1.

Noveron

Indications Listed in Dosage.

Dosage Adult : IV Facilitate endotracheal intubation; Muscle relaxant in
general anaesth; Facilitate mechanical ventilation in intensive care
Initial: 600 mcg/kg by inj. Maintenance: 150 mcg/kg by inj or by infusion
at 300-600 mcg/kg/hr.
Dosage Details Intravenous
Facilitate endotracheal intubation, Facilitate mechanical ventilation in
intensive care, Muscle relaxant in general anaesthesia
Adult: Initially, 600 mcg/kg by inj. Higher doses of 1 mg/kg may be used
for intubation during rapid sequence induction of anaesth. Maintenance:
150 mcg/kg by inj (may reduce to 75-100 mcg/kg for prolonged
inhalational anaesth) or by infusion at 300-600 mcg/kg/hr.
Child: Same as adult dose.
Elderly: Maintenance: 75-100 mcg/kg.
Special Patient Obese patients (≥130% of ideal body wt): Reduce dose, based on ideal
Group body wt. Biliary tract disease: Maintenance: 75-100 mcg/kg by inj or 300-
400 mcg/kg/hr by infusion.
Renal
Maintenance: 75-100 mcg/kg by inj or 300-400 mcg/kg/hr by infusion.
Impairment
Hepatic
Maintenance: 75-100 mcg/kg by inj or 300-400 mcg/kg/hr by infusion.
Impairment
Incompatibility Alkaline soln; amphotericin, amoxicillin, azathioprine, cefazolin,
cloxacillin, dexamethasone, diazepam, enoximone, erythromycin,
famotidine, furosemide, hydrocortisone Na succinate, insulin, intralipid,
methohexital, methylprednisolone, prednisolone Na succinate, thiopental,
trimethoprim, vancomycin. Y-site: Micafungin.
-(amino glikosida = misin=hambatan nmj mll penghambatan
pelepasan ach dari ujung saraf motoric (karena berkompetisi dengan
ion ca) dan jg mll stabilisasi membrane pasca sinaps.
- tetrasiklin jg menghambat transmisi nmj
Oleh karena it ups dg ab dan muscle relaxan hrs pertimbangkan dosis
dan penggunaan garam kalsium bila pernapasan spontan tdk segera
kembali
Special Patient w/ biliary tract disease, neuromuscular disease, previous
Precautions poliomyelitis, burn injury, severe electrolyte disturbances, Eaton-Lambert
syndrome, myasthenia gravis, CV disease, resp disease, pulmonary HTN;
obese patients. Renal and hepatic impairment. Elderly. Pregnancy and
lactation.
Adverse Drug Changes in vital signs, prolonged neuromuscular block, myopathy; inj site
Reactions pain/reaction.
Potentially Fatal: Anaphylaxis.
reaksi obat yang merugikan
Perubahan tanda-tanda vital, blok neuromuskular yang
berkepanjangan, miopati; inj situs nyeri / reaksi.
Berpotensi fatal: Anafilaksis.
Pregnancy ROUTE(S) : Parenteral
Category (US
FDA)
Category C: Either studies in animals have revealed adverse effects on the
foetus (teratogenic or embryocidal or other) and there are no controlled
studies in women or studies in women and animals are not available. Drugs
should be given only if the potential benefit justifies the potential risk to
the foetus.
Baik studi pada hewan telah mengungkapkan efek buruk pada janin
