Enemar
Enemar Uses, Dosage, Side Effects, Food Interaction and all others data.
Enemar is a typical non-depolarising curare-mimetic muscle relaxant. It acts as a competitive acetylcholine antagonist on neuromuscular junctions, displacing acetylcholine (hence competitive) from its post-synaptic nicotinic acetylcholine receptors. It is, unlike suxamethonium, a non-depolarising agent, which means, that it causes no spontaneous depolarisations upon association with the nicotinic receptor in neuromuscular junction, thus producing no muscle fasciculations upon administration. Enemar has no hormonal activity. It exerts slight vagolytic activity (i.e. diminishing activity of the vagus nerve) and no ganglioplegic (i.e., blocking ganglions) activity.
Nondepolarizing neuromuscular blocking agents inhibit neuromuscular transmission by competing with acetylcholine for the cholinergic receptors of the motor end plate, thereby reducing the response of the end plate to acetylcholine. This type of neuromuscular block is usually antagonized by anticholinesterase agents.
Enemar is a non-depolarising muscle relaxant similar to curare. It acts as a competitive acetylcholine antagonist on neuromuscular junctions, displacing acetylcholine (hence competitive) from its post-synaptic nicotinic acetylcholine receptors. It is, unlike suxamethonium, a non-depolarising agent, which means, that it causes no spontaneous depolarisations upon association with the nicotinic receptor in neuromuscular junction, thus producing no muscle fasciculations upon administration. Enemar has no hormonal activity. It exerts slight vagolytic activity (i.e. diminishing activity of the vagus nerve) and no ganglioplegic (i.e., blocking ganglions) activity.
| Trade Name | Enemar |
| Availability | Prescription only |
| Generic | Pancuronium |
| Pancuronium Other Names | Pancuronium |
| Type | Injection |
| Formula | C35H60N2O4 |
| Weight | Average: 572.8619 Monoisotopic: 572.455308418 |
| Protein binding | 77 to 91% |
| Groups | Approved |
| Therapeutic Class | Non depolarizing muscle relaxants |
| Manufacturer | Dolphin Laboratories |
| Available Country | India |
| Last Updated: | September 19, 2023 at 7:00 am |
Uses
Enemar is used for an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgical procedure of medium and long duration.
Enemar is also used to associated treatment for these conditions: General Anesthesia, Facilitation of small bowel intubation therapy, Smooth muscle relaxation prior to radiological procedures
How Enemar works
Nondepolarizing neuromuscular blocking agents inhibit neuromuscular transmission by competing with acetylcholine for the cholinergic receptors of the motor end plate, thereby reducing the response of the end plate to acetylcholine. This type of neuromuscular block is usually antagonized by anticholinesterase agents.
Dosage
Enemar dosage
Intravenous:
Facilitate endotracheal intubation, Muscle relaxant in general anaesthesia:
- Adult: Initially, 50-100 mcg/kg by inj, may reduce to 20-60 mcg/kg if given after suxamethonium. Maintenance: 10-20 mcg/kg.
- Child: 0-30 days Initially, 30-40 mcg/kg. Maintenance: 10-20 mcg/kg; >1 mth Same as adult dose.
Facilitate mechanical ventilation in intensive care:
- Adult: 60 mcg/kg every 1-1.5 hr or less frequently.
Side Effects
Tachycardia, HTN, bradycardia, bronchospasm, hypotension, CV collapse, excessive salivation; pain or local skin reactions at inj site. Rarely, hypersensitivity reactions.
Precaution
Patient with burn injury, biliary tract disease, pulmonary disease, muscular dystrophies, myasthenia gravis, myasthenic syndrome, electrolyte disturbance, altered pH, dehydration, CV disease, oedema, raised catecholamine concentration and those at risk of HTN. Renal and hepatic impairment. Childn. Pregnancy and lactation.
Interaction
Increased effect with inhalational anaesth, other non-depolarising muscle relaxants, antibiotics (polypeptide and aminoglycoside group), diazepam, propranolol, thiamine (high dose), MAOIs, quinidine, Mg sulfate, protamine, nitroglycerin, narcotic analgesics, diuretics, phenytoin, α and β adrenergic blockers, imidazoles, norepinephrine and epinephrine and prior suxamethonium. Decreased effect with neostigmine, edrophonium, corticosteroids (high dose); KCl, Ca chloride and NaCl; heparin (temporary decrease), azathioprine, theophylline, pyridostigmine, neurolept analgesia and propanidid.
