Edrophonium Chloride (7 brand names, 1 dosage form, 1 route)
Available dosage forms: INJECTABLE.
Routes of administration: INJECTION.
Brand Names
- EDROPHONIUM CHLORIDE
- EDROPHONIUM CHLORIDE PRESERVATIVE FREE
- ENLON
- ENLON-PLUS
- REVERSOL
- TENSILON
- TENSILON PRESERVATIVE FREE
Indications and Usage
ENLON is recommended for the differential diagnosis of myasthenia gravis and as an adjunct in the evaluation of treatment requirements in this disease. It may also be used for evaluating emergency treatment in myasthenic crises. Because of its brief duration of action, it is not recommended for maintenance therapy in myasthenia gravis.ENLON is also useful whenever a curare antagonist is needed to reverse the neuromuscular block produced by curare, tubocurarine, gallamine triethiodide or dimethyl-tubocurarine. It is not effective against decamethonium bromide and succinylcholine chloride. It may be used adjunctively in the treatment of respiratory depression caused by curare overdosage.
Contraindications
Known hypersensitivity to anticholinesterase agents; intestinal and urinary obstructions of mechanical type.
Adverse Reactions
Careful observation should be made for severe cholinergic reactions in the hyperreactive individual. The myasthenic patient in crisis who is being tested with ENLON should be observed for bradycardia or cardiac standstill and cholinergic reactions if an overdose is given.The following reactions common to anticholinesterase agents may occur, although not all of these reactions have been reported with the administration of ENLON, probably because of its short duration of action and limited indications: Eye:Increased lacrimation, pupillary constriction, spasm of accommodation, diplopia, conjunctival hyperemia. CNS:Convulsions, dysarthria, dysphonia, dysphagia. Respiratory:Increased tracheobronchial secretions, laryngospasm, bronchiolar constriction, paralysis of muscles of respiration, central respiratory paralysis. Cardiac:Arrhythmias (especially bradycardia), fall in cardiac output leading to hypotension. G.I.:Increased salivary, gastric and intestinal secretion, nausea, vomiting, increased peristalsis, diarrhea, abdominal cramps. Skeletal Muscle:Weakness, fasciculations. Miscellaneous:Increased urinary frequency and incontinence, diaphoresis.
Drug Interactions
Care should be given when administering this drug to patients with symptoms of myasthenic weakness who are also on anticholinesterase drugs. Since symptoms of anticholinesterase overdose (cholinergic crisis) may mimic underdosage (myasthenic weakness), their condition may be worsened by the use of this drug. (See OVERDOSAGE section for treatment.)
Overdosage
With drugs of this type, muscarine-like symptoms (nausea, vomiting, diarrhea, sweating, increased bronchial and salivary secretions and bradycardia) often appear with overdosage (cholinergic crisis). An important complication that can arise is obstruction of the airway by bronchial secretions. These may be managed with suction (especially if tracheostomy has been performed) and by the use of atropine. Many experts have advocated a wide range of dosages of atropine (for ENLON, see atropine dosage below), but if there are copious secretions, up to 1.2 mg intravenously may be given initially and repeated every 20 minutes until secretions are controlled. Signs of atropine overdosage such as dry mouth, flush and tachycardia should be avoided as tenacious secretions and bronchial plugs may form. A total dose of atropine of 5 to 10 mg or even more may be required. The following steps should be taken in the management of overdosage of ENLON:Adequate respiratory exchange should be maintained by assuring an open airway and by the use of assisted respiration augmented by oxygen.Cardiac function should be monitored until complete stabilization has been achievedAtropine sulfate in doses of 0.4 to 0.5 mg should be administered intravenously. This may be repeated every 3 to 10 minutes. Because of the short duration of action of ENLON the total dose required will seldom exceed 2 mg.Pralidoxime chloride (a cholinesterase reactivator) may be given intravenously at the rate of 50 to 100 mg per minute; usually the total dose does not exceed 1000 mg. Extreme caution should be exercised in the use of pralidoxime chloride when the cholinergic symptoms are induced by double-bond phosphorous anticholinesterase drugs. 9If convulsions occur or shock is present, appropriate measures should be instituted.