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Pronunciation:

(am be NOE nee um)

U.S. Brand Names:

Mytelase®

Synonyms:

Ambenonium Chloride

Generic Available:

Canadian Brand Names:

Mytelase®

Use:

Treatment of myasthenia gravis

Pregnancy Risk Factor:

Lactation:

Excretion in breast milk unknown/not recommended

Contraindications:

Routine administration of atropine or other belladonna alkaloids with ambenonium is contraindicated because they may suppress the muscarinic symptoms of excessive gastrointestinal stimulation, leaving only the more serious symptoms of muscle fasciculations and paralysis as signs of overdosage; should not be administered to patients receiving mecamylamine

Warnings/Precautions:

Prolonged action after cholinergics, drug should be discontinued until the patient is stabilized. Use with caution in patients with asthma, epilepsy, bradycardia, hyperthyroidism, or peptic ulcer. Differentiation of cholinergic/myasthenia crisis is critical, use edrophonium and clinical judgment. Anticholinergic insensitivity may develop for brief or prolonged periods. Reduce or withhold dosages until the patient becomes sensitive again. May require respiratory support.

Adverse Reactions:

Frequency not defined.

Cardiovascular: Arrhythmias (especially bradycardia), hypotension, decreased carbon monoxide, tachycardia, AV block, nodal rhythm, nonspecific ECG changes, cardiac arrest, syncope, flushing

Central nervous system: Convulsions, dysarthria, dysphonia, dizziness, loss of consciousness, drowsiness, headache

Dermatologic: Skin rash, thrombophlebitis (I.V.), urticaria

Gastrointestinal: Hyperperistalsis, nausea, vomiting, salivation, diarrhea, stomach cramps, dysphagia, flatulence

Genitourinary: Urinary urgency

Neuromuscular & skeletal: Weakness, fasciculations, muscle cramps, spasms, arthralgia

Ocular: Small pupils, lacrimation

Respiratory: Increased bronchial secretions, laryngospasm, bronchiolar constriction, respiratory muscle paralysis, dyspnea, respiratory depression, respiratory arrest, bronchospasm

Miscellaneous: Diaphoresis (increased), anaphylaxis, allergic reactions

Overdosage/Toxicology:

Have atropine on hand to reverse cholinergic crisis or hypersensitivity reaction.

Dosage:

Oral: Adults: 5-25 mg 3-4 times/day

Patient Education:

This drug will not cure myasthenia gravis, but it may reduce the symptoms. Use as directed; do not increase dose or discontinue without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. May cause dizziness, drowsiness, or postural hypotension (rise slowly from sitting or lying position and use caution when driving or climbing stairs); vomiting or loss of appetite (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or diarrhea (boiled milk, yogurt, or buttermilk may help). Report persistent abdominal discomfort; significantly increased salivation, sweating, tearing, or urination; flushed skin; chest pain or palpitations; acute headache; unresolved diarrhea; excessive fatigue, insomnia, dizziness, or depression; increased muscle, joint, or body pain; vision changes or blurred vision; or shortness of breath or wheezing. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Breast-feeding is not recommended.

Nursing Implications:

Have atropine ready to combat hypercholinergic response; have epinephrine ready to combat anaphylaxis

Dental Health: Effects on Dental Treatment:

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

May produce drowsiness

Mental Health: Effects on Psychiatric Treatment:

None reported; the cholinergic effects may counteract the anticholinergic effects of psychotropics

Dosage Forms:

Caplet, as chloride [scored]: 10 mg [contains lactose and sucrose]

International Brand Names:

Mytelase® (CA, CZ, FR, HU, PL, SE)

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