Edrophonium Chloride / Atropine Sulfate

Pronunciation: E-droe-FOE-nee-um KLOR-ide/AT-roe-peen SUL-fate
Class: Cholinergic muscle stimulant

Trade Names

Enlon-Plus
- Injection, solution edrophonium chloride 10 mg and atropine sulfate 0.14 mg per mL

Pharmacology

Edrophonium

Antagonizes the effect of nondepolarizing neuromuscular blocking agents primarily by inhibiting or inactivating acetylcholinesterase.

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Atropine

Inhibits action of acetylcholine or other cholinergic stimuli at postganglionic cholinergic receptors, including smooth muscles, secretory glands, and CNS sites.

Indications and Usage

Used as a reversal agent or antagonist of nondepolarizing neuromuscular blocking agents; adjunct in treating respiratory depression caused by curare overdosage.

Contraindications

Patients with intestinal or urinary obstruction of mechanical type; presence of acute glaucoma; adhesions between the iris and the lens of the eye; pyloric stenosis; hypersensitivity to any component of the product.

Dosage and Administration

Adults

IV 0.05 to 0.1 mL/kg (edrophonium 0.5 to 1 mg/kg in combination with atropine 0.007 to 0.014 mg/kg) administered slowly over 45 to 60 sec at a point of at least 5% recovery of twitch response to neuromuscular stimulation (95% block). A total dose of edrophonium 1 mg/kg should rarely be exceeded.

Storage/Stability

Store between 59° and 78°F.

Drug Interactions

Beta-adrenergic blockers (eg, propranolol)

The risk of excessive bradycardia from unopposed parasympathetic vagal tone may be increased.

Corticosteroids (eg, prednisolone)

Effects of edrophonium in myasthenia gravis may be antagonized, resulting in profound muscular depression refractory to anticholinesterases.

Muscle relaxants with no vagolytic effects (eg, vecuronium)

Compared with muscle relaxants with vagolytic effects, there may be a slightly higher incidence of vagotonic effects such as bradycardia and first-degree heart block when reversed with edrophonium/atropine.

Narcotic analgesics

Except when combined with potent inhaled anesthetics, narcotic analgesics appear to potentiate the effect of edrophonium on the sinus node and conduction system, increasing both the frequency and duration of bradycardia.

Nondepolarizing muscle relaxants

Do not administer prior to nondepolarizing muscle relaxants.

Phenothiazines (eg, chlorpromazine)

Therapeutic effects may be decreased by atropine.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Bradycardia, junctional rhythm, tachycardia (more than 10%); atrial premature contractions, first- and second-degree AV block, P-wave changes (3% to 10%); third-degree AV block, ventricular premature contractions (1% to 3%).

Edrophonium

Fall in cardiac output resulting in hypotension; nonspecific ECG changes.

CNS

Atropine

Restlessness with asthenia; speech disturbances.

Edrophonium

Convulsions; dysarthria; dysphagia; dysphonia.

Dermatologic

Atropine

Flushed dry skin; formation of scarlatiniform rash

Edrophonium

Diaphoresis.

EENT

Atropine

Blurred vision, dry nose, photophobia, slight mydriasis.

Edrophonium

Conjunctival hyperemia, diplopia, increased lacrimation, papillary constriction.

GI

Atropine

Dry mouth.

Edrophonium

Abdominal cramps, diarrhea, nausea, increased gastric and intestinal secretions, increased peristalsis, vomiting.

Genitourinary

Edrophonium

Increased urinary frequency.

Local

Tissue irritation.

Metabolic-Nutritional

Atropine

Thirst.

Musculoskeletal

Edrophonium

Fasciculations, weakness.

Respiratory

Edrophonium

Bronchiolar constriction, increased tracheobronchial secretions, laryngospasm, respiratory muscle paralysis.

Miscellaneous

Atropine

Fever.

Precautions

Monitor

Monitor response to therapy carefully and secure assisted or controlled ventilation.


Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Elderly

Use with caution, usually starting at the low end of the dosage range, because of the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant diseases or other drug therapy.

Sulfite Sensitivity

Contains sodium sulfite, which may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in susceptible individuals.

Gastric emptying

Atropine may slow gastric emptying and GI motility, which may interfere with absorption of other medications.

Myasthenia

Use with caution in patients with myasthenic weakness who are receiving anticholinesterase drugs. Anticholinesterase overdosage symptoms may mimic underdosage (myasthenic symptoms), which may worsen the condition of these patients.

Special risk patients

Use with caution in patients with bronchial asthma, cardiac arrhythmias, or prostatic hypertrophy, and in debilitated patients with chronic lung disease.

Overdosage

Symptoms

Muscarinic symptoms, including bradycardia, diarrhea, increased bronchial and salivary secretions, nausea, sweating, and vomiting. Airway obstruction may result from increased bronchial secretions.

Copyright © 2009 Wolters Kluwer Health.

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