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Sota
Omoigui's
Anesthesia Drug Handbook
3rd Edition:
:
Edrophonium Chloride
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SECTION
ONE:
Uses, Dosing,
Elimination
SECTION TWO:
Preparation, Pharmacology, Pharmacokinetics
SECTION THREE:
Interactions, Toxicity
Guidelines/Precautions
Principal Adverse Reactions
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Uses
reversal of nondepolarizing muscle relaxants, diagnostic assessment of myasthenia gravis, differential diagnosis and treatment of supraventricular tachyarrhythmias
Dosing
Reverse neuromuscular blockade: Slow IV 0.5-1.0 mg/kg. Maximum dose 40 mg. (with atropine 0.015 mg/kg, or glycopyrrolate 0.01 mg/kg)
Assessment of myasthenia/cholinergic crisis Slow IV 1 mg q 1-2 minutes until change in symptoms. Maximum dose 10 mg.
IM 10 mg
Supraventricular tachyarrhythmias
Slow IV 2 mg q 1-2 minutes until decrease in heart rate. Maximum dose 10 mg (have atropine available)
Infusion 0.25-2 mg/min (use undiluted injectate solution)
Elimination
hepatic, renal
How supplied
Injection: 10 mg/ml
Storage
Room temperature (15-30 degrees Celsius).
Pharmacology
This short acting quaternary ammonium anticholinesterase agent inhibits the hydrolysis of acetylcholine by competitively binding acetylcholinesterase. The build up of acetylcholine facilitates the transmission of impulses across the neuromuscular junction. In myasthenia gravis there is improved skeletal muscle tone in conditions of low acetylcholine and increased skeletal muscle weakness in conditions of cholinergic crisis. Cholinergic stimulation may be useful in terminating supraventricular tachyarrhythmias. Edrophonium may be more effective in converting supraventricular tachyarrhythmias to normal sinus rhythm when underlying organic heart disease is not present. When used for reversal of neuromuscular blockade, the muscarinic cholinergic effects (bradycardia, salivation) are prevented by concurrent use of atropine or glycopyrrolate.
Pharmacokinetics
ONSET OF ACTION: IV 30-60 seconds IM 2-10 minutes
PEAK EFFECT: IV 1-5 minutes
DURATION OF ACTION: IV 5-20 minutes IM 10-40 minutes
Interactions
does not antagonize and may prolong the Phase 1 block of depolarizing muscle relaxants such as succinylcholine; antagonizes the effects of nondepolarizing muscle relaxants such as tubocurarine, atracurium, vecuronium, pancuronium etc.; antagonism of neuromuscular blockade is reduced by aminoglycoside antibiotics, corticosteroids, magnesium, hypothermia, hypokalemia, respiratory and metabolic acidosis.
Guidelines
(1) Contraindicated in patients with peritonitis or mechanical obstruction of the intestines or urinary tract.
(2) Use with caution in patients with bradycardia, bronchial asthma, cardiac arrhythmias or peptic ulcer.
(3) Edrophonium overdose may induce a cholinergic crisis characterized by nausea, vomiting, bradycardia or tachycardia, excessive salivation and sweating, bronchospasm, weakness and paralysis.
(4) Treatment of a cholinergic crisis includes discontinuation of edrophonium and administration of atropine (10 mcg/kg IV q 3-10 minutes until muscarinic symptoms disappear.) and if necessary pralidoxime (15 mg/kg IV over 2 minutes) for reversal of nicotinic symptoms.
(5) Due to the brief duration of action of edrophonium, neostigmine or pyridostigmine are generally preferred for reversal of the effects of nondepolarizing muscle relaxants.
Principal Adverse Reactions
CVS: bradycardia, tachycardia, AV block, nodal rhythm, hypotension
PULM: increased oral, pharyngeal and bronchial secretions, bronchospasm, respiratory depression
CNS: seizures, dysarthria, headaches
EYE: lacrimation, miosis, visual changes
GI: nausea, emesis, flatulence, increased peristalsis
DERM: rash, urticaria
ALLERGIC: allergic reactions, anaphylaxis
Reactions
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4019 W. Rosecrans Ave., Hawthorne, CA 90250-7913
Toll-Free: (800) 9-MEDIC-9, Phone: (310) 675-9121,
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NOTICE:
Every effort has been made to ensure that the drug dosage schedules
herein are accurate and in accord with the standards accepted
at the time of publication. As new research and experience broaden
our knowledge, changes in treatment and drug therapy occur. The
medications described do not necessarily have specific approval
by the Food and Drug Administration for use in the situations
and the dosages for which they are recommended. This information
is advisory only. The package insert should be consulted for use
and dosage as approved by the FDA, for any changes in indications
and dosages and for added warnings and precautions. The ultimate
responsibility lies with the prescribing physician.
No part of this information may be reproduced or transmitted electronically
in any information storage or retrieval system, or within any
monitoring system without prior permission in writing from S.O.T.A.
Technologies (Electronic Publishers).
The Universal Drug Infusion Slide Ruler (patent pending) is now
available. It incorporates an infusion data guide and enables
infusion calculations for any drug at any dose and at any concentration.
It may be obtained by calling S.O.T.A Technologies (800 9-MEDIC-9)
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COMPOUNDED
TOPICAL MEDICATIONS MAY BE ORDERED (BY PRESCRIPTION ONLY) FROM L.A.
PAIN CLINIC. CALL 310 675-9121 or 1 800 9-MEDIC-9. |
Copyright 2000. Sota Omoigui, M.D. All rights reserved.
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