Pipecuronium bromide ( *** )- Nueromusc blockr-Adjun to anes
Drug Name:Pipecuronium bromide ( *** )- Nueromusc blockr-Adjun to anes
List Of Brands:
Indication Type Description:
Drug Interaction
Indication
Adverse Reaction
Contra-Indications
Dosages/ Overdosage Etc
Pharmacology/ Pharmacokinetics
Interaction with Food
Pregnancy and lactation
Drug Interaction:
Nondepolarizing Neuromuscular Blockers include- Pipercuranium, Vecuronium,Doxacuranium, Tobocurane,
Mivacuranium,Rocuronium, Cisatracurarium, Atracurarium,Pancuronium
Refer- Pancuronium
Interacting drugs- summary
+ Pipercuronium
Antibiotics /Aminoglycosides / Tetracycline / Polymixin B / Colistin and Colistimethate
Parentral/Peritoneal administration of high doses of cetain antibitotics
intensify or produce neuromuscular blockade on their own. If these
or other newly introduced antibiotics are used with pipercuronium
during surgery, consider prolongation of neuromuscular block,
Anesthetics Inhalational Enfluane, Isoflurane, Halothane
use of Inhalation anesthetics enhances neuromuscular blockade
on the order of enflurane > isoflurane > halothane. Minimal effects
are generally observed on onset of time and peak effect.
In routine use of neuromuscular blocking agents, only clinical duraton
is generally affected (prolonged).
Therefore anticipate a prolonged clinical duration following initial or
maintenace doses and prolonged recovery from neuromuscular
blocking effect of pipercuronium
Magnesium salts
administration for the management of toxemia of pregnancy enhance
neuromuscular blockade
Quinidine
experience concerning injection of of quinidine during recovery for use
of other muscle relaxants suggests that recurrent paralysis occur.
This possiblity must be considered for pipercuronium
Succinyl Chloine
pipercuronium can be administered following recovery from
succinylcholine when the latter is used to facilitate endotracheal
intubation. The use of pipercuranium before succinylcholine, in order
to attenuate some of the side effects of succinyl choline, is not
recommended.
Indication:
Adjunct to general anesthesia for skeletal muscle relaxation
Nondepolarizing Neuromuscular Blockers include-
Pipercuranium, Vecuronium,Doxacuranium, Tobocurane, Mivacuranium,Rocuronium, Cisatracurarium, Atracurarium,Pancuronium Refer- Pancuronium
New Drugs Approved by (DCI) Drug Controller GENERAL - India For Marketing (Ref- IDMA Publication)
Name of Drug Indication Date of Approval
Pipecuronium Bromide Non-depolarising muscle November 1992
relaxing agent
Adverse Reaction:
The most frequent- adverse drug reaction to nonpolarizing blocking agent as a class is an extension of the drugs pharmacologic reaction, beyond the time period needed for surgery and anesthesia Clinical signs may may vary from skeletal muscle waekness resulting in paralysis leading to respiraory insufficiency and apnea.
This may be due to drugs effect or inadequate anatgonism.
Cardiovascular-
Hypotension, bardycardia, hypotension, myocardial ischemia, cerebrovascular accident, thrombosis, atrila fibrilation, ventricular extrasystole.
Metabolic/Nutritional:
Hypoglycemia, hyperkalemia, increased creatinine
Musculoskeletal:
Muscle atripht, difficult intubation
Respiratory:
Dysnpnea, respiratory depression, laryngismus, atelectasis
Miscellaneous:
Hypesthesia, CNS depression, anuria, rash, urticaria
Contra-Indications:
Respiratory insufficiency. Hypersens to any neuromuscular blocking agent.
Special precautions:
Pulmonary disease, dehydration, severly ill patients, hepatic/renal impairment.
Bradycardia- pipercuronium has little or no effect on the heart rate, and it will not counteract the bradycardia produced by many opoid anesthestics or vagal stimulation.
Increased volume distribution- conditions asociated with an increased volume of distribution ( eg, circulation time in cardiovascular disease, old age, edematous states) may be associated with a delay in onset time. Because higher doses may produce a longer duration of action, the intial dosage should not usually beincreased to enhance onset time.
Obesity- the most common patient condition associated with prolonged clinical duration is obesity, defined at > 30% over ideal body weight. Base dose on ideal body for height in obese patients.
Malignant hyperhermia- (MH) human MH has not been reported with the administration of
pipercuronium
CNS- pipercurinium has no known efect on consciousness, pain threshold or cerebration. Therefore administration must be accomp[anied by adequate anesthesis
Fluid/ electrolye imbalance- experience with other drugs has suggested that acute (eg diarrhea ) or chronic ( eg adrenicortical insufficiency) electrolyte imbalance may alter neuromuscular blockade.
Warning:
Antagonism of neuromuscular blockade:
Such as neostigmine should not administered prior to thr demonstration of some spontaneous recovery from neuromuscular blockade. The use of a nerve stimulator to document recovery and antagonism of neuromuscular blockade is recommended.
Hemodynamics: Clinically significant bradycardia, hypotension and hypertension have occured. The most common observations comparing vital signs immediately prior to initial dosage with pipercuronium and 2 minutes after injection, are a slight decrease in heart rate and systolic and diastolic blood pressure.
Myasthenia gravis or myasthenic syndrome- Small doses of nondepolarizing neuromuscular blocking agents have profound efects. Shorter acting muscle relaxants may be more suitable for these patients.
Long term use- Pipecuronium is not recommended for use in patients requiring prolonged mechanical ventilation in the ICU or prior to following other nondepolarizing neuromuscular blocking agents.
Renal function impairment- because it is primarily excreted by the kidney and because some shorter acting drugs (vercurinium and atracurium) have a more predictable duration of action in patients with renal dysfunction, use with extra caution in patients with renal failure .
Pregnancy- use during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Children- infants ( 3 months to 1 year ) under balanced anesthesia or halothane anesthesia manifest similar dose response to pipercuronium as do adults ona mcg/kg basis. Infants appear to be more sensitive to pipercuronium but the duration of action is shorter in infants.
Dosages/ Overdosage Etc:
Indications:
Adjunct to general anesthesia for skeletal muscle relaxation.
Dosage:
Individualise dose.
Adults- Initial dose- less than 70 to 80mcg/kg
Overdosage-
Symptoms
Extended skeletal muscle weakness, decreased respiratory reserve, lower tidal volume, prolonged apnea, cardiovascular collapse and sudden release of histamine. sufficiently excessive doses of nondepolarizing muscle relaxants have no antidote.
Treatment
1. A peripheral nerve stimulator may be used to assesss the degree of residual neuromuscular blockade
2. For residual neuromuscular blockade with respiratory paralysis or inadequate ventilation, maintain airway and administer manual or mechanical ventilation.
Missed dose-
1. If you miss a dose of this medicine, take it as soon as possible.
2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing
schedule.
3. Do not double doses.
Pharmacology/ Pharmacokinetics:
Pharmacology:
Pipecuronium bromide is a long acting nondepolarizing neuromuscullar blocker, possesses the characteristic pharmacological actions of this drug class(curariform). It competes for cholinergic receptors at the motar end-plate. This action is antagonised by acetylcholinesterase inhibitors, such as neostigmine.
Interaction with Food:
Not applicable.
Pregnancy and lactation:
Pregnancy:
No adequate and well controlled studies carried out on pregnancy. Use only if needed.
Children-
Infants ( 3 months to 1 year ) under balanced anesthesia or halothane anesthesia manifest similar dose response to pipercuronium as do adults ona mcg/kg basis. Infants appear to be more sensitive to pipercuronium but the duration of action is shorter in infants.
