Alternate Name(s):
TENSILON®, ENLON®
Classification:
Diagnostic agent for myasthenia gravis; parasympathomimetic to reverse curariform drugs
Original Date:
August 2005
Indications:
- Differential diagnosis of myasthenia gravis, evaluation of treatment of myasthenia gravis
- Curare antagonist for reversal of neuromuscular blockade produced by tubocurarine, curare, gallamine triethiodide, atracurium, vecuronium, pancuronium
- Treatment of respiratory depression caused by curare overdose
Reconstitution and Stability:
- Stable at room temperature
- Protect from light
- Available as 10 mg/mL ampoules and multi-dose vials
Compatibility:
- Solutions Compatible: D5W, 0.9% NaCl, D5NS, ringer's lactate for 4 hours at room temperature
- Additives/Above Cassette Compatible: no information
- Y-site Compatible: KCl (up to 40 mEq/L), heparin
Incompatible: no information
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | YES, usually IV |
| IM | YES, usually IV |
| IV Push |
YES |
| IV Intermittant Infusion | NO |
| IV Continuous Infusion | NO |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Infant:
- Myasthenia gravis diagnosis:
- 0.5-1 mg IM/SC OR
- 0.1 mg IV followed by 0.4 mg (if no response): total dose = 0.5 mg
Pediatric:
- Myasthenia gravis diagnosis:
- <34 kg: 2 mg IM/SC
- >34 kg: 5 mg IM/SC OR
- 0.04 mg/kg IV followed by 0.16 mg/kg IV given within 45 seconds, if no response
- Maximum: 10 mg total
Adolescent/Adult :
- Myasthenia gravis diagnosis:
- 10 mg IM/SC: if no cholinergic reaction occurs, give 2 mg 30 minutes later to rule out false negative OR
- Use 10 mg in tuberculin syringe, 2 mg test dose administered over 15-30 seconds leaving needle in situ; If no reaction in 45 seconds, inject remaining 8 mg. May repeat in 30 minutes
- Curare antagonist:
- 10 mg IV over 30-45 seconds. May repeat Q 5-10 minutes
- Maximum: 40 mg total dose
Potential hazards of parenteral administration:
- Thrombophlebitis
- Bradycardia and cardiac arrhythmias (antidote-atropine sulphate), A-V block
- Hypotension
- Bronchospasm, respiratory distress especially in asthmatics
- Increased salivary, gastrointestinal, lacrimal and bronchial secretions
- Weakness and fasciculations
- Seizures, drowsiness, headaches
Notes:
- May cause cholinergic crisis (IV atropine should be available)
- Resuscitation equipment should be readily available
- Not effective in reversing paralysis caused by succinylcholine
- Caution in patients with asthma or cardiac arrhythmias
- Supportive ventilation must be readily available in apneic patients
- Not recommended for maintenance therapy in myasthenia gravis due to short duration of action
- Contraindicated in intestinal and urinary obstruction of mechanical type
- Monitor pre- and post-injection strength, heart rate, respiratory rate, blood pressure, changes in fasciculations
- Dose may need to be reduced in chronic renal failure