Piperecuronium bromide (Pipecuronii bromidum)

Pharmacodynamics Pharmacokinetics Indications Carefully Contraindications Dosing and Administration Side effects
Read on
Clinical and pharmacological group: & nbsp

"N-holinoblokatory (muscle relaxants, curare-like remedies)"

Included in the formulation
  • Aperomide®
    lyophilizate in / in 
    RUSSIAN CARDIOLOGICAL NPK FGU ROSMEDTEKHNOLOGIY - EXPERIMENTAL PRODUCTION OF MEDICAL AND BIOLOGICAL PREPARATIONS     Russia
  • Arduan
    lyophilizate in / in 
    GEDEON RICHTER, OJSC     Hungary
  • Vero-Pipecuronius
    lyophilizate in / in 
    VEROPHARM SA     Russia
  • Piperecuronium bromide
    powder in / in 
    Sinbias Pharma, LLC     Ukraine
    • Included in the list (Order of the Government of the Russian Federation No. 2782-r of 30.12.2014):

    VED

    АТХ:

    M.03.A.C.06   Piperecuronium bromide

    Pharmacodynamics:Competitive blockade of the N-cholinergic receptors of the neuromuscular synapse: binds the αγ or αδ N-cholinoreceptor subunits at the joints and reduces the frequency of opening the channel (rather than the conductivity of a single channel), which leads to hyperpolarization of the postsynaptic membrane. In high concentrations, a non-competitive and potential-dependent blockade. Has a myorelaxing (peripheral) effect. The onset of action after intravenous administration is 2.5-3 minutes, the maximum effect is 3-5 minutes, the duration of action is 0.5-2 hours. Causes the release of histamine and has a slight ganglion blocking effect.
    Pharmacokinetics:The half-life is 6.2 minutes, while chronic renal failure is 4.3 minutes.Biotransformation in tissues to active and inactive metabolites. Elimination by the kidneys - 75% unchanged, 20% in the form of metabolites. Cumulates in chronic kidney failure.
    Indications:Relaxation of skeletal muscles and relief of endotracheal intubation during surgical interventions and diagnostic procedures in conditions of mechanical ventilation.
    ICD-10

    XXI.Z100.Z100 *   CLASS XXII Surgical Practice

    XXI.Z40-Z54.Z40   Prophylactic surgical intervention

    Contraindications:Myasthenia gravis, an individual drug intolerance.
    Carefully:Impaired liver and / or kidney function.

    Severe heart failure.

    Bronchogenic carcinoma.

    Edema.

    Dehydration.

    Violation of the electrolyte and acid-base balance.

    Hypothermia.

    Respiratory failure.

    Pregnancy and lactation:Contraindicated in early pregnancy and breastfeeding. The action category for fetus by FDA is C.
    Dosing and Administration:Endotracheal intubation, for adults and children over 14 years of age: the initial dose is 70-85 μg / kg (against the background of suxamethonium - 40-50 μg / kg), maintaining a dose of 10-15 μg / kg.
    Side effects:Nervous system and sensory organs: hypoesthesia, suppression of the central nervous system.

    The cardiovascular system: bradycardia, lowering of arterial pressure, cerebrovascular disorders, myocardial ischemia, thrombosis, atrial fibrillation, ventricular extrasystole.

    Respiratory system: shortness of breath, respiratory depression, atelectasis, apnea (during the aftereffect).

    Metabolism: increase in the level of creatinine, hypoglycemia, hyperkalemia.

    Allergic reactions: rash, hives, anaphylactic reactions.

    Others: muscular atrophy, anuria.

    Overdose:When an overdose develops acute respiratory arrest, severe hypotension, prolonged paralysis, shock.

    Treatment symptomatic: artificial ventilation, the introduction of anticholinesterase drugs (neostigmine methyl sulfate, edrophonia, physostigmine and others) together with atropine to prevent m-cholinomimetic effects of the latter.

    Interaction:β-Adrenoblockers - increased action of pipecuronium.

    Aminoglycosides, vancomycin, capreomycin, lincomycin, massive infusions of citrated blood, local (including procaine and lidocaine) and general anesthetics, polymyxins, tetracyclines, trimetafan, ureidopenicillins - additive muscle relaxant effect.

    Anesthetics common (halothane, isoflurane, methoxyflurane, trichlorethylene, chloroform, cyclopropane, enflurane, diethyl ether) - additive muscle relaxant effect.

    Antimiasthenic drugs, calcium salts, and eudrophonia - decreased myorelaxing activity.

    Aprotinin - the risk of apnea.

    Blockers of slow calcium channels, ganglion blockers, lidocaine, procainamide, magnesium salts, quinidine - Increased neuromuscular blockade.

    Botulinum toxin A - strengthening neuromuscular blockade.

    Muscle relaxants, depolarizing - enhancement of muscle relaxation, if prescribed before the administration of nondepolarizing muscle relaxants.

    Opioid analgesics are an additive depressive effect on respiratory function, a reduction in muscle rigidity caused by fentanyl and its derivatives, an additive depressive effect on hemodynamics, an additive effect on the release of histamine.

    Anticonvulsants (carbamazepine, phenytoin), metoclopramide - Increase the duration of action of pipecuronium.

    Means that reduce the concentration of potassium in the plasma (amphotericin B, bumetanide, glucocorticoids, especially with high mineralocorticoid activity, inhibitors of carbonic anhydrase, indapamide, thiazide diuretics, chronic use of ACTH, furosemide, ethacrynic acid) - increased muscle relaxancy.

    Special instructions:During the application of the drug, it is necessary to monitor blood pressure, oxygen saturation of blood.
    Instructions
    Up