Pancuronium

The use of pancuronium bromide in pregnant women with respect to safety has not been established. Therefore the drug should only be administered to pregnant women when the attending physician decides that the potential benefits outweigh the risks.

Pancuronium bromide may be used for caesarean section. Pancuronium bromide does not affect Apgar score, foetal muscle tonus nor cardiorespiratory adaptation of the new-born. From assays of pancuronium bromide concentration in umbilical blood samples it is apparent that only very limited placental transfer of pancuronium bromide occurs.

The reversal of neuromuscular block induced by pancuronium bromide may be unsatisfactory in patients receiving magnesium sulfate for toxaemia of pregnancy because magnesium salts enhance neuromuscular blockade. Dosages should be reduced in such cases.

The use of pancuronium bromide in breast feeding women with respect to safety has not been established. Therefore the drug should only be administered to lactating women when the attending physician decides that the potential benefits outweigh the risks.

It is not recommended to use potentially dangerous machinery or drive a car within 24 hours after full recovery from the neuromuscular blocking action of pancuronium bromide.

High doses of a depolarising drug may cause end-plate desensitisation and prolong post-operative apnoea.

Cardiac disorders and vascular disorders: Increased pulse rate and cardiac output. Blood pressure may rise. Arrhythmias may occur occasionally.

Eye disorders: Pancuronium bromide decreases intra-ocular pressure and induces miosis, both effects being favourable in ophthalmic surgery.

Gastrointestinal disorders: Salivation is sometimes noted during anaesthesia.

Skin and subcutaneous tissue disorders: Occasional transient rash has been noted.

Immune system disorders: Hypersensitivity

Severe anaphylactoid reactions have been reported uncommonly. In the case of previous anaphylactic reactions to neuromuscular blocking agents, special precautions should be taken since allergic cross reactivity between neuromuscular blocking agents has been reported.

Since neuromuscular blocking agents in general are known to be capable of inducing histamine release both locally and systemically, the possible occurrence of itching and erythematous reactions at the site of injection and/or generalised histaminoid (anaphylactoid) reactions such as bronchospasm and cardiovascular changes should always be taken into consideration when administering these drugs.

General disorders and administration site conditions: Injection Site Reactions: Pain or local skin reactions noted at the site of injection.

Respiratory disorders: Bronchospasm has rarely been reported.