(teratogenik atau embryocidal atau lainnya) dan tidak ada penelitian
terkontrol pada wanita atau studi pada wanita dan hewan tidak
tersedia. Obat harus diberikan hanya jika manfaat potensial
membenarkan potensi risiko pada janin.
Monitoring Monitor heart rate, BP, twitch response, assisted ventilation status.
Parameters Monitor denyut jantung, tekanan darah, respons kedutan, status
bantuan ventilasi
Overdosage Symptoms: Prolonged neuromuscular blockade. Management: Maintain
patent airway, controlled ventilation and adequate sedation. May
administer an anticholinesterase agent in conjunction w/ an appropriate
anticholinergic agent once recovery from neuromuscular block is observed.
Gejala: blokade neuromuskular yang berkepanjangan.
Penatalaksanaan: Pertahankan jalan napas paten, ventilasi terkontrol
dan sedasi yang cukup. Dapat diberikan agen antikolinesterase
bersama dengan agen antikolinergik yang tepat setelah pemulihan
dari blok neuromuskular diamati.
Drug Increased effect w/ halogenated volatile anaesth (e.g. enflurane,
Interactions isoflurane), antibiotics (e.g. aminoglycoside, lincosamide and polypeptide
antibiotics, acylamino-penicillin antibiotics), diuretics, quinidine, quinine,
Mg and lithium salts, Ca channel blockers, local anaesth, acute admin of
phenytoin or β-blocking agents, corticosteroid (long-term use) and after
intubation w/ suxamethonium. Decreased effect w/ Ca chloride and KCl,
protease inhibitors (e.g. gabexate, ulinastatin), chronic admin of phenytoin
or carbamazepine.
Mechanism of Description: Rocuronium competes for nicotinic cholinoreceptors at the
Action motor end-plate, resulting to neuromuscular blockade.
Onset: Good intubation conditions: W/in 1-2 min. Max neuromuscular
blockade: W/in 4 min.
Duration: Approx 30-50 min.
Pharmacokinetics:
Distribution: Volume of distribution: Approx 0.25 L/kg. Plasma protein
binding: Approx 30%.
Metabolism: Minimally hepatic, converted to 17-desacetylrocuronium
(main metabolite).
Excretion: Via urine (up to 40% w/in 24 hr) and bile. Elimination half-
life: Approx 1.2-1.4 hr.
 Deskripsi: Rocuronium kompetisi dgn cholinoreceptors nikotinik
pada motor end-plate, yang mengakibatkan blokade neuromuskular.
Onset: Kondisi intubasi yang baik: W / dalam 1-2 menit. Blokade
neuromuskular maks: W / dalam 4 menit.
Durasi: Sekitar 30-50 mnt.
Farmakokinetik:
Distribusi: Volume distribusi: Sekitar 0,25 L / kg. Protein plasma
mengikat: Sekitar 30%.
Metabolisme: Minimal hati, diubah menjadi 17-desacetylrocuronium
(metabolite utama).
Ekskresi: Melalui urin (hingga 40% dalam 24 jam) dan empedu.
Waktu paruh eliminasi: Sekitar 1,2-1,4 jam
Storage Store between 2-8°C. Protect from light.
Simpan antara 2-8 ° C. Lindungi dari cahaya.
MIMS Class Neuromuscular Blocking Agents
ATC M03AC09 - rocuronium bromide ; Belongs to the class of other quaternary
Classification ammonium-containing agents used as peripherally-acting muscle
relaxants.

