Pancuronium Bromide
Pancuronium bromide
Also known as: Pavulon · Org-NA-97 · pancuronii bromidum · Pancuronium bromide
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| As a paralytic during mechanical ventilation | 0.05-0.1 mg/kg IV | IV | lasts about an hour | — | 🌎 NA |
| General muscle relaxation | 0.044-0.11 mg/kg IV | IV | as needed | — | 🌎 NA |
| Anesthesia maintenance adjunct (when inhalational agents result in severe hypotension) | 0.02-0.04 mg/kg IV | IV | provides 30-45 minutes of muscle relaxation | — | 🌎 NA |
| Neuromuscular blockade during anaesthesia | 0.025-0.075 mg/kg initially; repeat doses at increments of 0.01 mg/kg | IV | as needed | Duration of action >45 min | 🌍 EU |
- As a paralytic during mechanical ventilation: must give sedation as well
- General muscle relaxation: higher dose used initially; lower doses required if repeated doses are necessary
- Anesthesia maintenance adjunct (when inhalational agents result in severe hypotension): Used when IV/regional techniques are inadequate to prevent spontaneous movement
- Neuromuscular blockade during anaesthesia: Initially use a higher dose. Repeated doses may be cumulative and lead to difficulty in antagonism.
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| General muscle relaxation | 0.044-0.11 mg/kg IV | IV | as needed | — | 🌎 NA |
| Neuromuscular blockade during anaesthesia | 0.025-0.075 mg/kg initially; repeat doses at increments of 0.01 mg/kg | IV | as needed | Duration of action >45 min | 🌍 EU |
- General muscle relaxation: higher dose used initially; lower doses required if repeated doses are necessary
- Neuromuscular blockade during anaesthesia: Initially use a higher dose. Repeated doses may be cumulative and lead to difficulty in antagonism.
Small Mammals
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Muscle relaxation | 0.1 mg/kg IV | IV | as needed | — | 🌎 NA |
- Muscle relaxation: Dose for rabbits
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Pancuronium bromide is a non-depolarizing neuromuscular blocking agent primarily used as an adjunct to general anesthesia. It provides skeletal muscle relaxation to facilitate endotracheal intubation, mechanical ventilation, and various surgical procedures.
CRITICAL CLINICAL NOTE: Pancuronium possesses NO analgesic, sedative, or amnestic properties. Patients must be adequately sedated and anesthetized before and during its use to prevent the terrifying experience of being paralyzed while conscious.
- It is a long-acting aminosteroid muscle relaxant.
- Compared to other agents, it has a relatively long duration of action (30-45 minutes depending on dose) and relies heavily on renal excretion.
- It is considered 5 times as potent as d-tubocurarine and approximately ⅓ as potent as vecuronium (though some sources suggest equipotency in animals).
Mechanism of action
Pancuronium acts as a competitive antagonist at the nicotinic acetylcholine receptors (nAChRs) located at the neuromuscular junction (motor endplate).
- Pancuronium competitively binds to nAChRs → prevents acetylcholine (ACh) from binding → inhibits depolarization of the muscle fiber membrane → results in flaccid skeletal muscle paralysis.
- Cardiovascular Effects: Unlike some other neuromuscular blockers, pancuronium has slight vagolytic (anticholinergic) activity at postganglionic muscarinic receptors in the heart → leads to slight increases in heart rate and blood pressure.
- It rarely causes histamine release compared to older agents like d-tubocurarine.
Safety & warnings
Contraindications
- Known hypersensitivity to pancuronium or bromides
- Myasthenia gravis (extreme caution or contraindicated)
- Conscious or inadequately anaesthetized animals
- Lack of positive pressure ventilation facilities
- Lack of monitoring equipment (nerve stimulator)
Adverse effects
- Slight elevations in cardiac rate and blood pressure
- Hypersalivation (if not pretreated with an anticholinergic agent)
- Prolonged or profound muscular weakness
- Respiratory depression
- Histamine release with resultant hypersensitivity reaction (Very Rare)
- Tachycardia (due to vagolytic effect)
- Prolonged neuromuscular blockade
- Mild hypertension
Precautions
WARNING: Pancuronium has NO analgesic or sedative/anesthetic actions. It must only be used in adequately anesthetized/sedated patients with full ventilatory support available.