Food Interaction
No interactions found.Enemar Drug Interaction
Moderate: dexamethasone, diltiazemUnknown: aspirin, charcoal, epinephrine, amoxicillin, RHO Immunoglobulin , azithromycin, multivitamin, dextran, low molecular weight, glucose, heparin, sodium iodide, acetaminophen, procaine penicillin, valproic acid, cyanocobalamin, pyridoxine, cholecalciferol, phytonadione
Enemar Disease Interaction
Major: histamine release, liver disease, paresis, pulmonary impairModerate: renal dysfunction
Volume of Distribution
- 241 to 280 mL/kg
Half Life
1.5 to 2.7 hours.
Clearance
- Plasma cl=1.1–1.9 mL/minute/kg
Pregnancy & Breastfeeding use
Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.
Contraindication
Enemar must not be administered to patients with know hypersensitivity to puncuronium of the bromide ion.
Special Warning
Obese patient: Adjust dose based on ideal body wt.
Renal Impairment:
- Haemodialysis/peritoneal dialysis patient: Avoid use.
- Continuous renal replacement therapy: 50% of normal dose.
- CrCl (mL/min) <10: Avoid use.
- CrCl (mL/min) 10-50: 50% of normal dose.
Acute Overdose
Symptoms: Prolonged apnoea, resp depression and/or muscle weakness. Death may follow acute resp failure.
Management: May administer neostigmine 2.5 mg and atropine 1.2 mg to reverse neuromuscular block while ventilation is continued. When admin of the anticholinesterase agent fails to reverse neuromuscular blockade, continue ventilation until spontaneous breathing is restored.
Innovators Monograph
You find simplified version here Enemar
FAQ
What is Enemar used for?
Enemar is a nondepolarizing muscle relaxant approved to induce skeletal muscle relaxation during anesthesia and to facilitate the management of patients undergoing mechanical ventilation.
How does Enemar work?
Enemar work by competitively inhibits the nicotinic acetylcholine receptor at the neuromuscular junction by blocking the binding of acetylcholine.
What are the common side effects of Enemar?
Common side effects of Enemar are include increased saliva, skeletal muscle weakness, drooling, rash, bronchospasm, flushing, redness, low blood pressure, high blood pressure, and rapid heartbeat.
Is Enemar safe during breastfeeding?
No information is available on the use of Enemar during breastfeeding. Because it is highly polar and poorly absorbed orally, it is not likely to reach the breastmilk in high concentration or to reach the bloodstream of the infant.
When do I give Enemar?
Enemar injection is indicated as an adjunct to general anesthesia, to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
How do I administer Enemar?
Enemar administration is by intravenous bolus. A continuous IV infusion may be a consideration in the management of the critically ill patient. The typical intubating dose is 0.1 mg/kg with a 3 to 5-minute onset to maximal muscle relaxation.
Does Enemar cause hypotension?
Among the advantages claimed for Enemar are the lack of ganglion blockade and histamine release, both of which may produce hypotension2.
Why is Enemar considered a high alert medication?
Enemar bears a heightened risk of causing significant patient harm when it is used in error.
How long does Enemar take to work?
Onset of action is relatively slow compared to other similar drugs, in part due to its low dose: an intubating dose takes 3–6 minutes for full effect. Clinical effects last for about 100 minutes.
Is Enemar short acting?
Enemar is a long-acting, nondepolarizing compound that after a bolus dose of 0.06 to 0.08 mg/kg is effective for 90 minutes.
How is Enemar best taken?
Use Enemar as ordered by your doctor. Read all information given to you. Follow all instructions closely.
Enemar is given as a shot into a vein or into a vein nonstop for a period of time.
What happen if I overdose on Enemar?
If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
How can I store Enemar?
Refrigerate; however, stable for up to 6 months at room temperature.
Why does Enemar cause tachycardia?
Enemar produced tachycardia and increased arterial pressure; this cardiac stimulation has been attributed to vagolytic action, a release of norepinephrine from the sympathetic nerve terminals, or inhibition of neuronal uptake of norepinephrine.
Can Enemar stop my heart?
Enemar has been shown to be very cardiac stable and has no effects on heart rate or blood pressure.
Who should not take Enemar?
If you have acidosis, a high level of acid in the blood. low amount of potassium in the blood. overweight. myasthenia gravis, a skeletal muscle disorder you should not take Enemar.
