Pipecuronium Vecuronium

CjHgOj 108-22-5) see Desoxycortone acetate Estriol Pancuronium bromide Pipecuronium bromide Vecuronium bromide... 

Pancuronium is a synthetic compound now frequently used and not likely to cause histamine release or ganglionic blockade. It is approx. 5-fold more potent than d-tubocurarine, with a somewhat longer duration of actioa Increased heart rate and blood pressure are attributed to blockade of cardiac M2-cholinoceptors, an effect not shared by newer pancuronium congeners such as vecuronium and pipecuronium. 

The intermediate-acting steroid muscle relaxants (eg, vecuronium and rocuronium) tend to be more dependent on biliary excretion or hepatic metabolism for their elimination. These muscle relaxants are more commonly used clinically than the long-acting steroid-based drugs (eg, pancuronium, pipecuronium). 

Rocuronium Zemuron (also Vecuronium, Pancuronium, and Pipecuronium)... 

C.2H27N04 107188-37-4) see Troglitazone 17-acetoxy-5a-androsta-2,16-diene (C2 Hw()2 50588-42-6) see Pancuronium bromide Pipecuronium bromide Vecuronium bromide... 

Bradycardia is occasionally seen (2), but this may be due to co-administration of vagotonic drugs with atracur-ium, vecuronium, and pipecuronium. 

Clinically important, potentially hazardous interactions with adefovir, aldesleukin, aminoglycosides, atracurium, bumetanide, carbenicillin, cephalexin, cephalothin, doxacurium, ethacrynic acid, furosemide, methoxyflurane, non-polarizing muscle relaxants, pancuronium, pipecuronium, polypeptide antibiotics, rocuronium, succinylcholine, teicoplanin, torsemide, tubocurarine, vecuronium... 

Clinically important, potentially hazardous interactions with amikacin, aminoglycosides, galantamine, gentamicin, kanamycin, neomycin, paromomycin, physostigmine, pipecuronium, streptomycin, tobramycin, vancomycin, vecuronium... 

NMBAs are further differentiated by their duration of action during anesthesia. Succinylcholine and mivacurium are common ultra-short-acting competitive NMBAs (5-10 min). An intermediate duration of action (30-45 min) is maintained with the use of atracurium, cisatracurium, rocuronium and vecuronium. A long-lasting duration of action (90-100 min) is observed with d-tubocurarine, doxacurium, metocurine, pancuronium and pipecuronium. 

Atracurium, vecuronium, doxacurium, pipecuronium (no longer marketed in the U.S.), mivac-urium, and rocuronium are even more selective. The maintenance of cardiovascular reflex responses usually is desired during anesthesia. 

Vecuronium, pipecuronium, rocuronium None None None... 

Pipecuronium bromide, a long-acting neuromuscular blocking agent, exhibits minimal cardiovascular effects. Like pancuronium and vecuronium, pipecuronium undergoes some hydrolysis but is excreted primarily unchanged in the urine with very small amounts in the bile. Pipecuronium may be used in patients with coronary artery disease, but neuromuscular blockade is prolonged in patients with renal failure. 

Anticipate the need to use more (possibly up to twice as much) doxacu-rium, metocurine, pancuronium, pipecuronium, rocuronium and vecuronium in patients who have taken these antiepileptics for more than a week, and expect an accelerated recovery. The effects on tubocurarine and atracurium appear only to be small or moderate, whereas mivacurium appears not to interact. 

No change in neuromuscular blockade was seen in patients given intravenous cefuroxime shortly before pipecuronium or rocuronium in a controlled study. Similarly, intravenous cefoxitin given before, during and after surgery was not associated with a clinically important prolongation of vecuronium blockade. ... 

An increase in the neuromuscular blocking effects of vecuronium with metronidazole has been reported in cats, but a later study in patients failed to find any evidence of an interaction, and another study with ro-curonium also found no evidence of an interaction with metronidazole. Similarly, no interaction was seen with rocuronium and metronida-zole/cefiu-oxime. Another study found no significant interaction between pipecuronium and metronidazole. ... 

SmithI, White PF. Pipecuronium-induced prolongation of vecuronium neuromuscular block. BrJ Anaesth 993) 70, 446-8. 

Noninterfering alfentanil, aprotinin, atropine, bupivacaine, chlorpromazine, dalteparin, dexamethasone, diazepam, dopamine, droperidol, etomidate, fentanyl, furosemide, gallamine, haloperidol, midazolam, morphine, neostigmine, nitroglycerin, nitroprusside, oxytocin, pancuronium, pentobarbital, phenylephrine, phenytoin, pipecuronium, piperacillin, promethazine, propofol, ranitidine, succinylcholine, sufentanil, terbutaline, thiopental, vecuronium, verapamil... 

Pipecuronium is a modification of pancuronium where both quaternary ammonium groups were desmethylated, but quaternary nitrogens were introduced into what was a piperidine ring in pancuronium. Pipecuronium is similar to pancuronium in efficacy. It shows some elimination by liver but this is not as predominant as in recuronium or vecuronium. Pipecuronium has a half-life of 1.7 hours in normal renal function and 4 hours in renal function impairment. The onset of action is reported to be 2.5-3 minutes and the duration of action about 45 minutes. Pipecuronium is supplied in a sterile injection containing 10 mg of the bromide salt. ... 

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