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Pharmacology · Neuromuscular blockers

Pancuronium !

Long-acting aminosteroid muscle relaxant, the prototype of the group. Its vagolytic effect causes tachycardia; it is eliminated mostly by the kidney.

Updated 2026-11-01

  • Class: Neuromuscular blockers
  • Receptor: Muscle nicotinic acetylcholine receptor (motor end plate)
  • ATC code: M03AC01

Also called: Pancuronium bromide

There is no structure with pancuronium. The figure shows rocuronium, another aminosteroid, at the acetylcholine site of the Torpedo ray muscle-type nicotinic receptor.

Target in 3D: Muscle nicotinic acetylcholine receptor (motor end plate). PDB structure 8ESK (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Pancuronium competes with acetylcholine for the nicotinic receptor of the motor end plate without activating it and produces long-lasting flaccid paralysis. It releases no histamine, but it blocks cardiac muscarinic receptors (vagolytic effect), which raises heart rate and blood pressure.

  1. Competes with acetylcholine at the nicotinic receptor
  2. Long-lasting flaccid paralysis
  3. Blocks cardiac muscarinic receptors: tachycardia
  4. Renal and hepatic elimination: accumulates if they fail

Pharmacokinetics

Metabolism
Part is hydrolysed in the liver to active metabolites.
Elimination
Renal and hepatic; failure of these organs prolongs its effect.

Indications

  • Prolonged muscle relaxation in long surgery or mechanical ventilation when a lasting block is wanted

Adverse effects

Common

  • Tachycardia
  • Hypertension
  • Increased cardiac output

Contraindications

  • Hypersensitivity to pancuronium

Key interactions

Halogenated agents, aminoglycosides, magnesium, lithium
Enhance the block.
Neostigmine with atropine or glycopyrronium
Reverse the competitive block.

What is monitored

  • Train-of-four
  • Heart rate and blood pressure
  • Renal function

Administration and safety

  • Paralysing agent: store apart with warnings.
  • Only with adequate sedation or anaesthesia and ventilation available.

Nursing care

  • Watch heart rate and blood pressure after the dose, with extra care if there is kidney or coronary disease.
  • Assess recovery of strength before extubation; the effect lasts longer than other blockers.
  • Care for the eyes and skin of the paralysed patient.

Test yourself

Think of the answer, then tap the question to see it.

Why does pancuronium cause tachycardia?

It blocks cardiac muscarinic receptors (vagolytic effect).

Which organs eliminate pancuronium?

The kidney and the liver; if they fail, its effect is prolonged.

What advantage do vecuronium and rocuronium have over pancuronium?

Their duration is intermediate and they cause almost no tachycardia, because they lack the vagolytic effect.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 13 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.