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# 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](https://durgical.com/en/pharmacology/classes/neuromuscular-blockers/)
- Receptor: Muscle nicotinic acetylcholine receptor (motor end plate)
- ATC code: M03AC01

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

Also called: Pancuronium bromide

◎**Muscle nicotinic acetylcholine receptor (motor end plate)**Pancuronium

ⓘ 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](https://www.rcsb.org/structure/8ESK) · Drag to rotate · pinch to zoom

## 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.

- Competes with acetylcholine at the nicotinic receptor
- Long-lasting flaccid paralysis
- Blocks cardiac muscarinic receptors: tachycardia
- 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

### Serious (rare, important)

- Prolonged residual block and apnoea
- Anaphylaxis

## 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.

## Memory aid

PANcuronium = «Pulse Accelerates, Never quick to leave»: vagolytic and long-acting.

## 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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## Related drugs

- [Vecuronium](https://durgical.com/en/pharmacology/vecuronium/)
- [Rocuronium](https://durgical.com/en/pharmacology/rocuronium/)

[← Back to the class: Neuromuscular blockers](https://durgical.com/en/pharmacology/classes/neuromuscular-blockers/)

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](https://atcddd.fhi.no/atc_ddd_index/?code=M03AC01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/pancuronium/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/pancuronium/