DrugLib.com — Drug Information Portal

Rx drug information, pharmaceutical research, clinical trials, news, and more

Enlon Plus (Edrophonium Chloride / Atropine Sulfate) - Drug Interactions, Contraindications, Overdosage, etc

 
 



DRUG INTERACTIONS

Drug Interactions

ENLON-PLUS (edrophonium chloride, USP and atropine sulfate, USP) Injection should not be administered prior to the administration of any nondepolarizing muscle relaxants. It should be administered with caution to patients with symptoms of myasthenic weakness who are also on anticholinesterase drugs. Anticholinesterase overdosage (cholinergic crisis) symptoms may mimic underdosage (myasthenic weakness), so the use of this drug may worsen the condition of these patients (see OVERDOSAGE section for treatment).

Narcotic analgesics, except when combined with potent inhaled anesthetics, appear to potentiate the effect of edrophonium on the sinus node and conduction system, increasing both the frequency and duration of bradycardia. In patients with cardiovascular disease, given anesthesia with narcotic and nitrous oxide without a potent inhalational agent, there is increased risk for clinically significant bradycardia. In patients receiving beta-adrenergic blocking agents there is increased risk for excessive bradycardia from unopposed parasympathetic vagal tone. Such patients should receive atropine sulfate alone prior to ENLON-PLUS.

Compared to muscle relaxants with some vagolytic activity, muscle relaxants with no vagolytic effects, i.e. vecuronium, may be associated with a slightly higher incidence of vagotonic effects such as bradycardia and first-degree heart block when reversed with ENLON-PLUS.

OVERDOSAGE

Muscarinic symptoms (nausea, vomiting, diarrhea, sweating, increased bronchial and salivary secretions and bradycardia) may appear with overdosage (cholinergic crisis) of ENLON-PLUS (edrophonium chloride, USP and atropine sulfate, USP) Injection, but may be managed by the use of additional atropine sulfate. Obstruction of the airway by bronchial secretions can arise and may be managed with suction (especially if tracheostomy has been performed).

Should edrophonium chloride overdosage occur:

  • 1.Maintain respiratory exchange.
  • 2.Monitor cardiac function.

Appropriate measures should be taken if convulsions occur or shock is present.

Principal manifestations of overdosage (poisoning) with atropine sulfate are delirium, tachycardia and fever. In the treatment of atropine poisoning, respiratory assistance and symptomatic support are indicated. Death is usually due to paralysis of the medullary centers.

In the clinical studies performed with ENLON-PLUS, there were no reported overdoses and therefore no clinical information is available regarding overdosing with ENLON-PLUS.

CONTRAINDICATIONS

ENLON-PLUS (edrophonium chloride, USP and atropine sulfate, USP) Injection is not to be used in patients with known hypersensitivity to either of the components, or in patients with intestinal or urinary obstruction of mechanical type. Atropine sulfate is contraindicated in the presence of acute glaucoma, adhesions (synechiae) between the iris and lens of the eye, and pyloric stenosis.

REFERENCES

  • 1. Cronnelly R, Morris RB, Miller RD: Edrophonium: Duration of action and atropine requirement in humans during halothane anesthesia. Anesthesiology 1982;57:261-266.
  • 2. Hinderling PH, Gundert-Remy U, Schmidlin O, Heinzel G: Integrated pharmacokinetics and pharmacodynamics of atropine in healthy humans. I: Pharmacokinetics; II: Pharmacodynamics. J Pharmaceutical Sci 1985; 74:I-703-710; II-711-717.
  • 3. Morris RB, Cronnelly R, Miller RD, Stanski DR, Fahey MR: Pharmacokinetics of edrophonium and neostigmine when antagonizing d- tubocurarine neuromuscular blockade in man. Anesthesiology 1981;54:399-402.
  • 4. Morris RB, Cronnelly R, Miller RD, Stanski DR, Fahey MR: Pharmacokinetics of edrophonium in anephric and renal transplant patients. Br J Anaesth 1981;53:1311-1313.
  • 5. Fisher DM, Cronnelly R, Sharma M, Miller RD: Clinical pharmacology of edrophonium in infants and children. Anesthesiology 1984; 61:428-433.
  • 6. Silverberg PA, Matteo RS, Ornstein E, Young WL, Diaz J: Pharmacokinetics and pharmacodynamics of edrophonium in the elderly. Anesth Analg 1986;65:S142.
  • 7. Virtanen R, Kanto J, Iisalo E, Iisalo EU, Salo M, Sjovall S: Pharmacokinetic studies on atropine with special reference to age. Acta Anaesthesiol Scand 1982;26:297-300.
  • 8. Back DJ, Calvey TN: Excretion of 14C-edrophonium and its metabolites in bile: role of the liver cell and the peribiliary vascular plexus. Br J Pharmacol., 1972; 44:534.

Enlon-Plus is a registered trademark of Mylan Teoranta.

Manufactured for:
Mylan Institutional LLC
Rockford, IL 61103 U.S.A.

Manufactured by:
Akorn Inc.
Lake Forest, IL 60045 U.S.A.

BEPOON
Rev. 01/13

REVISED JANUARY 2013
MI:ENLOPS:R2

-- advertisement -- The American Red Cross
 
Home | About Us | Contact Us | Site usage policy | Privacy policy

All Rights reserved - Copyright DrugLib.com, 2006-2017