Milik kelas agen yang mengandung amonium kuaterner lainnya digunakan sebagai pelemas otot
perifer-bertindak.
2. Ketamin

Indications Induction of anaesth.

Dosage Adult : IV 1-4.5 mg/kg as inj or infuse 0.5-2 mg/kg. IM 6.5-13 mg/kg.
Dosage Details Intramuscular
Induction of anaesthesia
Adult: 6.5-13 mg/kg. A dose of 10 mg/kg produces surgical anaesth w/in 3-4 min
after inj lasting for 12-25 min. Increments of half to the full induction dose may
be repeated as needed for maintenance of anesth. For diagnostic or other
procedures not involving intense pain: 4 mg/kg as initial dose.
Dewasa: 6,5-13 mg / kg. Dosis 10 mg / kg menghasilkan anestesi bedah dlm
3-4 menit setelah inj berlangsung selama 12-25 menit. Kenaikan setengah
hingga dosis induksi penuh dapat diulang sesuai kebutuhan untuk
pemeliharaan anestesi. Untuk diagnosis atau prosedur lain yang tidak
melibatkan rasa sakit yang hebat: 4 mg / kg sebagai dosis awal.

Intravenous
Induction of anaesthesia
Adult: 4.5 mg/kg via slow IV inj over 60 sec. A dose of 2 mg/kg produces surgical
anaesth w/in 30 sec after inj lasting for 5-10 min. Increments of half to the full
induction dose may be repeated as needed for maintenance of anesthesia.
Alternatively, a total induction dose of 0.5-2 mg/kg via infusion, given at an
appropriate rat, and maintained at 10-45 mcg/kg/min, adjusted according to
response.
Dewasa: 4,5 mg / kg melalui inj IV lambat lebih dari 60 detik. Dosis 2 mg /
kg menghasilkan anestesi bedah dalam 30 detik setelah inj berlangsung
selama 5-10 menit. Pertambahan setengah hingga dosis induksi penuh dapat
diulang sesuai kebutuhan untuk pemeliharaan anestesi. Sebagai alternatif,
dosis induksi total 0,5-2 mg / kg melalui infus, diberikan pada tikus yang
sesuai, dan dipertahankan pada 10-45 mcg / kg / menit, disesuaikan dengan
respon.
Reconstitution 50 mg/mL and 100 mg/mL vials may be further diluted in 5% dextrose or 0.9%
NaCl to prepare a maintenance infusion containing 1 mg/mL (or 2 mg/mL in
patients w/ fluid restrictions).
Rekonstitusi 50 mg / mL dan 100 mg / mL vial dapat diencerkan lebih lanjut
dalam 5% dekstrosa atau 0,9% NaCl untuk menyiapkan infus pemeliharaan
yang mengandung 1 mg / mL (atau 2 mg / mL pada pasien dengan
pembatasan cairan).
Incompatibility Barbiturates and diazepam.
Contraindications Patient w/ HTN, eclampsia or pre-eclampsia, severe coronary or myocardial
disease, cerebrovascular accident or cerebral trauma.
asien dengan HTN, eklamsia atau pre-eklampsia, penyakit koroner atau
miokard berat, kecelakaan serebrovaskular atau trauma otak.
Special Patient w/ cardiac decompensation, chronic alcoholic or acutely alcohol-
Precautions intoxicated patients, pre-anaesth elevated CSF pressure, globe injuries, increased
intraocular pressure (e.g. glaucoma), neurotic traits or psychiatric illness (e.g.
schizophrenia, acute psychosis), acute intermittent porphyria, seizures,
hyperthyroidism, pulmonary or upper resp infection, intracranial mass lesions,
head injury, or hydrocephalus, hypovolaemia, dehydration, cardiac disease esp
coronary artery disease (e.g. CHF, myocardial ischaemia, MI). Pregnancy and
lactation.
Adverse Drug Emergence reactions (e.g. vivid dreams, hallucinations, confusion, irrational
Reactions behaviour); increased muscle tone sometimes resembling seizures; temporary
HTN and tachycardia, hypotension, bradycardia, arrhythmias, apnoea,
laryngospasm, resp depression, diplopia, nystagmus, nausea, vomiting,
lacrimation, hypersalivation, raised intraocular and CSF pressure, transient rash
and pain at inj site, cystitis.
Reaksi emergensi (misalnya mimpi yang jelas, halusinasi, kebingungan,
perilaku irasional); tonus otot yang meningkat terkadang menyerupai
kejang; HTN sementara dan takikardia, hipotensi, bradikardia, aritmia,
apnea, spasme laring, depresi resp, diplopia, nistagmus, mual, muntah,
lakrimasi, hipersalivasi, peningkatan tekanan intraokular dan CSF, ruam
sementara dan nyeri pada tempat inj, sistitis.
Pregnancy ROUTE(S) : Parenteral
Category (US
FDA)
Category B: Either animal-reproduction studies have not demonstrated a foetal
risk but there are no controlled studies in pregnant women or animal-reproduction
studies have shown an adverse effect (other than a decrease in fertility) that was
not confirmed in controlled studies in women in the 1st trimester (and there is no
evidence of a risk in later trimesters).
Baik studi reproduksi hewan belum menunjukkan risiko janin tetapi tidak
