by no means Edrophonium and Atropine as we speak

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plenty of Edrophonium and Atropine Professional Interactions Reviews Q & A More Pronunciation (ed roe FOE nee um & A troe peen) Index Terms Atropine Sulfate and Edrophonium Chloride Edrophonium Chloride and Atropine Sulfate Edrophonium Chloride/Atropine Slideshow Understanding Insulin: What You Need To Know Dosage Forms Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product Solution, Intravenous: Enlon-Plus: Edrophonium chloride 10 mg/mL and atropine sulfate 0.14 mg/mL (15 mL [DSC]) [contains phenol, sodium sulfite] Enlon-Plus: Edrophonium chloride 10 mg/mL and atropine sulfate 0.14 mg/mL (5 mL [DSC]) [contains sodium sulfite] Brand Names: U.S. Enlon-Plus [DSC] Pharmacologic Category Acetylcholinesterase Inhibitor Anticholinergic Agent Antidote Pharmacology Edrophonium: Inhibits destruction of acetylcholine by acetylcholinesterase. This facilitates transmission of impulses across myoneural junction and results in increased cholinergic response. Atropine: Minimizes or prevents the muscarinic cholinergic effects caused by edrophonium (eg, bradycardia, bronchoconstriction, increased secretions). Excretion Edrophonium: Primarily urine (67%) Onset of Action Edrophonium: Antagonism of nondepolarizing muscle relaxants: 3 minutes; Atropine: Heart rate: Immediate Time to Peak Edrophonium: Antagonism of nondepolarizing muscle relaxants: 1.2 minutes; Atropine: Heart rate: 2 to 16 minutes Duration of Action Edrophonium: Antagonism of nondepolarizing muscle relaxants: 70 minutes; Atropine: Heart rate: 170 minutes Half-Life Elimination Edrophonium: Adults: 1.2 to 2.4 hours; Anephric patients: 2.4 to 4.4 hours Protein Binding Atropine: ~14% Use: Labeled Indications Respiratory depression caused by curare overdosage: Adjunctive treatment of respiratory depression caused by curare overdosage. Reversal of nondepolarizing neuromuscular blocking agents: Reversal of nondepolarizing neuromuscular-blocking agents. Contraindications Hypersensitivity to edrophonium, atropine, or any component of the formulation; intestinal or urinary obstruction of the mechanical type. Atropine is contraindicated in acute glaucoma, adhesions (synechiae) between the iris and lens of the eye, and pyloric stenosis. Documentation of allergenic cross-reactivity for anticholinesterase muscle stimulants is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty. Dosing: Adult Note: Enlon-Plus is no longer available in the U.S. Reversal of neuromuscular blockade: IV: 0.05 to 0.1 mL/kg given over 45 to 60 seconds. The dose delivered is 0.5 to 1 mg/kg of edrophonium and 0.007 to 0.014 mg/kg of atropine. An edrophonium dose of 1 mg/kg should rarely be exceeded. Note: Monitor closely for bradyarrhythmias. Dosing: Geriatric Refer to adult dosing. Dosing: Renal Impairment There are no dosage adjustments provided in the manufacturer s labeling. Dosing: Hepatic Impairment There are no dosage adjustments provided in the manufacturer s labeling. Administration Administer IV slowly over 45 seconds to 1 minute at a point of at least 5% recovery of twitch response to neuromuscular stimulation (95% block). Storage Store at 20 C to 25 C (68 F to 77 F). Drug Interactions AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy Amifampridine: May diminish the anticholinergic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Amifampridine. Monitor therapy Amifampridine: Acetylcholinesterase Inhibitors may enhance the therapeutic effect of Amifampridine. Amifampridine side effects may also be increased. Amifampridine may enhance the therapeutic effect of Acetylcholinesterase Inhibitors. Acetylcholinesterase inhibitor side effects may also be increased. Monitor therapy Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy Anticholinergic Agents: Acetylcholinesterase Inhibitors may diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy Benoxinate: Acetylcholinesterase Inhibitors may enhance the therapeutic effect of Benoxinate. Specifically, the effects of benoxinate may be prolonged. Monitor therapy Beta-Blockers: Acetylcholinesterase Inhibitors may enhance the bradycardic effect of Beta-Blockers. Exceptions: Levobunolol; Metipranolol. Monitor therapy Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Monitor therapy Cardiac Glycosides: Edrophonium may enhance the AV-blocking effect of Cardiac Glycosides. Monitor therapy Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Monitor therapy Cholinergic Agonists: Acetylcholinesterase Inhibitors may enhance the adverse/toxic effect of Cholinergic Agonists. Monitor