Edrophonium Chloride

Mechanism :

Edrophonium chloride is an anticholinesterase agent which antagonizes the action of nondepolarizing neuromuscular blocking drugs. Edrophonium chloride inactivates the enzyme acetylcholinesterase by combining with it in a reversible manner. The inactivation of the enzyme prevents the hydrolysis of acetylcholine and allows the accumulation of the neurotransmitter.

Indication :

Reverse the neuromuscular blocking action of non-depolarizing skeletal muscle relaxants such as vecuronium, tubocurarine, metocurine, atracurium, or pancuronium.
Test for differential diagnosis of Myasthenia Gravis.

Contraindications :

Known hypersensitivity to anticholinesterase agents; intestinal and urinary obstructions of mechanical type.

Dosing :

Available as Inj 10 mg/ml

0.5 mg/kg by slow IV injection to ensure that the emergence of cholinergic reactions is detected. Maximum dose 1 mg/kg.

Test for differential diagnosis of Myasthenia Gravis:

Infants:

0.5 mg IV

<34 kg:

1 mg IV/IM. If there is no response after 45 seconds, it may be titrated up 5-10 mg in increments of 1 mg every 30 to 45 seconds.

>34 kg:

5 mg IM/IV. If there is no response after 45 seconds, it may be titrated up 10 mg in increments of 1 mg every 30 to 45 seconds.

Adverse Effect :

Arrhythmias, bradycardia, fall in cardiac output leading to hypotension, convulsions, dysphonia, dysarthria, dysphagia, increased tracheobronchial secretions, bronchiolar constriction, laryngospasm, respiratory muscle paralysis, increased lacrimation, spasm of accommodation, pupillary constriction, diplopia, conjunctival hyperemia, weakness, fasciculation, nausea, vomiting, increased peristalsis, increased gastric and intestinal secretions, diarrhea, abdominal cramps, increased urinary frequency and incontinence, diaphoresis.

Interaction :

Anticholinesterase Drugs: Caution in 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.

Hepatic Dose :

Specific guidelines for dosage adjustments in hepatic impairment are not available.