ada penelitian terkontrol pada wanita hamil atau penelitian reproduksi
hewan telah menunjukkan efek buruk (selain penurunan kesuburan) yang
tidak dikonfirmasi dalam penelitian terkontrol pada wanita di abad ke-1.
trimester (dan tidak ada bukti risiko pada trimester kemudian).
Patient Avoid driving, operating hazardous machinery or engaging in hazardous activities
Counselling w/in 24 hr or more after anaesth.
Hindari mengemudi, mengoperasikan mesin berbahaya atau melakukan
kegiatan berbahaya dalam 24 jam atau lebih setelah anestesi.
Monitoring Monitor heart rate, BP, resp rate, transcutaneous oxygen saturation, emergence
Parameters reactions. Cardiac function should be continuously monitored in patients w/
increased BP or cardiac decompensation.
Monitor denyut jantung, tekanan darah, kecepatan respirasi, saturasi
oksigen transkutan, reaksi emergensi. Fungsi jantung harus terus dipantau
pada pasien dengan peningkatan TD atau dekompensasi jantung.
Overdosage Symptoms: Resp depression. Management: Employ supportive ventilation.
Mechanical support of respiration is preferred to admin of analeptics.
Gejala: Resp depresi. Penatalaksanaan: Gunakan ventilasi pendukung.
Dukungan mekanis respirasi lebih disukai untuk admin analeptik.
Drug Interactions Prolonged recovery time w/ barbiturates or narcotics. May potentiate
neuromuscular blocking effects of atracurium and tubocurarine including resp
depression w/ apnoea. May increase risk of bradycardia, hypotension or decreased
cardiac output w/ halogenated anaesthetics. May potentiate CNS depression and
risk of resp depression w/ CNS depressants (e.g. phenothiazines, sedating H1-
blockers, skeletal muscle relaxants). May antagonise hypnotic effect of thiopental.
May increase risk of HTN w/ thyroid hormones. May increase risk of hypotension
w/ antihypertensive agents. Reduction in seizure threshold resulting in
unpredictable extensor-type seizures when given concurrently w/ theophylline.
Waktu pemulihan yang lama dengan barbiturat atau narkotika. Dapat
mempotensiasi efek pemblokiran neuromuskular atracurium dan
tubocurarine termasuk depresi resp w / apnea. Dapat meningkatkan risiko
bradikardia, hipotensi atau penurunan curah jantung dg anestesi
 terhalogenasi. Dapat mempotensiasi depresi SSP dan risiko depresi respr
dengan depresan SSP (misalnya fenotiazin, penenang H1-blocker, relaksan
otot skeletal). Dapat menimbulkan efek hipnotik thiopental. Dapat
meningkatkan risiko HTN dengan hormon tiroid. Dapat meningkatkan
risiko hipotensi dengan agen antihipertensi. Pengurangan ambang kejang
mengakibatkan kejang tipe ekstensor tak terduga ketika diberikan
bersamaan dengan teofilin
Food Interaction May potentiate CNS depression when used concurrently w/ alcohol.
Dapat mempotensiasi depresi SSP bila digunakan bersamaan dengan
alkohol.
Mechanism of Description: Ketamine is a noncompetitive N-methyl-D-aspartate receptor
Action antagonist that blocks glutamate. It has a direct action on the cortex and limbic
system. It produces a cataleptic-like state wherein the patient is withdrawn from
the surrounding environment.
Onset: 30 sec (IV); 3-4 min (IM).
Duration: 5-10 min (IV); 12-25 min (IM).
Pharmacokinetics:
Absorption: Rapidly absorbed following parenteral admin.
Distribution: Crosses the placenta. Volume of distribution: 3 L/kg.
Metabolism: Hepatic biotransformation to norketamine (active metabolite).
Other metabolic pathways include hydroxylation of the cyclohexone ring and
conjugation w/ glucuronic acid.
Excretion: Via urine as metabolites. Elimination half-life: 10-15 min (alpha
phase); 2.5 hr (beta phase).
Deskripsi: Ketamine adalah antagonis reseptor N-metil-D-aspartat
nonkompetitif yang menghalangi glutamat. Ia memiliki tindakan langsung
pada korteks dan sistem limbik. Ini menghasilkan keadaan seperti kataleptik
dimana pasien ditarik dari lingkungan sekitarnya.
Onset: 30 detik (IV); 3-4 menit (IM).
Durasi: 5-10 menit (IV); 12-25 mnt (IM).
Farmakokinetik:
Absorpsi: Admin parenteral yang diserap dengan cepat.
Distribusi: Melintasi plasenta. Volume distribusi: 3 L / kg.
Metabolisme: Biotransformasi hati menjadi norketamine (metabolit aktif).
Jalur metabolik lainnya termasuk hidroksilasi cincin siklohekson dan
konjugasi dengan asam glukuronat.
Ekskresi: Melalui urin sebagai metabolit. Eliminasi paruh waktu: 10-15
menit (fase alfa); 2,5 jam (fase beta).
Storage Store between 20-25°C.
MIMS Class Anaesthetics - Local & General
3. Durogesic

