Possible Interaction: Pancuronium and Tubocurarine

“Among non-depolarizing relaxants an adequate facilitation for endotracheal intubation was observed, two minutes after administration of atracurium and vecuronium, while endotracheal intubation was difficult when using d-tubocuranine and pancuronium.”

“Studies in both animals and man have shown pancuronium to be approximately 5 times more potent than d-tubocurarine on a weight-for-weight basis.”

“However, pancuronium and vecuronium each shifted the apparent IC50 of (+)-tubocurarine less than expected for complete competition but more than expected for independent binding.”

“Ten combinations, including (+)-tubocurarine+ pancuronium and pancuronium+vecuronium , were highly synergistic such that the combination was two to three times more effective than expected for additivity.”

“It is concluded that onset and recovery from a DTC blockade are markedly age-related, and this relationship may be accentuated by pretreatment with pancuronium.”

“Times to ten per cent spontaneous recovery following DTC with pancuronium priming were 71.0 ± 8.1 (0-1 yr), 42.7 ±3.8 (1-3yr), and29.3 ±3.9 min (3-10 yr).”

“We describe a patient on longterm therapy with verapamil … hr after the administration of 2 mg of pancuronium and … of tubocurarine , exhibited a marked degree of residual neuromuscular blockade that was resistant to reversal by ….5 mg) but was promptly reversed by edrophonium (28 mg; 0.5 mgkg-I).”

“A combination of pancuronium and d-tubocurarine is associated with potentiation of the neuromuscular blocking effects of each drug used singly.”

“The combination of pancuronium and d-tubocurarine also was associated with greater cardiovascular stability.”

“Combination of pancuronium (Pm) with d-tubocurarine (dTC) or metocurine (mTC) produces potentiation of neuromuscular effects.”

“Combination of pancuronium and metocurine or pancuronium and d-tubocurarine produces potentiation of neuromuscular blocking effects such that administration of relatively small doses of these drugs can yield clinically effective neuromuscular blockade.”

“Regardless of mechanism, combining pancuronium with dTc or with metocurine can provide surgical relaxation or ideal conditions for endotracheal intubation with smaller amounts of each drug than would be anticipated if their effects were simply additive.”