Arduan
Instructions for use:
- 1. Release form and composition
- 2. Indications for use
- 3. Contraindications
- 4. Method of application and dosage
- 5. Side effects
- 6. Special instructions
- 7. Drug interactions
- 8. Analogs
- 9. Terms and conditions of storage
- 10. Terms of dispensing from pharmacies
Prices in online pharmacies:
from 1849 rub.
Buy
Arduan is a muscle relaxant of a non-depolarizing competitive type of peripheral long-acting.
Release form and composition
Dosage form - lyophilisate for the preparation of a solution for intravenous (IV) administration: almost white or white dry substance; solvent - a clear, colorless liquid (4 mg in glass colorless vials, in plastic trays of 5 vials, in a cardboard box 5 trays complete with 25 ampoules of solvent).
1 bottle of Arduan contains:
- active substance: pipcuronium bromide - 4 mg;
- auxiliary components: mannitol.
The ampoule in the solvent contains 0.9% sodium chloride solution - 2 ml.
Indications for use
The use of Arduan is indicated for relaxation of skeletal muscles and endotracheal intubation during the period of general anesthesia in surgical operations requiring muscle relaxation for a period of more than 20-30 minutes, and in conditions of artificial ventilation.
Contraindications
- severe liver failure;
- age up to 3 months;
- the period of pregnancy and breastfeeding;
- hypersensitivity to the components of the drug.
It is recommended to prescribe the drug with caution to patients with an increased volume of circulating blood or dehydration, edematous syndrome, renal failure (the duration of action of the drug and the period of post-anesthetic depression increase), impaired acid-base balance (hypercapnia, acidosis), obstruction of the biliary tract, in violation of water-electrolyte metabolism (hypermagnesemia, hypokalemia, hypocalcemia), taking diuretics, malignant hyperthermia, hypothermia, hypoproteinemia, digitalization, cachexia, respiratory depression, chronic heart failure in the stage of decompensation, hepatic failure, with anaphylactic reaction to any muscle relaxant in), under the age of 14.
In addition, a careful assessment of the potential risk when using Arduan in patients with myasthenia gravis (including Eaton-Lambert syndrome, myasthenia gravis) is required, since even low doses of the drug can cause both a strong and weakened effect.
Method of administration and dosage
Arduan is intended for intravenous administration only.
The solution should be prepared before direct administration by adding 1 ampoule of the supplied solvent to the contents of 1 vial with the drug.
Only freshly prepared solution must be used!
The dose is prescribed for each patient individually, taking into account the type of anesthesia, the expected duration of the operation, possible interaction with drugs used before or during anesthesia, comorbidities and the patient's clinical condition.
The neuromuscular blockade is recommended to be controlled with a peripheral nerve stimulator.
Recommended dosage for patients over 14 years of age:
- intubation and subsequent surgery: the initial dose is 0.08-0.1 mg per 1 kg of the patient's body weight. This dose provides enough intubation for 2.5-3 minutes and muscle relaxation for 60-90 minutes;
- muscle relaxation during surgery after intubation using suxamethonium: the initial dose is 0.05 mg per 1 kg of body weight, provides muscle relaxation lasting 30-60 minutes;
- maintenance dose: 0.01-0.02 mg per 1 kg of body weight, during the operation provides muscle relaxation for 30-60 minutes.
For patients with chronic renal failure, the dose of Arduan should not exceed 0.04 mg per 1 kg of body weight; higher doses may increase the duration of muscle relaxation.
For patients with overweight and obesity, a dose calculated for the ideal weight should be used to prevent an increase in the duration of the drug.
The recommended dosage for children has age restrictions:
- 3-12 months of life: at the rate of 0.04 mg per 1 kg of the child's weight, provides the duration of muscle relaxation 10-44 minutes;
- 1-14 years old: 0.05-0.06 mg per 1 kg, provides the duration of muscle relaxation 18-52 minutes.
To terminate the muscle relaxant effect of the drug in the period of 80-85% of blockade controlled by a stimulator of peripheral nerve fibers, or during the period of partial blockade, which is determined by clinical signs, the patient is administered atropine (0.5-1.25 mg) in combination with galantamine (10 -30 mg) or neostigmine methyl sulfate (1-3 mg).
