. potension, and cardiovascular collapse have been re- Licensed product information states that elderly patients may re- ported. Pancuronium has been associated with exces- ◊ Reviews. quire decreased infusion rates or smaller or less frequent mainte- sive salivation in some patients. 1. Atherton DPL, Hunter JM. Clinical pharmacokinetics of the nance bolus doses. newer neuromuscular blocking drugs. Clin Pharmacokinet 1999; 1. Maddineni VR, et al. Neuromuscular and haemodynamic effects Pancuronium should be used with caution in patients 36: 169–89. of mivacurium in elderly and young adult patients. Br J Anaesth with raised catecholamine concentrations, or in those 1994; 73: 608–12. who are receiving drugs with sympathomimetic ef-
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