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Pronunciation |
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(pi
pe kur OH nee
um) |
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U.S. Brand
Names |
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Arduan® |
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Generic
Available |
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No |
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Synonyms |
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Pipecuronium Bromide |
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Pharmacological Index |
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Neuromuscular Blocker Agent, Nondepolarizing |
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Use |
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Adjunct to general anesthesia, to provide skeletal muscle relaxation during
surgery and to provide skeletal muscle relaxation for endotracheal intubation;
recommended only for procedures anticipated to last 90 minutes or
longer |
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Pregnancy Risk
Factor |
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C |
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Contraindications |
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Hypersensitivity to pipecuronium or bromide |
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Warnings/Precautions |
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Use with caution in patients with renal impairment, obesity, cardiovascular
disease, myasthenia gravis, myasthenic syndrome, and in the
elderly |
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Adverse
Reactions |
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1% to 10%: Cardiovascular: Hypotension, bradycardia
<1%: Atrial fibrillation, myocardial ischemia, thrombosis, hypertension,
ventricular extrasystole, CNS depression, urticaria, hypoglycemia, hyperkalemia,
muscle atrophy, anuria, respiratory depression, dyspnea |
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Overdosage/Toxicology |
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Support ventilation by artificial means; paralysis including cessation of
respiration |
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Drug
Interactions |
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Increased effect with enflurane, halothane, isoflurane, ketorolac, quinidine,
succinylcholine |
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Stability |
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Compatible with D5W, 0.9% sodium chloride, D5 0.9%
sodium chloride, LR, sterile and bacteriostatic water for
injection |
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Mechanism of
Action |
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Pipecuronium bromide is a nondepolarizing neuromuscular blocking agent
structurally related to pancuronium and vecuronium. Studies in adult patients
have demonstrated that pipecuronium is ~20% to 50% more potent than pancuronium
as a neuromuscular blocking agent. The neuromuscular effects and
pharmacokinetics of pipecuronium appears to lack vagolytic or autonomic activity
and produces minimal cardiovascular effects. |
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Pharmacodynamics/Kinetics |
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Onset of action: Effective neuromuscular blockade is generally observed
within 2-3 minutes
Metabolism: In the liver primarily to 3-desacetyl-pipecuronium
Half-life, elimination: 2-2.5 hours
Elimination: Renally (40% unchanged drug) |
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Usual Dosage |
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I.V.:
3 months to 1 year: Adult dosage
1-14 years: May be less sensitive to effects
Adults: Dose is individualized based on ideal body weight, ranges are 85-100
mcg/kg initially to a maintenance dose of 5-25 mcg/kg
Dosing adjustment in renal impairment:
Clcr 61-80 mL/minute: 70 mcg/kg
Clcr 41-60 mL/minute: 55 mcg/kg
Clcr <40 mL/minute: 50 mcg/kg
Extended duration should be expected |
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Administration |
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Not recommended for dilution into or administration from large volume I.V.
solutions |
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Nursing
Implications |
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Not recommended for dilution into or administration from large volume I.V.
solutions |
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Dosage Forms |
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Injection, as bromide: 10 mg (10 mL) |
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References |
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Khuenl-Brady KS, Reitstatter B, Schlager A, et al,
"Long-Term Administration of Pancuronium and Pipecuronium in the Intensive Care Unit,"
Anesth Analg, 1994, 78(6):1082-6.
Larijani GE, Bartkowski RR, Azod SS, et al,
"Clinical Pharmacology of Pipecuronium Bromide," Anesth Analg, 1989,
68(6):734-9. |
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