Arduan
Generic Name
Pipecuronium Bromide
Manufacturer
Organon (original), various generic manufacturers
Country
Global
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| arduan 4 mg injection | ৳ 136.00 | N/A |
Description
Overview of the medicine
Pipecuronium Bromide is a long-acting, non-depolarizing neuromuscular blocking agent used as an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Uses & Indications
Dosage
Adults
Initial dose for intubation: 0.07-0.08 mg/kg IV. Maintenance doses are typically 0.01-0.015 mg/kg IV. Dosing must be individualized based on patient factors and neuromuscular monitoring.
Elderly
May require reduced initial doses and/or longer intervals between maintenance doses due to potential for slower elimination and increased sensitivity. Start with the lower end of the adult dose range.
Renal_impairment
Significant dose reduction and/or extended dosing intervals are required. Monitor neuromuscular function closely. Use with caution or consider alternative NMBAs.
How to Take
Administer intravenously (IV) as a bolus injection or sometimes as a continuous infusion. Must be administered by or under the supervision of experienced clinicians who are familiar with the use of neuromuscular blocking agents and have access to resuscitative equipment.
Mechanism of Action
Pipecuronium competitively binds to nicotinic acetylcholine receptors at the neuromuscular junction, preventing acetylcholine from binding. This blocks nerve impulse transmission, leading to skeletal muscle paralysis without depolarization.
Pharmacokinetics
Onset
2-3 minutes (for intubation doses)
Excretion
Primarily renal (60-70% as unchanged drug and metabolites), some biliary excretion.
Half life
Approximately 1.5 - 2.5 hours (elimination half-life)
Absorption
Rapid and complete absorption following intravenous administration.
Metabolism
Minimal hepatic metabolism, some active metabolites are formed.
Side Effects
Contraindications
- Known hypersensitivity to pipecuronium, bromide, or any component of the formulation.
- Conditions where muscle relaxation is contraindicated (e.g., inadequate ventilatory support).
Drug Interactions
Inhalation Anesthetics
Potentiate the effect of pipecuronium, increasing both magnitude and duration of block. Dose reduction of pipecuronium may be necessary.
Calcium Channel Blockers
May enhance neuromuscular block.
Magnesium Salts, Lithium
May potentiate the effect.
Diuretics (e.g., Furosemide)
May enhance or antagonize effects depending on fluid and electrolyte balance.
Corticosteroids (chronic use)
May increase risk of prolonged weakness or myopathy.
Aminoglycosides, Polymyxins, Tetracyclines
May enhance and prolong neuromuscular block.
Storage
Store refrigerated at 2°C to 8°C (36°F to 46°F). Protect from light. Do not freeze. Reconstituted solution should be used promptly.
Overdose
Overdose results in prolonged neuromuscular blockade and respiratory paralysis. Management includes maintaining airway, providing mechanical ventilation, and administering reversal agents (e.g., neostigmine, sugammadex) under strict medical supervision.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. Not known whether excreted in human milk; use with caution in nursing mothers.
Side Effects
Contraindications
- Known hypersensitivity to pipecuronium, bromide, or any component of the formulation.
- Conditions where muscle relaxation is contraindicated (e.g., inadequate ventilatory support).
Drug Interactions
Inhalation Anesthetics
Potentiate the effect of pipecuronium, increasing both magnitude and duration of block. Dose reduction of pipecuronium may be necessary.
Calcium Channel Blockers
May enhance neuromuscular block.
Magnesium Salts, Lithium
May potentiate the effect.
Diuretics (e.g., Furosemide)
May enhance or antagonize effects depending on fluid and electrolyte balance.
Corticosteroids (chronic use)
May increase risk of prolonged weakness or myopathy.
Aminoglycosides, Polymyxins, Tetracyclines
May enhance and prolong neuromuscular block.
Storage
Store refrigerated at 2°C to 8°C (36°F to 46°F). Protect from light. Do not freeze. Reconstituted solution should be used promptly.
Overdose
Overdose results in prolonged neuromuscular blockade and respiratory paralysis. Management includes maintaining airway, providing mechanical ventilation, and administering reversal agents (e.g., neostigmine, sugammadex) under strict medical supervision.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. Not known whether excreted in human milk; use with caution in nursing mothers.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years, consult specific product labeling for exact shelf life. Reconstituted solution has limited stability.
Availability
Hospital and Clinical Use
Approval Status
Approved (Internationally)
Patent Status
Off-patent
Clinical Trials
Extensive clinical trials have established the efficacy and safety of pipecuronium bromide as a neuromuscular blocking agent in various surgical and critical care settings. Ongoing research continues to optimize its use and understand long-term outcomes.
Lab Monitoring
- Neuromuscular function monitoring (e.g., Train-of-Four stimulation) is essential to assess the depth of blockade and guide dosing and reversal.
- Electrolyte balance.
Doctor Notes
- Always have resuscitative equipment and reversal agents readily available.
- Monitor neuromuscular function (e.g., TOF) throughout administration.
- Adjust dose carefully in patients with renal impairment or elderly patients.
Patient Guidelines
- This medication is administered by a healthcare professional in a hospital setting.
- Patients should inform their doctor about all current medications and medical conditions.
- Patients will be monitored closely for the effects of the medication.
Missed Dose Advice
This medication is administered by a healthcare professional in a controlled setting, typically during surgery or intensive care. Missing a dose is not applicable in this context.
Driving Precautions
Not applicable as patients receiving pipecuronium bromide will be under general anesthesia or critical care and will not be operating machinery or driving.
Lifestyle Advice
- Not applicable as this medication is used in acute clinical settings under medical supervision.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.