What's on this Page
What is Pipecuronium
NOTE: This drug is discontinued in the US.
Pipecuronium is a long-acting, nondepolarizing, neuromuscular blocker, which is structurally related to pancuronium. It is used to cause skeletal muscle relaxation as an adjunct to general anesthesia or for endotracheal intubation.
The use of pipecuronium in clinical practice has been limited by its long duration of action.
Pipecuronium antagonizes the action of acetylcholine by competitively binding to cholinergic receptors on the motor endplate.
The time to maximum peak and clinical duration of neuromuscular blockade is dose-dependent.
Pipecuronium should be used only for procedures expected to last over 90 minutes. Pipecuronium is not recommended for ICU patients requiring prolonged mechanical ventilation.
Compared to pancuronium, another long-acting nondepolarizing agent, pipecuronium is 20—50% more potent, but has a similar onset, duration of action, and other pharmacokinetic parameters.
However, pipecuronium does not produce the tachycardia and blood pressure elevations seen with pancuronium, and is thus preferable to pancuronium in patients with coronary artery disease.
Pipecuronium lacks significant histamine releasing properties and is not metabolized by plasma cholinesterase.
Like other neuromuscular blockers, significant variation in patient sensitivity and dosage requirements exist for pipecuronium, requiring careful patient selection, dosage titration and monitoring.
Pipecuronium was approved by the FDA on June 26, 1990.
Indications
- endotracheal intubation
- neuromuscular blockade
For neuromuscular blockade, as an adjunct to general anesthesia during surgery, or to facilitate endotracheal intubation or mechanical ventilation
Side Effects
- anaphylactoid reactions
- apnea
- bradycardia
- dyspnea
- hyperglycemia
- hyperkalemia
- hypotension
- malignant hyperthermia
- muscle paralysis
- rash
- respiratory depression
- urticaria
Monitoring Parameters
- arterial blood gases (ABGs)
- peripheral nerve stimulation
- serum electrolytes
- serum magnesium
Contraindications
- acid/base imbalance
- breast-feeding
- bromide hypersensitivity
- burns
- chronic obstructive pulmonary disease (COPD)
- corticosteroid therapy
- dehydration
- electrolyte imbalance
- geriatric
- hepatic disease
- hypermagnesemia
- hypocalcemia
- hypokalemia
- hyponatremia
- infants
- intramuscular administration
- lung cancer
- malignant hyperthermia
- metabolic alkalosis
- myasthenia gravis
- myopathy
- neonates
- neuromuscular disease
- obesity
- pregnancy
- pulmonary disease
- renal disease
- renal failure
- renal impairment
- respiratory acidosis
- respiratory depression
- respiratory insufficiency
Interactions
No information is available regarding drug interactions associated with Pipecuronium
