Pronunciation:

(ed roe FOE nee um)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Lactation:

Contraindications:

Warnings/Precautions:

Adverse Reactions:

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:

Drug Interactions:

Decreased effect: Atropine, nondepolarizing muscle relaxants, procainamide, quinidine

Increased effect: Succinylcholine, digoxin, I.V. acetazolamide, neostigmine, physostigmine

Compatibility:

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: I.M.: 2-10 minutes; I.V.: 30-60 seconds

Duration: I.M.: 5-30 minutes: I.V.: 10 minutes

Distribution: Vd: 1.1 L/kg

Half-life elimination: 1.8 hours

Dosage:

Infants:

I.M.: 0.5-1 mg

I.V.: Initial: 0.1 mg, followed by 0.4 mg if no response; total dose = 0.5 mg

Children:

Diagnosis: Initial: 0.04 mg/kg over 1 minute followed by 0.16 mg/kg if no response, to a maximum total dose of 5 mg for children <34 kg, or 10 mg for children >34 kg or

Alternative dosing (manufacturer's recommendation):

34 kg: 1 mg; if no response after 45 seconds, repeat dosage in 1 mg increments every 30-45 seconds, up to a total of 5 mg

>34 kg: 2 mg; if no response after 45 seconds, repeat dosage in 1 mg increments every 30-45 seconds, up to a total of 10 mg

I.M.:

<34 kg: 1 mg

>34 kg: 5 mg

Titration of oral anticholinesterase therapy: 0.04 mg/kg once given 1 hour after oral intake of the drug being used in treatment; if strength improves, an increase in neostigmine or pyridostigmine dose is indicated

Adults:

Diagnosis:

I.V.: 2 mg test dose administered over 15-30 seconds; 8 mg given 45 seconds later if no response is seen; test dose may be repeated after 30 minutes

I.M.: Initial: 10 mg; if no cholinergic reaction occurs, administer 2 mg 30 minutes later to rule out false-negative reaction

Titration of oral anticholinesterase therapy: 1-2 mg given 1 hour after oral dose of anticholinesterase; if strength improves, an increase in neostigmine or pyridostigmine dose is indicated

Reversal of nondepolarizing neuromuscular blocking agents (neostigmine with atropine usually preferred): I.V.: 10 mg over 30-45 seconds; may repeat every 5-10 minutes up to 40 mg

Termination of paroxysmal atrial tachycardia: I.V. rapid injection: 5-10 mg

Differentiation of cholinergic from myasthenic crisis: I.V.: 1 mg; may repeat after 1 minute. Note: Intubation and controlled ventilation may be required if patient has cholinergic crisis

Dosing adjustment in renal impairment: Dose may need to be reduced in patients with chronic renal failure

Administration:

Monitoring Parameters:

Test Interactions:

Patient Education:

Additional Information:

Anesthesia and Critical Care Concerns/Other Considerations:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

Enlon®: 10 mg/mL (15 mL) [contains sodium sulfite]

Reversol®: 10 mg/mL (10 mL) [contains sodium sulfite]

International Brand Names: