Ambenonium
Pronunciation
(am be NOE nee um)
U.S. Brand Names
Mytelase®
Synonyms
Ambenonium Chloride
Generic Available
No
Canadian Brand Names
Mytelase®
Use
Treatment of myasthenia gravis
Pregnancy Risk Factor
C
Lactation
Excretion in breast milk unknown/not recommended
Contraindications
Routine administration of atropine or other belladonna alkaloids with ambenonium is contraindicated because they may suppress the muscarinic symptoms of excessive gastrointestinal stimulation, leaving only the more serious symptoms of muscle fasciculations and paralysis as signs of overdosage; should not be administered to patients receiving mecamylamine
Warnings/Precautions
Prolonged action after cholinergics, drug should be discontinued until the patient is stabilized. Use with caution in patients with asthma, epilepsy, bradycardia, hyperthyroidism, or peptic ulcer. Differentiation of cholinergic/myasthenia crisis is critical, use edrophonium and clinical judgment. Anticholinergic insensitivity may develop for brief or prolonged periods. Reduce or withhold dosages until the patient becomes sensitive again. May require respiratory support.
Adverse Reactions
Frequency not defined.
Cardiovascular: Arrhythmias (especially bradycardia), hypotension, decreased carbon monoxide, tachycardia, AV block, nodal rhythm, nonspecific ECG changes, cardiac arrest, syncope, flushing
Central nervous system: Convulsions, dysarthria, dysphonia, dizziness, loss of consciousness, drowsiness, headache
Dermatologic: Skin rash, thrombophlebitis (I.V.), urticaria
Gastrointestinal: Hyperperistalsis, nausea, vomiting, salivation, diarrhea, stomach cramps, dysphagia, flatulence
Genitourinary: Urinary urgency
Neuromuscular & skeletal: Weakness, fasciculations, muscle cramps, spasms, arthralgia
Ocular: Small pupils, lacrimation
Respiratory: Increased bronchial secretions, laryngospasm, bronchiolar constriction, respiratory muscle paralysis, dyspnea, respiratory depression, respiratory arrest, bronchospasm
Miscellaneous: Diaphoresis (increased), anaphylaxis, allergic reactions
Overdosage/Toxicology
Have atropine on hand to reverse cholinergic crisis or hypersensitivity reaction.
Dosage
Oral: Adults: 5-25 mg 3-4 times/day
Patient Education
This drug will not cure myasthenia gravis, but it may reduce the symptoms. Use as directed; do not increase dose or discontinue without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. May cause dizziness, drowsiness, or postural hypotension (rise slowly from sitting or lying position and use caution when driving or climbing stairs); vomiting or loss of appetite (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or diarrhea (boiled milk, yogurt, or buttermilk may help). Report persistent abdominal discomfort; significantly increased salivation, sweating, tearing, or urination; flushed skin; chest pain or palpitations; acute headache; unresolved diarrhea; excessive fatigue, insomnia, dizziness, or depression; increased muscle, joint, or body pain; vision changes or blurred vision; or shortness of breath or wheezing.
Pregnancy/breast-feeding precautions:
Inform prescriber if you are or intend to become pregnant. Breast-feeding is not recommended.
Nursing Implications
Have atropine ready to combat hypercholinergic response; have epinephrine ready to combat anaphylaxis
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May produce drowsiness
Mental Health: Effects on Psychiatric Treatment
None reported; the cholinergic effects may counteract the anticholinergic effects of psychotropics
Dosage Forms
Caplet, as chloride [scored]: 10 mg [contains lactose and sucrose]
International Brand Names
Mytelase® (CA, CZ, FR, HU, PL, SE)
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