- Extreme Caution: Patients with myasthenia gravis (neuromuscular blocking agents should be used with extreme caution, if at all).
- Caution: Renal dysfunction. Plasma half-lives are doubled in renal failure; atracurium may be a better choice for these patients.
- Caution: Hepatic or biliary disease (lower doses may be necessary).
- Caution: Patients where tachycardias may be deleterious (due to the drug's slight vagolytic effects).
Drug interactions
May reverse pancuronium's neuromuscular blocking effects
May enhance the neuromuscular blocking activity of pancuronium
May reverse the effects of nondepolarizing neuromuscular blocking agents
May enhance the neuromuscular blocking activity of pancuronium
May enhance the neuromuscular blocking activity of pancuronium
May enhance the neuromuscular blocking activity of pancuronium
May speed the onset of action and enhance the neuromuscular blocking actions of pancuronium. Do not give pancuronium until succinylcholine effects have subsided.
May inhibit or reverse the neuromuscular blocking action of pancuronium and possibly induce arrhythmias
Increased risk for cardiac arrhythmias when used with halothane anesthesia
Prolonged neuromuscular blockade
Prolonged neuromuscular blockade
Prolonged neuromuscular blockade
Prolonged neuromuscular blockade
Monitoring
- Level of neuromuscular blockade (via peripheral nerve stimulation)
- Cardiac rate and rhythm
- Blood pressure
- Adequacy of ventilation and oxygenation
- Peripheral nerve stimulation (e.g., Train-of-Four)
- Heart rate and rhythm
- Respiratory rate, effort, and ventilator parameters (EtCO2, SpO2)
- Body temperature
- Acid-base status
- Serum potassium levels
Pharmacokinetics
Half-life
Absorption
After IV administration, muscle relaxation sufficient for endotracheal intubation generally occurs within 2-3 minutes (dose-dependent). Duration of action may persist 30-45 minutes.
Distribution
In humans, approximately 87% bound to plasma proteins, but may be used in hypoalbuminemic patients. Activity is not substantially affected by plasma pH or carbon dioxide levels.
Metabolism
Partially metabolized by the liver.
Elimination
Approximately 40% is excreted unchanged by the kidneys. The remainder is excreted in the bile (11%) or metabolized by the liver. In patients with renal failure, plasma half-lives are doubled.
Overdose
Overdosage increases the risk of hypotension, histamine release, and prolonged duration of muscle blockade.
Treatment:
- Conservative Support: Maintain mechanical ventilation, oxygen therapy, and IV fluids until spontaneous breathing returns.
- Pharmacologic Reversal: Blockade may be reversed by administering an anticholinesterase agent (e.g., edrophonium, physostigmine, or neostigmine).
- CRITICAL: An anticholinergic (atropine or glycopyrrolate) MUST be administered prior to or alongside the reversal agent to prevent severe bradycardia and muscarinic side effects.
- Suggested Reversal Protocol: Neostigmine 0.06 mg/kg IV after Atropine 0.02 mg/kg IV.
Available products
Formulations
- Injection: 1 mg/mL
- Injection: 2 mg/mL
- 2 mg/ml injectable solution
Human-labeled
- Pancuronium Bromide for Injection: 1 mg/mL in 10 mL vials
- Pancuronium Bromide for Injection: 2 mg/mL in 2 mL & 5 mL vials & ampules
- Pancuronium bromide 2 mg/ml injection
Regulatory status
POM (Prescription Only Medicine). Use restricted to anaesthetized animals with ventilation support.
POM-V. Use restricted to anaesthetized animals with ventilation support.
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store under refrigeration (2-8°C). According to the manufacturer, it is stable for 6 months at room temperature. Do not store pancuronium in plastic syringes or containers as it may be adsorbed to plastic surfaces (it may be administered in plastic syringes, however).
Client information
Pancuronium is a strong muscle relaxant used strictly in hospital settings during surgery or when a pet needs help breathing on a mechanical ventilator.
- No Pain Relief: This drug does not provide pain relief or sedation. Your veterinary team will always ensure your pet is fully asleep, unconscious, and comfortable with other anesthetic medications before giving this drug.
- Breathing Support: Because it temporarily stops all skeletal muscles from moving, including the muscles used for breathing, your pet's breathing will be carefully supported by a machine and continuously monitored by professionals while under its effects.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.