Anesthetics:
Indications for: ANECTINE
Adjunct to general anesthesia to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Adult Dosage:
Individualize. Patients homozygous for atypical plasma cholinesterase gene: give test dose of 5–10mg (1mg/mL solution) by slow IV infusion. Short surgical (tracheal intubation): usual dose: 0.6mg/kg IV; range: 0.3–1.1mg/kg IV. Long surgical: (1–2mg/mL solution) by continuous infusion given at a rate of 2.5–4.3mg/min; alternatively by intermittent IV inj: initially 0.3–1.1mg/kg, followed by 0.04–0.07mg/kg. If suitable vein is inaccessible, may give by IM inj: up to 3–4mg/kg, max 150mg total dose.
Children Dosage:
See full labeling. Emergency tracheal intubation: infants and small children: 2mg/kg IV; older pediatric patients and adolescents: 1mg/kg IV. If suitable vein is inaccessible, may give by IM inj: up to 3–4mg/kg, max 150mg total dose.
ANECTINE Contraindications:
Genetic susceptibility to malignant hyperthermia. Skeletal muscle myopathies. Acute phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury.
Boxed Warning:
Risk of cardiac arrest due to hyperkalemic rhabdomyolysis in children.
ANECTINE Warnings/Precautions:
To be administered only by those skilled in management of artificial respiration. Have intubation, adequate ventilation, oxygen therapy available. Should not be administered prior to induction of unconsciousness (unless emergency). Pretreatment with anticholinergic agents (eg, atropine) may reduce occurence of bradyarrythmias. Caution in patients with reduced plasma cholinesterase activity in presence of gene abnormalities (eg, heterozygous or homozygous for atypical plasma cholinesterase gene), pregnancy, severe hepatic or renal disease, malignant tumors, infections, burns, anemia, heart disease, peptic ulcer, myxedema, or drugs affecting cholinesterase activity (see Interactions). Electrolyte abnormalities, digitalis toxicity, acute phase of injury (see Contraindications), chronic abdominal infection, subarachnoid hemorrhage, or conditions causing degeneration of central and peripheral nervous systems: increased risk of hyperkalemia. Risk of malignant hyperthermia; discontinue all triggering agents if suspected (eg, volatile anesthetic agents, succinylcholine). Risk of medication errors; confirm proper selection of intended product and ensure dose is clearly labeled/communicated. Monitor for possible transition into Phase II block (see full labeling). Glaucoma or eye injury. Bone fractures or muscle spasm. Neuromuscular blockade may be prolonged in hypokalemia or hypocalcemia. Children with skeletal muscle myopathy. Elderly. Pregnancy. Labor & delivery. Nursing mothers.
ANECTINE Classification:
Skeletal muscle relaxant (depolarizing).
ANECTINE Interactions:
Potentiated by promazine, oxytocin, aprotinin, certain non-penicillin antibiotics, quinidine, β-adrenergic blockers, procainamide, lidocaine, trimethaphan, lithium carbonate, magnesium salts, quinine, chloroquine, diethyl ether, isoflurane, desflurane, metoclopramide, terbutaline, chronically administered oral contraceptives, glucocorticoids, certain MAOIs, organophosphates, ecothiophate, and certain antineoplastics. Antagonized by anticholinergics.
Adverse Reactions:
Respiratory depression or apnea (may be prolonged), cardiac arrest, malignant hyperthermia, arrhythmias, bradycardia, tachycardia, hyper- or hypotension, hyperkalemia, increased intraocular pressure, increased intragastric pressure, muscle fasciculation, jaw rigidity, post-op muscle pain, rhabdomyolysis with possible myoglobinuric acute renal failure, excessive salivation, rash, hypersensitivity reactions; children: acute rhabdomyolysis with hyperkalemia, ventricular dysrhythmias and cardiac arrest (rare).
Drug Elimination:
Renal (<10%). Half-life: ~47 seconds.
Generic Drug Availability:
YES
How Supplied:
Multi-dose vial (10mL)—10
