Pipecuronium bromide

General information

Pipecuronium bromide is a bisquaternary steroid analogue of pancuronium. In vitro pipecuronium reversibly inhibits both human red cell acetylcholinesterase and human plasma cholinesterase to an extent that might have clinical implications [ ]. Its potency is similar to that of pancuronium and its onset and duration are also approximately the same. Accumulation can occur [ ], and maintenance doses should be one-quarter to one-sixth of the initial dose to achieve a similar effect, depending on the anesthetic technique used.

From animal investigations hepatic uptake appears to be a factor in the drug’s total plasma clearance, but renal excretion seems to be the main route of elimination. Ligation of renal pedicles in dogs [ ] resulted in reduced elimination of pipecuronium, with a four-fold increase in mean residence time and a four-fold increase in hepatobiliary elimination, which did not compensate for the loss of urinary excretion. In humans, about 40% of pipecuronium is excreted unchanged in the urine together with another 15% as 3-hydroxypipecuronium in 24 hours [ ]. The half-life is around 135–160 minutes.

Organs and systems