Pipecuronium bromide

By Medically reviewed by hellodoktor

Generic Name: Pipecuronium bromide Brand Name(s): Pipecuronium bromide and Pipecuronium bromide.

Uses

What is pipecuronium bromide used for?

Pipecuronium bromide is commonly used for injection is a long-acting neuromuscular blocking agent, indicated as an adjunct to general anesthesia, to provide skeletal muscle relaxation during surgery.

Pipecuronium bromide can also be used to provide skeletal muscle relaxation for endotracheal intubation.

How should I take pipecuronium bromide?

This drug is injected through intravenous by your doctor.

How do I store pipecuronium bromide?

Pipecuronium bromide is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store pipecuronium bromide in the bathroom or the freezer. There may be different brands of pipecuronium bromide that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush pipecuronium bromide down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using pipecuronium bromide?

Before using this drug, tell your doctor if:

  • You are pregnant or breastfeeding. This is because, while you are expecting or feeding a baby, you should only take medicines on the recommendation of a doctor.
  • You are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • You have allergy with any of active or inactive ingredients of pipecuronium bromide or other medications.
  • You have any other illnesses, disorders, or medical conditions.

Due to the long duration of action, do not use in myasthenia gravis or Eaton-Lambert syndrome, as low doses can lead to a profound effect. Clients undergoing cesarean section. Use of pipecuronium before succinylcholine in order to reduce side effects of succinylcholine. In those requiring prolonged mechanical ventilation in the ICU or prior to or following other nondepolarizing neuromuscular blocking agents.

Although the drug is used in infants and children, no information is available on maintenance dosing. Also, children 1-14 years of age under balanced or halothane anesthesia may be less sensitive to the drug than adults. Use with caution in clients with impaired renal function. The drug should be administered only if there are adequate facilities for intubation, artificial respiration, oxygen therapy, and administration of an antagonist. Obesity may prolong the duration of action. Conditions resulting in an increased volume of distribution (e.g., old age, edematous states, slower circulation time in CV disease) may cause a delay in the time of onset.

Is it safe during pregnancy or breastfeeding?

There are no adequate studies in women for determining risk when using pipecuronium bromide during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking pipecuronium bromide. Pipecuronium bromide is pregnancy risk category C, according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk
  • B=No risk in some studies
  • C=There may be some risk
  • D=Positive evidence of risk
  • X=Contraindicated
  • N=Unknown

Side effects

What side effects can occur from pipecuronium bromide?

When using this drug, some side effects may occur, such as:

  • Skeletal muscle paralysis resulting in respiratory insufficiency
  • Apnea
  • Hypotension
  • Bradycardia
  • Hypertension
  • Thrombosis
  • Myocardial ischemia
  • Atrial fibrillation
  • Ventricular extrasystole
  • Hypesthesia
  • CNS depression
  • Dyspnea
  • Respiratory depression
  • Laryngismus
  • Atelectasis
  • Hypoglycemia
  • Hyperkalemia
  • Increased creatinine
  • Rash
  • Urticarial
  • Anuria

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with pipecuronium bromide?

Pipecuronium bromide may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Products may interact with your drug, including:

  • Aminoglycosides
  • Bacitracin
  • Colistin/Sodium colistimethate
  • Enflurane
  • Halothane
  • Isoflurane
  • Magnesium salts
  • Polymyxin B
  • Quinidine
  • Tetracyclines

Does food or alcohol interact with pipecuronium bromide?

Pipecuronium bromide may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Pipecuronium bromide?

Pipecuronium bromide may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using pipecuronium bromide.

What is the dose of pipecuronium bromide for an adult?

Adjunct to general anesthesia.  

Initial dose may be based on the C CR and the ideal body weight (see information provided by manufacturer). Dose is individualized. The dose range is 50-100 mcg/kg.

ET intubation using balanced anesthesia.

70-85 mcg/kg with halothane, isoflurane, or enflurane in clients with normal renal function who are not obese; duration of muscle relaxation is 1-2 hr using this dosage range.

Use following recovery from succinylcholine.

50 mcg/kg in clients with normal renal function who are not obese; duration of muscle relaxation using this dose is 45 min.

Maintenance. 

10-15 mcg/kg given at 25% recovery of control T 1 will provide muscle relaxation for an average of 50 min using balanced anesthesia; lower doses should be used in clients receiving inhalation anesthetics.

What is the dose of Pipecuronium bromide for a child?

Use following recovery from succinylcholine. 

50 mcg/kg in clients with normal renal function who are not obese; duration of muscle relaxation using this dose is 45 min.

Maintenance. 

The duration of action in infants following a dose of 40 mcg/kg ranged from 10 to 44 min while the duration in children following a dose of 57 mcg/kg ranged from 18 to 52 min.

How is pipecuronium bromide available?

Pipecuronium bromide is available in the following dosage forms and strengths:

  • Pipecuronium bromide 10 mg injection

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency service or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of pipecuronium bromide, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 15, 2017 | Last Modified: September 13, 2019

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