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Guanidine

Pronunciation

(GWAHN i deen)

Index Terms

  • Guanidine Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral, as hydrochloride:

Generic: 125 mg

Pharmacologic Category

  • Cholinergic Agonist

Use: Labeled Indications

Reduction of the symptoms of muscle weakness associated with the myasthenic syndrome of Eaton-Lambert, not for myasthenia gravis

Contraindications

Hypersensitivity to guanidine or any component of the formulation

Dosing: Adult

Eaton-Lambert syndrome: Oral: Initial: 10-15 mg/kg/day in 3-4 divided doses, gradually increase to 35 mg/kg/day, or up to development of side effects

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

No dosage adjustment provided in manufacturer’s labeling.

Dosing: Hepatic Impairment

No dosage adjustment provided in manufacturer’s labeling.

Storage

Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).

Drug Interactions

Acetylcholinesterase Inhibitors: May enhance the adverse/toxic effect of Cholinergic Agonists. Monitor therapy

Beta-Blockers: May enhance the adverse/toxic effect of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Management: Administer these agents in combination with caution, and monitor for conduction disturbances. Avoid methacholine with any beta blocker due to the potential for additive bronchoconstriction. Monitor therapy

Cimetropium: Cholinergic Agonists may diminish the anticholinergic effect of Cimetropium. Monitor therapy

Adverse Reactions

Frequency not defined.

Cardiovascular: Atrial fibrillation, flushing, hypotension, palpitation, tachycardia

Central nervous system: Ataxia, confusion, emotional lability, fever, hallucination, irritability, jitteriness, lightheadedness, mood changes, nervousness, psychotic state

Dermatologic: Bruising, dry skin, folliculitis, petechiae, purpura, rash, skin eruptions

Gastrointestinal: Abdominal cramps, anorexia, diarrhea, gastric irritation, nausea, sore throat, xerostomia

Hematologic: Anemia, bone-marrow suppression, leukopenia, thrombocytopenia

Hepatic: Abnormal liver function tests

Neuromuscular & skeletal: Paresthesia, trembling, tremor

Renal: Creatinine increased, interstitial nephritis (acute or chronic), renal tubular necrosis, uremia

Miscellaneous: Cold extremities, diaphoresis

Warnings/Precautions

Concerns related to adverse effects:

• Bone marrow suppression: Dose-related, fatal bone marrow suppression had been reported with use. Avoid concurrent use with medications known to suppress bone marrow. Monitor closely; discontinue use if bone marrow suppression is suspected.

Disease-related concerns:

• Renal impairment: Use with caution in patients with renal impairment.

Monitoring Parameters

CBC with differential (baseline and frequently thereafter); creatinine, BUN, urinalysis

Pregnancy Considerations

Animal reproduction studies have not been conducted.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience abdominal pain, flushing, sweating a lot, lack of appetite, nausea, diarrhea, abdominal cramps, or dry mouth. Have patient report immediately to prescriber signs of infection, signs of kidney problems (urinary retention, blood in urine, change in amount of urine passed, or weight gain), behavioral changes, severe dizziness, passing out, burning or numbness feeling, change in balance, tremors, confusion, mood changes, hallucinations, arrhythmia, or tachycardia (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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