Side effects
- respiratory system: rarely - respiratory depression, apnea, cough, bronchospasm, laryngospasm (against the background of an allergic reaction), lung atelectasis;
- nervous system: rarely - drowsiness, depression of the central nervous system, paralysis of skeletal muscles, hypesthesia;
- the blood coagulation system: rarely - a decrease in the activated partial thromboplastin and prothrombin time, thrombosis;
- musculoskeletal system: rarely - a feeling of weakness of the skeletal muscles after the completion of muscle relaxation, muscle atrophy;
- cardiovascular system: rarely - decrease or increase in blood pressure (BP), myocardial and brain ischemia, myocardial infarction, atrial fibrillation, arrhythmias, ventricular premature beats, bradycardia, tachycardia;
- metabolism: rarely - hypokalemia, hypocalcemia, hyperglycemia, hypomagnesemia;
- organ of vision: ptosis, blepharitis;
- urinary system: rarely - anuria, hypercreatininemia;
- allergic reactions: rarely - such hypersensitivity reactions as skin rash, Quincke's edema.
special instructions
Arduan is intended for use only in a hospital setting, in an operating room equipped with appropriate equipment for artificial ventilation of the lungs and provided with everything necessary for the immediate treatment of anaphylactic or anaphylactoid reactions.
Due to the effect of the drug on the respiratory muscles, the presence of an artificial respiration specialist during the operation is mandatory.
It is necessary to ensure the maintenance and careful monitoring of vital functions, both during the period of surgery and after it, until muscle contractility is fully restored.
When calculating the dose, one should take into account the clinical condition and the individual tolerance of the drug by the patient, its interaction with simultaneously used drugs, the technique of the forthcoming anesthesia.
The recommended doses of the drug do not have a significant cardiovascular effect and, as a rule, do not cause bradycardia.
Requires a preliminary thorough analysis of the need to prescribe vagolytic drugs for premedication and their dose.
The drug is recommended to be used under the control of a peripheral nerve stimulator, which ensures the prevention of relative overdose and appropriate control of the restoration of muscle activity.
Patients with impaired neuromuscular transmission, renal insufficiency, impaired function of the biliary tract and / or liver, obesity, an indication of a history of polio should reduce the dose of Arduan.
Due to the risk of cross-hypersensitivity, with increased caution, it is necessary to administer a solution of pipcuronium bromide to patients with anaphylactic reactions against a background of muscle relaxants in history.
For patients with impaired liver function, the drug is recommended to be prescribed in the minimum effective dose only in a special case, if the potential risk to the patient is lower than the intended benefit.
Arduan should be used after the normalization of the electrolyte balance, acid-base balance, elimination of dehydration, this will allow you to control the intensity and duration of the effect of the drug.
The duration of the muscle relaxant effect is lower in children 1-14 years old, since at this age a person is less sensitive to pipcuronium bromide.
You cannot drive vehicles and mechanisms within the first 24 hours after the cessation of the drug.
Drug interactions
The continuation of the duration and increase in the intensity of Arduan's action is influenced by the simultaneous use of non-depolarizing and depolarizing muscle relaxants, inhalation anesthetics (methoxyflurane, halothane, enflurane, diethyl ether, cyclopropane, isoflurane), anesthetics for intravenous administration (gamma-hydroxybutyric acid, barbitol, propuranide ketamine, etomidate), antibacterial agents (aminoglycosides, nitroimidazole derivatives, including bacitracin, metronidazole, clindamycin, capreomycin, tetracyclines, polymyxins, including lincomycin, colistin, amphotericin B), glucocorticoids and mineralocorticoids, citrate inhibitors, anticorticoid drugs acids, alpha-blockers, beta-blockers, corticotropin, thiamine, monoamine oxidase inhibitors, protamine sulfate, guanidine,phenytoin, quinidine, magnesium salts, slow calcium channel blockers, procainamide, lidocaine and procaine for intravenous administration.
The combination with drugs that cause a decrease in the level of potassium concentration in the blood, aggravates respiratory depression, and can lead to its complete cessation.
Respiratory depression is also enhanced by opioid analgesics.
High doses of sufentanil reduce the need for high initial doses of the drug. The use of Arduan prevents or reduces muscle stiffness that occurs against the background of high doses of opioid analgesics (including alfentanil, sufentanil, fentanyl), reduces the risk of arterial hypotension and bradycardia.
When used simultaneously with suxamethonium, the drug is recommended to be administered after the disappearance of the clinical signs of the action of suxamethonium.
Administration of the drug after long-term preliminary therapy of neostigmine with methyl sulfate, glucocorticosteroids, edrophonium chloride, pyridostigmine bromide, norepinephrine, azathioprine, epinephrine, theophylline, potassium chloride, sodium chloride, calcium chloride can cause a decrease in its muscle relaxant effect.
The residual effects of muscle relaxants are temporarily masked by doxapram.
Analogs
Arduan's analogs are: Pipercuronium bromide, Vero-Pipercuronium, Atracurium, Aperomid, Intuban, Atrakad, Esmeron, Norkuron.
Terms and conditions of storage
Keep out of the reach of children.
Store in a dark place at a temperature of 2-8 ° C.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Arduan: prices in online pharmacies
|
Drug name Price Pharmacy |
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Arduan 4 mg / 2 ml lyophilisate for preparation of solution for intravenous administration complete with solvent 25 pcs. 1849 RUB Buy |
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
