Pipecuronium Bromide

• Facilitation of endotracheal intubation during anesthesia
• Skeletal muscle relaxation during surgery or mechanical ventilation
• Adjunct in anesthesia to provide muscle relaxation for prolonged surgical procedures
• Facilitation of controlled ventilation in intensive care units

• Route: Intravenous injection or infusion
• Adults:
• Initial dose: 0.07 to 0.1 mg/kg IV bolus
• Maintenance: 0.02 to 0.05 mg/kg IV bolus as needed or continuous infusion at 0.09 to 0.15 mg/kg/hour
• Onset: 2 to 3 minutes
• Duration: Approximately 30 to 40 minutes per dose
• Pediatrics: Use with caution; dosing based on body weight with close monitoring
• Elderly: May require dose adjustment due to altered pharmacokinetics
• Renal impairment: Dose reduction and careful monitoring advised because of primarily renal excretion
• Hepatic impairment: Generally no adjustment required

Pipecuronium bromide is a non-depolarizing aminosteroid neuromuscular blocking agent. It competitively binds to nicotinic acetylcholine receptors at the neuromuscular junction, preventing acetylcholine from activating these receptors. This inhibition blocks depolarization of the motor endplate, leading to muscle relaxation and paralysis, facilitating intubation and surgical procedures requiring controlled muscle paralysis.

• Absorption: Not applicable (administered intravenously)
• Distribution: Rapidly distributed into extracellular fluid; volume of distribution approx. 0.2–0.3 L/kg
• Metabolism: Minimal hepatic metabolism
• Elimination: Primarily excreted unchanged via the kidneys (70–80%)
• Half-life: Approximately 2.5 to 3 hours in normal renal function
• Onset of action: 2–3 minutes
• Duration of action: 30–40 minutes per dose

• Pregnancy: FDA category C; use only if benefits justify potential risks due to lack of adequate human studies
• Lactation: Unknown if excreted in breast milk; caution advised during breastfeeding

• Neuromuscular blocking agent, non-depolarizing aminosteroid

• Known hypersensitivity to pipecuronium bromide or aminosteroid neuromuscular blockers
• Conditions with increased sensitivity to neuromuscular blockers (e.g., myasthenia gravis) without proper monitoring
• Severe renal impairment without dose adjustment
• Situations where neuromuscular blockade is contraindicated, such as inability to secure airway

• Use cautiously in renal impairment due to risk of prolonged blockade
• Monitor neuromuscular function to avoid residual paralysis postoperatively
• Facilities for airway management and ventilatory support must be available
• Rare risk of histamine release causing hypotension or bronchospasm
• Adjust dose carefully in elderly and debilitated patients

• Common: Muscle weakness, prolonged paralysis, mild hypotension, flushing
• Serious (rare): Anaphylaxis, bronchospasm, residual neuromuscular blockade, prolonged apnea

• Potentiated by inhalational anesthetics, aminoglycosides, magnesium salts, lithium, and calcium channel blockers
• Reversed by cholinesterase inhibitors (e.g., neostigmine)
• Additive effects with other neuromuscular blockers
• Electrolyte disturbances (e.g., hypokalemia) may increase neuromuscular blockade

• No significant recent changes; emphasis on monitoring neuromuscular function to prevent residual paralysis
• Caution highlighted for use in patients with renal impairment
• Recommendations for use of short-acting reversal agents to improve safety

• Store at 20°C to 25°C (68°F to 77°F)
• Protect from light and moisture
• Do not freeze
• Keep vial tightly closed
• Use immediately after dilution; discard any unused portions