therapy Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination Corticosteroids (Systemic): May enhance the adverse/toxic effect of Acetylcholinesterase Inhibitors. Increased muscular weakness may occur. Monitor therapy Dipyridamole: May diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination EPHEDrine (Systemic): Atropine (Systemic) may enhance the therapeutic effect of EPHEDrine (Systemic). Monitor therapy Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Monitor therapy Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy Neuromuscular-Blocking Agents (Nondepolarizing): Acetylcholinesterase Inhibitors may diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Monitor therapy OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy Opioid Analgesics: Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Analgesics. Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Avoid combination Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Consider therapy modification Succinylcholine: Acetylcholinesterase Inhibitors may increase the serum concentration of Succinylcholine. Management: Consider alternatives to this combination due to a risk of prolonged neuromuscular blockade. Consider therapy modification Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Adverse Reactions See individual agents. Warnings/Precautions Concerns related to adverse effects: Anticholinesterase insensitivity: If patient becomes insensitive to the drug, reduce dose or discontinue edrophonium until patient sensitive again. Respiratory arrest: Rare reports of respiratory arrest have occurred with edrophonium. Tissue irritation: May cause tissue irritation if extravasated. Disease-related concerns: Arrhythmias: Use with caution in patients with cardiac arrhythmias (eg, bradyarrhythmias). Asthma: Use with caution in patients with bronchial asthma. Chronic lung disease: Use with caution in patients with chronic lung disease. Prostatic hyperplasia: Use with caution in patients with prostatic hyperplasia. Myasthenia gravis: Avoid use in myasthenia gravis; may exacerbate muscular weakness. Concurrent drug therapy issues: Anticholinergics: Consider additive adverse effects with concurrent use of atropine and other anticholinergics (eg, tricyclic antidepressants, antipsychotics, some antihistamines, anti-Parkinson drugs). Atropine: Patients who are bradycardic or at risk of being bradycardic (eg, those on a beta-blocker or cardiovascular patients who received anesthesia with an opioid and nitrous oxide only) should first receive atropine prior to edrophonium-atropine combination. Most arrhythmias occur within 2 minutes of administration and reverse shortly thereafter. Atropine should be available for immediate use in case of severe cholinergic reaction. Bradyarrhythmias respond to small doses of atropine. Nondepolarizing muscle relaxants: Should not be administered before any nondepolarizing muscle relaxant. Dosage form specific issues: Sodium sulfite: Products may contain sodium sulfite. Monitoring Parameters Vital signs, ECG, and ventilatory support; neuromuscular function Pregnancy Risk Factor C Pregnancy Considerations Animal reproduction studies have not been conducted with this combination. Refer to individual agents. 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 dry mouth, nausea, vomiting, diarrhea, abdominal cramps, loss of strength and energy, sweating a lot, or polyuria. Have patient report immediately to prescriber abnormal heartbeat, difficulty breathing, slow breathing, shallow breathing, severe dizziness, passing out, seizures, difficulty speaking, difficulty swallowing, bradycardia, tachycardia, or severe injection site redness, burning, or pain (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 health care 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. Next Interactions Print this page Add to My Med List More about atropine/edrophonium Drug Interactions Support Group 0 Reviews Add your own review/rating Drug class: cholinergic muscle stimulants Professional resources Other brands: Enlon-Plus Related treatment guides Reversal of Nondepolarizing Muscle Relaxants} Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Atropine / edrophonium Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Drug Class Cholinergic muscle stimulants Related Drugs cholinergic muscle stimulants pyridostigmine , Mestinon , neostigmine , Prostigmin , Prostigmin Bromide Reversal of Nondepolarizing Muscle Relaxants pyridostigmine , Mestinon , neostigmine , sugammadex , edrophonium , Bridion , Reversol , Mestinon Timespan , More...} } maybe


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