No

Neuromuscular Blocker Agent, Nondepolarizing

Adjunct to general anesthesia, to provide skeletal muscle relaxation during surgery and to provide skeletal muscle relaxation for endotracheal intubation; recommended only for procedures anticipated to last 90 minutes or longer

C

Hypersensitivity to pipecuronium or bromide

Use with caution in patients with renal impairment, obesity, cardiovascular disease, myasthenia gravis, myasthenic syndrome, and in the elderly

1% to 10%: Cardiovascular: Hypotension, bradycardia

<1%: Atrial fibrillation, myocardial ischemia, thrombosis, hypertension, ventricular extrasystole, CNS depression, urticaria, hypoglycemia, hyperkalemia, muscle atrophy, anuria, respiratory depression, dyspnea

Support ventilation by artificial means; paralysis including cessation of respiration

Increased effect with enflurane, halothane, isoflurane, ketorolac, quinidine, succinylcholine

Compatible with D₅W, 0.9% sodium chloride, D₅ 0.9% sodium chloride, LR, sterile and bacteriostatic water for injection

Pipecuronium bromide is a nondepolarizing neuromuscular blocking agent structurally related to pancuronium and vecuronium. Studies in adult patients have demonstrated that pipecuronium is ~20% to 50% more potent than pancuronium as a neuromuscular blocking agent. The neuromuscular effects and pharmacokinetics of pipecuronium appears to lack vagolytic or autonomic activity and produces minimal cardiovascular effects.

Onset of action: Effective neuromuscular blockade is generally observed within 2-3 minutes

Metabolism: In the liver primarily to 3-desacetyl-pipecuronium

Half-life, elimination: 2-2.5 hours

Elimination: Renally (40% unchanged drug)

I.V.:

3 months to 1 year: Adult dosage

1-14 years: May be less sensitive to effects

Adults: Dose is individualized based on ideal body weight, ranges are 85-100 mcg/kg initially to a maintenance dose of 5-25 mcg/kg

Dosing adjustment in renal impairment:

Cl_cr 61-80 mL/minute: 70 mcg/kg

Cl_cr 41-60 mL/minute: 55 mcg/kg

Cl_cr <40 mL/minute: 50 mcg/kg

Extended duration should be expected

Not recommended for dilution into or administration from large volume I.V. solutions

Not recommended for dilution into or administration from large volume I.V. solutions

Injection, as bromide: 10 mg (10 mL)

Khuenl-Brady KS, Reitstatter B, Schlager A, et al, "Long-Term Administration of Pancuronium and Pipecuronium in the Intensive Care Unit," Anesth Analg, 1994, 78(6):1082-6.

Larijani GE, Bartkowski RR, Azod SS, et al, "Clinical Pharmacology of Pipecuronium Bromide," Anesth Analg, 1989, 68(6):734-9.