Edrophonium and atropine are available by the brand name of ENLON-PLUS. It is a combination of edrophonium that inhibits the enzyme acetyl-cholinesterase and atropine that is added to minimize the muscarinic adverse effects of edrophonium.

Edrophonium and atropine Uses:

• Respiratory depression caused by curare overdosage:

  • It is used as an adjunctive treatment of patients with respiratory depression caused by curare overdosage.

• Reversal of nondepolarizing neuromuscular blocking agents:

  • Additionally, it is used to undo the effects of drugs that prevent neuromuscular nondepolarization.

Adult dose:

Edrophonium Dose to reverse neuromuscular blockade:

• 0.05 to 0.1 mL/kg intravenously given over 45 to 60 seconds.
• The dose delivered is equivalent to 0.5 to 1 mg/kg of edrophonium and 0.007 to 0.014 mg/kg of atropine.
• Rarely, a dose exceeding 1 mg/kg is required.
• Note: Patients should be monitored closely for bradyarrhythmias.

Dose in Children:

Not indicated. [/bg_collapse]   [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Dose in Pregnancy & lactation" collapse_text="Dose in Pregnancy & lactation" ]

Pregnancy Risk Factor C

• • The drug has not yet been tested in human or animal pregnancies.
  • You can also contact individual agents.

  Use of atropine and edrophonium during lactation:

  • This combination has not been shown to be safe for lactating women.
  • You can also contact individual agents.

Dose in Kindney disease:

In the manufacturer’s labeling, dose adjustment has not been provided.

Dose in Liver disease:

In the manufacturer’s labeling, adjustment in the dose has not been provided in patients with liver disease.

Side effects:

See side effects of individual agents (atropine and edrophonium) 

Contraindications to Edrophonium and atropine:

• Allergy reactions to drugs (edrophonium, atropine) and any component of the formulation
• Occlusion of the intestines or obstruction of the urinary tract.
• Acute glaucoma, synechiae or adhesions between iris and eye lens, and
• Pyloric stenosis.

Warnings and precautions

• Sensitivity to anticholinesterase

  • If the patient is allergic to the drug, the dose can be decreased or discontinued.
  • You may withhold treatment until your patient becomes more sensitive.

• Respiratory arrest

  • Rarely has there been a case of respiratory arrest with this drug.

• Tissue irritation

  • If the drug is extravasated, it may act as an irritant and cause tissue irritation.

• Arrhythmias

  • Bradyarrhythmias can develop. Patients at-risk for cardiac arrhythmias should be used with caution.

• Asthma

  • Patients suffering from bronchial asthma should be cautious when using the drug.

• Chronic lung disease

  • Patients suffering from chronic lung disease should be cautious.

• Prostatic hyperplasia

  • It can cause urinary retention so patients with prostatic hyperplasia should not use it.

• Myasthenia gravis

  • Patients with myasthenia gravis may experience muscle weakness. It should be used with caution.

Edrophonium and atropine: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Vital signs,
• ECG, and
• ventilatory support;
• Neuromuscular function

How to administer Edrophonium and atropine?

IV:

• It is administered as a slow intravenous injection over one minute at a point of at least 5% recovery of twitch response to neuromuscular stimulation (95% block).

Mechanism of action of Edrophonium and atropine:

• Edrophonium
  • It blocks the enzyme acetylcholinesterase, which is responsible for reducing acetylcholine. This inhibits the production of acetylcholine in the neuromuscular junction, which facilitates nerve impulse transmission across the myoneural junction. This causes an increase in the cholinergic response.
  Atropine
  • When combined with edrophonium, Atropine reduces or prevents muscarinic effects such as bradycardia and bronchoconstriction. It also decreases or eliminates the increased bronchial, salivary, and bronchial secretions that are caused by edrophonium.

See individual agents (Atropine and edrophonium) Onset of action:

• Edrophonium: It takes 3 minutes for the drugs to act when used to antagonize the effects of nondepolarizing muscle relaxants.
• Atropine: The effect on heart rate is immediate

Duration:

• Edrophonium: Antagonism of nondepolarizing muscle relaxants: 70 minutes;
• Atropine: Heart rate: 170 minutes

Protein binding:

• Atropine: ~14%

Half-life elimination:

• Edrophonium: Adults: 1.2 to 2.4 hours;
• Anephric patients: 2.4 to 4.4 hours

Time to peak, plasma:

• Edrophonium: Antagonism of nondepolarizing muscle relaxants: 1.2 minutes;
• Atropine: Heart rate: 2 to 16 minutes

Excretion:

• Edrophonium: Primarily urine (67%)

International Brand Names:

Enlon-Plus 

Edrophonium and atropine Brand Names in Pakistan:

No Brands Available in Pakistan.