THERAPEUTICS

Brands

• Enlon, Reversol, Tensilon, Enlon-Plus

Generic?

• Yes

Class

• Cholinesterase inhibitor

Commonly Prescribed for

(FDA approved in bold)

• Myasthenia gravis (MG): diagnostic test

• Curare antagonist (to reverse respiratory depression)

How the Drug Works

• Improves symptoms of MG by preventing the metabolism of acetylcholine by cholinesterase. This improves neuromuscular transmission in MG

How Long Until It Works

• Less than 1 minute

If It Works

• Usually assists with the differential diagnosis of MG. Pyridostigmine is used for long-term treatment

If It Doesn't Work

• If no effect with the 10 mg dose, question the diagnosis of MG

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Not applicable

Tests

• None

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Pro-cholinergic properties of the drug

Notable AEs

• Diarrhea, abdominal cramps, nausea, increased salivation, miosis, increased bronchial secretions, worsening of bronchial asthma, fasciculations, muscle weakness, and diaphoresis

Life-Threatening or Dangerous AEs

• Bradycardia – possibly leading to hypotension – is most common

Weight Gain

• Unusual

Sedation

• Unusual

What to Do About AEs

• Give atropine to treat airway obstruction from bronchial secretions

Best Augmenting Agents to Reduce AEs

• Not applicable

DOSING AND USE

Usual Dosage Range

• MG: 10 mg in adults

Dosage Forms

• Injection: 10 mg/mL

How to Dose

• In adults, give 0.2 mL (2 mg) within 15–30 seconds. If no reaction occurs after 45 seconds, give the remaining 8 mg. Discontinue the test if any cholinergic reactions and monitor for any clinical changes

• Alternatively give 10 mg IM. In patients with hypersensitivity (cholinergic reaction), wait 30 minutes and give a lower dose (2mg) to rule out a false-negative reaction

Dosing Tips

• Not applicable

Overdose

• Not applicable

Long-Term Use

• Not applicable

Habit Forming

• Not applicable