Edrophonium Chloride

Pronouncation: (eh-droe-FOE-nee-uhm KLOR-ide)
Class: Anticholinesterase muscle stimulant

Trade Names:
Enlon
- Injection 10 mg/mL

Trade Names:
Reversol
- Injection 10 mg/mL

Trade Names:
Tensilon
- Injection 10 mg/mL

Pharmacology

Facilitates myoneural junction impulse transmission by inhibiting acetylcholine destruction by cholinesterase.

Pharmacokinetics

Onset

30 to 60 sec.

Duration

10 min.

Indications and Usage

Differential diagnosis of myasthenia gravis; adjunct in evaluating treatment of myasthenia gravis; evaluation of emergency treatment of myasthenic crises; reversal of neuromuscular blockade by curare gallamine or tubocurarine; treatment of respiratory depression caused by curare overdose.

Contraindications

Hypersensitivity to anticholinesterases; mechanical intestinal and urinary obstruction.

Dosage and Administration

Diagnosis of Myasthenia Gravis
Adults

IM/IV 10 mg.

Children 34 kg or less

IV 2 mg. If no response after 45 sec, may titrate up to 10 mg in increments of 1 mg every 30 to 45 sec. or IM 5 mg as single dose.

Children more than 34 kg

IV 1 mg. If no response after 45 sec, may titrate up to 5 mg in increments of 1 mg every 30 to 45 sec or IM 2 mg as single dose.

Infants

IV 0.5 mg.

Crisis Test
Adults

IV When respiration is adequate, give 1 mg initially. If after 1 min patient is not further impaired, give additional 1 mg.

Curare Antagonist
Adults

IV 10 mg over 30 to 45 sec. Repeat as needed up to max total dose of 40 mg.

Evaluation of Myasthenia Gravis Treatment
Adults

IV 1 to 2 mg 1 h after ingestion of treatment drug.

Storage/Stability

Store at room temperature.

Drug Interactions

Corticosteroids

May antagonize anticholinesterases in myasthenia gravis, producing profound muscular depression.

Succinylcholine

Neuromuscular blockade produced by succinylcholine may be either prolonged or antagonized.

Laboratory Test Interactions

None well documented

Adverse Reactions

Cardiovascular

Arrhythmia (especially bradycardia); hypotension; tachycardia; atrioventricular block; nodal rhythm; nonspecific ECG changes; cardiac arrest; syncope.

CNS

Convulsions; dysarthria; dysphonia; dizziness; loss of consciousness; drowsiness; headache.

Dermatologic

Rash; urticaria; flushing.

EENT

Lacrimation; miosis; spasm of accommodation; diplopia; conjunctival hyperemia; visual changes.

GI

Increased salivary, gastric and intestinal secretions; nausea; vomiting; dysphagia; increased peristalsis; diarrhea; abdominal cramps; flatulence.

Genitourinary

Urinary urgency, frequency and incontinence.

Respiratory

Increased tracheobronchial secretions; laryngospasm; bronchiolar constriction; respiratory paralysis; dyspnea; respiratory depression; respiratory arrest; bronchospasm.

Miscellaneous

Allergy and anaphylaxis; weakness; fasciculations; muscle cramps and spasms; arthralgia; diaphoresis.

Precautions

Monitor

Neuromuscular status

Assess neuromuscular status before and frequently during therapy.


Pregnancy

Undetermined.

Lactation

Undetermined.

Special Risk Patients

Use with caution in patients with bronchial asthma, epilepsy, bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias, or peptic ulcer.

Anticholinesterase insensitivity

May develop.

Atropine

Keep atropine available in syringe as antidote.

Overdosage

Symptoms

Increasing parasympathomimetic action, cholinergic crisis, nausea, vomiting, diarrhea, sweating, increased bronchial and salivary secretions with resulting bronchial obstruction, bradycardia.

Patient Information

  • Teach patient and family name, desired action, method of administration and potential adverse reactions of edrophonium.
  • Inform patient that effects of medication last up to 30 min after IM administration.
  • Show patient and family how to assess and record changes in muscle strength.
  • Advise patient that urinary urgency and frequency and increased GI motility and secretion will occur and should be reported to health care provider.
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