Edrophonium chloride

Generic Medicine Info
Indications and Dosage
Diagnosis of myasthenia gravis
Adult: Initially, 10 mg. If cholinergic reaction occurs, administer 2 mg after 30 min to rule out false-negative reactions.
Child: ≤34 kg: 2 mg; >34 kg: 5 mg.

Diagnosis of myasthenia gravis
Adult: Initially, 2 mg test dose over 15-30 seconds. If no cholinergic reaction after 45 seconds, administer 8 mg. If reaction occurs, discontinue testing and then administer IV atropine. Test may be repeated after 30 min, if necessary.
Child: ≤34 kg: 1 mg test dose; >34 kg: 2 mg test dose. If no reaction after 45 seconds, 1 mg may be given every 30-45 seconds up to max cumulative dose of 5 mg (≤34 kg) or 10 mg (>34 kg). Infants: 0.5 mg.

Anticholinesterase therapy evaluation
Adult: 1-2 mg given 1 hr after oral anticholinesterase dose. Controlled patients show adequate response; undertreated patients show myasthenic response; and overtreated patients show cholinergic response.

Cholinergic and myasthenic crisis differentiation
Adult: 1 mg, may repeat after 1 min.

Reversal of neuromuscular blockade
Adult: Given to reverse blockade from nondepolarising agents: 10 mg given slowly over 30-45 seconds, may repeat every 5-10 min as necessary. Max total: 40 mg. Alternatively, 0.5-1 mg/kg.
Mechanical obstruction of GI or genitourinary tract.
Special Precautions
Patient w/ bronchial asthma, cardiac arrhythmia (e.g. bradyarrhythmia). Not indicated to reverse non-depolarising neuromuscular blockade in patients w/ myasthenia gravis. Childn. Pregnancy and lactation.
Adverse Reactions
Significant: Transient bradycardia, cardiac and resp arrest, anticholinesterase insensitivity.
Nervous: Weakness, seizure, dysarthria, dizziness, drowsiness, headache, loss of consciousness.
CV: Arrhythmia, hypotension, AV block, nonspecific ECG changes, flushing, syncope, tachycardia, thrombophlebitis.
GI: Nausea, vomiting, diarrhoea, abdominal cramps, increased peristalsis, increased gastric and intestinal secretions, dysphagia, dysphonia, flatulence.
Resp: Laryngospasm, increased bronchial secretions, bronchospasm, resp paralysis.
Genitourinary: Urinary frequency, urgency, and incontinence.
Musculoskeletal: Muscle cramps, fasciculation.
Ophthalmologic: Increased lacrimation, miosis, accommodation spasm, diplopia, conjunctival hyperaemia.
Dermatologic: Diaphoresis, rash, urticaria.
Potentially Fatal: Cholinergic crisis, asthma.
IM/IV/Parenteral: C
Monitoring Parameters
Monitor pre- and post-injection strength, heart and resp rate, and BP.
Symptoms: Cholinergic crisis manifesting as nausea, vomiting, diarrhoea, excessive sweating, increased bronchial and salivary secretions, bradycardia or tachycardia, cardiospasm, hypotension, blurred vision, weakness, incoordination, muscle cramps, fasciculation, paralysis, bronchospasm, airway obstruction, resp paralysis, pulmonary oedema, cardiac arrest. Management: Administer 0.4-0.5 mg IV atropine, repeated every 3-10 min to control cholinergic symptoms. Maintain adequate respiration by assuring an open airway (through tracheostomy, bronchial aspiration, and postural drainage) and providing assisted respiration w/ oxygen. Monitor cardiac function until complete stabilisation. In case of airway obstruction due to bronchial secretions, administer up to 1.2 mg IV atropine, repeated every 20 min until secretions are controlled.
Drug Interactions
Antagonised muscarinic effects w/ atropine. May cause an increased sensitivity of the heart to edrophonium when given w/ digitalis. May prolong the phase 1 blockade of depolarising muscle relaxants (e.g. suxamethonium, decamethonium). May antagonise the effects of nondepolarising muscle relaxants (e.g. atracurium, pancuronium, vecuronium, tubocurarine, metocurine).
Mechanism of Action: Edrophonium chloride is a synthetic quaternary ammonium cholinergic agent. It reversibly inhibits the hydrolysis of acetylcholine by binding to the anionic site of acetylcholinesterase, thereby causing accumulation of acetylcholine. This results in increased cholinergic responses including increased tonus of skeletal and intestinal muscles, bronchial and ureteral constriction, miosis, bradycardia, and increased sweat and salivary secretions.
Onset: 30-60 seconds (IV); 2-10 min (IM).
Duration: 5-10 min (IV); 5-30 min (IM).
Distribution: Volume of distribution: 0.9 ± 0.13 L/kg.
Excretion: Mainly via urine (67%). Elimination half-life: 126 ± 59 min.
Chemical Structure

Chemical Structure Image
Edrophonium chloride

Source: National Center for Biotechnology Information. PubChem Database. Edrophonium chloride, CID=8307, https://pubchem.ncbi.nlm.nih.gov/compound/Edrophonium-chloride (accessed on Jan. 21, 2020)

Store between 20-25°C.
MIMS Class
Antidotes & Detoxifying Agents / Radiographic & Diagnostic Agents
Anon. Edrophonium. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 04/05/2017.

Buckingham R (ed). Edrophonium Chloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/05/2017.

Enlon Injection, Solution (Mylan Institutional LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 04/05/2017.

McEvoy GK, Snow EK, Miller J et al (eds). Edrophonium Chloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 04/05/2017.

Disclaimer: This information is independently developed by MIMS based on Edrophonium chloride from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2024 MIMS. All rights reserved. Powered by MIMS.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Already a member? Sign in
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Already a member? Sign in