Dithylinum

Dithylinum – the drug used for short-term muscle relaxation.

Form of release and structure

Dithylinum is released in the form of solution for intravenous and intramuscular administration (on 5 ml in ampoules, on 5 or 10 ampoules in a cardboard pack).

Active agent is a part of 1 ml of solution: succinylcholine iodide – 20 mg.

Indications to use

• Shutdown of spontaneous breath (bronkhoskopiya, intrakhealny intubation);
• Full muscle relaxation (reposition of dislocations, endoscopy, reposition of changes, abdominal, thoracic, gynecologic operative measures);
• Poisoning with strychnine;
• Tetanus (symptomatic treatment);
• Spasms at a countershock (prevention).

Contraindications

• Muscular dystrophy of Dyushenn;
• Hyperpotassemia;
• Malignant hyperthermia (including in the anamnesis);
• Bronchial asthma;
• Myatonia (inborn and dystrophic);
• Myasthenia;
• Acute liver failure;
• Closed-angle glaucoma;
• The getting injuries of eyes;
• Fluid lungs;
• Age till 1 year;
• Pregnancy and period of a lactation (breastfeeding);
• Hypersensitivity to drug components.

Dithylinum should be applied with care at the following diseases / states:

• Decrease of the activity of serumal pseudo-cholinesterase (anemia, a liver failure in an end-stage, widespread burns, a cachexia, persistent infections, long starvation, injuries);
• Chronic renal failure;
• State after plasma transfusion;
• Puerperal period;
• Plasma exchange;
• Tuberculosis;
• Tetanus;
• Artificial circulation;
• Malignant new growths;
• General diseases of connecting fabric;
• Myxedema;
• The emergency surgical interventions at patients with "a full stomach";
• Chronic and acute intoxication insecticides – cholinesterase inhibitors (at hit inside) or antikholinesterazny means (physostigmine, неостигмин, a distigmina bromide);
• Simultaneous use with the drugs competing with suktsinilkholiny for cholinesterase (Procainum intravenously).

Route of administration and dosage

The adult Ditilin enter intravenously slowly, kapelno or struyno (for long drop infusion 0,1% solution are used). Depending on a clinical situation, at intravenous administration the single dose can vary from 0,1 to 1,5-2 mg/kg of body weight.

When carrying out an intubation of a trachea enter 0,2-0,8 mg/kg; for prevention of complications during performing electropulse treatment (a separation of sinews and muscles, spasms) – 0,1-1 mg/kg intravenously (to 150 mg); for shutdown of spontaneous breath and muscle relaxation – 0,2-1 mg/kg; when performing endoscopy – 0,2 mg/kg; for a relaxation of skeletal muscles by comparison of fragments of bones after changes and reposition of dislocations – 0,1-0,2 mg/kg.

Throughout all operation Dithylinum it is possible to apply to long relaxation of muscles fractionally: on 0,5-1 mg/kg with a break of 5-7 minutes. As a rule, introduction of repeated doses promotes more long action.

To children Dithylinum is entered intravenously on 1-2 mg/kg or intramusculary in doses to 2,5 mg/kg (as much as possible – 150 mg).

Side effects

During use of drug development of allergic reactions (a bronchospasm, an acute anaphylaxis) and hyperpotassemias can be observed.

Also at introduction of Dithylinum there can be following side effects: lowering of arterial pressure, arrhythmia, disturbance of conductivity of heart, bradycardia (is more often at children, at repeated use – at adults and children), fever, cardiogenic shock, hypersalivation, increase in intraocular pressure, a mialgiya (in the postoperative period), long paralysis of respiratory muscles. In rare instances can be observed рабдомиолиз with development of a myoglobinuria and myoglobinemia.

Children, women and young patients (it is preferential at vagotonik) can have a short-term bradycardia, in some cases – an asystolia.

10-12 hours later after introduction of Dithylinum development of muscular pains is possible.

At repeated use of drug the apnoea and excessively long relaxation of muscles is sometimes observed long.

Special instructions

Dithylinum is applied only in the conditions of specialized departments with the equipment to artificial ventilation of the lungs when carrying out the general anesthesia.

Fibrillar muscular twitchings and the subsequent development of muscular pains can be avoided by means of preliminary introduction before infusion of Dithylinum (in 1 minute) chloride Diplacinum in a dose of 10-15 mg or Tubocurarini chloridum in a dose of 3-4 mg.

Slow introduction of Dithylinum, and also preliminary intravenous injection of 1-1,5 mg of atropine substantially prevent development of bradycardia and increase in bronchial secretion.

Patients with a renal failure (without symptoms of neuropathy and a hyperpotassemia) should enter Dithylinum once in average doses. Drug is not recommended to be used in the raised doses or for repeated introductions (because of risk of emergence of a hyperpotassemia).

Prolonged muscle relaxation with possible development of an apnoea can be observed because of several reasons: hereditary insufficiency of serumal cholinesterase or temporary decrease in its level, "atypical" cholinesterase of blood serum.

Medicinal interaction

At simultaneous use of Dithylinum with some medicines there can be undesirable effects:

• Verapamil, B Amphotericinum, antikholinesterazny means, procaineamide, Procainum, clindamycin, lidocaine, beta adrenoblockers, aminoglikozidny antibiotics, cyclopropane, quinidine, organophosphorous insecticides, Propanididum, salts of magnesium and lithium, chloroquine, quinine, pankurony, medicines with potential ability to reduce activity of cholinesterase of blood (дифенгидрамин, Aprotininum, are oestrogenic, промегазин, oxytocin, oral contraceptives, glucocorticosteroids in high doses): lengthening and strengthening of myorelaxation action of Dithylinum;
• Cardiac glycosides: strengthening of cardial effects;
• Anti-myasthenic drugs: decrease in their efficiency;
• Galogensoderzhashchy means for the general anesthesia: strengthening of undesirable impact on cardiovascular system;
• Atropine and thiopental of sodium: reduction of undesirable impact on cardiovascular system.

Drug is compatible to other muscle relaxants, narcotic analgetics, Ringer's solution, 6% dextran solution, isotonic solutions of sodium chloride and 5% fructose solution.

Dithylinum pharmaceutical is incompatible with alkaline solutions and solutions of barbiturates (because of formation of a deposit), and also with blood preparations and donor blood (because of hydrolysis).

Terms and storage conditions

To store in protected from light, the place, unavailable to children, at a temperature of 2-8 °C.

Period of validity – 1,5 years.