Edrophonium
TENSILON
What it isUltra-short cholinesterase inhibitor; historical myasthenia diagnosis.
Why this oneIts two-minute action allowed a bedside test that improved weakness within seconds.
What limits itBradycardia and cholinergic crisis required atropine at hand. Superseded by antibody and electrophysiological testing.
FDA-approved for
- myasthenia diagnosis (~1950)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Diagnosis of myasthenia gravis (IV test) | Adults | 2 mg IV; if no reaction after 45 sec give remaining 8 mg | — | 10 mg total |
| Diagnosis of myasthenia gravis (IV test) | Children | 1 mg (≤75 lb) or 2 mg (>75 lb) IV; infants 0.5 mg | Titrate in 1 mg increments | 5 mg (<75 lb) / 10 mg (heavier) |
| Curare antagonist | Adults | 10 mg IV slow over 30-45 sec | Repeat PRN | 40 mg |
Renal Undefined
Hepatic Undefined
Maximum 40 mg as a curare antagonist
Instructions
- IV: inject slowly over 30-45 seconds; have atropine available for cholinergic reaction
- IM route for patients with inaccessible veins
Contraindications
- Mechanical intestinal or urinary obstruction
Cautions
- Severe cholinergic reactions in hyperreactive individuals
- Bradycardia or cardiac standstill during crisis testing
- Keep atropine available
Adverse reactions
- Increased lacrimation/salivation/secretions
- Bradycardia/arrhythmias
- Hypotension
- Nausea, vomiting, diarrhea, abdominal cramps
- Muscle weakness/fasciculations
- Laryngospasm/bronchospasm
Pregnancy Undefined
Lactation Undefined
NO BOXED WARNINGS
Principal riskCholinergic crisis; superseded by antibody testing
Classes and tags
Clinical profile
Mechanism of action: Edrophonium ballicule
