Troymidate

Uses

Troymidate is used by intravenous injection for the induction of general anesthesia. When considering use of Troymidate, the usefulness of its hemodynamic properties should be weighed against the high frequency of transient skeletal muscle movements. Intravenous Troymidate is also used for the supplementation of subpotent anesthetic agents, such as nitrous oxide in oxygen, during maintenance of anesthesia for short operative procedures such as dilation and curettage or cervical conization.

Troymidate is also used to associated treatment for these conditions: General Anesthesia

How Troymidate works

Troymidate binds at a distinct binding site associated with a Cl^- ionopore at the GABA_A receptor, increasing the duration of time for which the Cl^- ionopore is open. The post-synaptic inhibitory effect of GABA in the thalamus is, therefore, prolonged.

Dosage

Troymidate dosage

Troymidate Injection is intended for administration only by the intravenous route. The dose for induction of anesthesia in adult patients and in pediatric patients above the age of ten (10) years will vary between 0.2 and 0.6 mg/kg of body weight, and it must be individualized in each case. The usual dose for induction in these patients is 0.3 mg/kg, injected over a period of 30 to 60 seconds. There are inadequate data to make dosage recommendations for induction of anesthesia in patients below the age of ten (10) years; therefore, such use is not recommended. Geriatric patients may require reduced doses of etomidate.

Smaller increments of intravenous etomidate may be administered to adult patients during short operative procedures to supplement subpotent anesthetic agents, such as nitrous oxide. The dosage employed under these circumstances, although usually smaller than the original induction dose, must be individualized. There are insufficient data to support this use of etomidate for longer adult procedures or for any procedures in pediatric patients; therefore, such use is not recommended. The use of intravenous fentanyl and other neuroactive drugs employed during the conduct of anesthesia may alter the etomidate dosage requirements. Consult the prescribing information for all other such drugs before using.

Premedication: Troymidate Injection is compatible with commonly administered pre-anesthetic medications, which may be employed as indicated. Troymidatehypnosisdoes not significantly alter the usual dosage requirements ofneuromuscularblocking agents employed for endotrachealintubationor other purposes shortly after induction of anesthesia.

Parenteraldrug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. To prevent needle-stick injuries, needles should not be recapped, purposely bent, or broken by hand.

Side Effects

Excitatory phenomena e.g. myoclonus; pain on inj site; hyperventilation, hypoventilation, apnoea, hiccups and snoring, HTN, hypotension, postoperative nausea and vomiting. Rarely, convulsions, cardiac arrhythmias, laryngospasm.

Toxicity

Undesirable side effects of etomidate that may limit its use include pain on injection, myoclonus and adrenocortical suppression lasting 4-6 hours following an induction dose.

Precaution

Patient with cortico-adrenal insufficiency (e.g. patient with sepsis), pre-existing epilepsy, hepatic cirrhosis. Renal impairment. Elderly and childn. Pregnancy and lactation.

Interaction

Increased hypnotic effect when used with neuroleptic drugs, opioids and sedatives. May enhance the effect of hypotensive drugs.

Food Interaction

Troymidate Alcohol interaction

[Moderate] GENERALLY AVOID:

Alcohol may potentiate some of the pharmacologic effects of central nervous system (CNS)-active agents.

Use in combination may result in additive CNS depression and/or impairment of judgment, thinking, and psychomotor skills.

Patients receiving CNS-active agents should be advised to avoid or limit consumption of alcohol.

Ambulatory patients should be counseled against driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Half Life

75 minutes.

Elimination Route

Approximately 75% of the administered dose is excreted in the urine during the first day after injection.

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

Troymidate is contraindicated in patients who have shown hypersensitivity to it.

Acute Overdose

Symptoms: Hypotension, resp depression, which may lead to arrest, disorientation, delayed awakening.

Management: Supportive treatment. Admin of hydrocortisone (not ACTH) 50-100 mg may be required.

Storage Condition

Store between 20-25°C.

Innovators Monograph

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