Manufacturer Johnson & Johnson

Contents Fentanyl
Management of chronic & intractable pain in patients requiring
Indications/Uses
continuous opioid administration for an extended period of time.
Individualised based upon the status of the patient & should be assessed
at regular intervals after application. Patch should be replaced every 72
Dosage/Directions hr. Initial dose selection: Appropriate initiating dose should be based on
for Use patient's current opioid use. Ped Should be administered only to opioid-
tolerant ped patient (>2 yr) who are already receiving at least 30 mg or
oral morphine equiv/day.
Use in the management of acute post-op pain may result in serious
hypoventilation/resp depression, opioid-naive & non-opioid tolerant
Special Precautions states, chronic pulmonary disease, drug dependence, increased
intracranial pressure; cardiac, hepatic & renal diseases; fever. Childn.
Elderly.
Hypoventilation, nausea, vomiting, constipation, somnolence,
Adverse Reactions confusion, hallucination, euphoria, pruritus & urinary retention.
View ADR Monitoring Form
CNS depressant drugs. Ritonavir, ketoconazole, itraconazole,
Interactions troleandomycin, nelfinavir, nefazodone, verapamil, diltiazem,
amiodarone.
Preg Safety (US) C, D (if prolonged use/high doses at term)
MIMS Class Analgesics (Opioid)
N02AB03 - fentanyl ; Belongs to the class of phenylpiperidine
ATC Classification
derivative opioids. Used to relieve pain.
Regulatory
G
Classification

Presentation/Packing
Form Packing/Price
Durogesic transdermal patch
5 × 1's
12 mcg/hr
Durogesic transdermal patch
5 × 1's (Rp600,000/boks)
25 mcg/hr
Durogesic transdermal patch
5 × 1's (Rp1,080,000/boks)
50 mcg/hr
Isi Fentanyl
Indikasi / Penggunaan Manajemen nyeri kronis & keras pada pasien yang memerlukan
administrasi opioid kontinu untuk jangka waktu yang lama.
Dosis / Petunjuk Penggunaan Individual berdasarkan status pasien & harus dinilai secara berkala
setelah aplikasi. Tambalan harus diganti setiap 72 jam. Pemilihan dosis awal: Dosis inisiasi yang
sesuai harus didasarkan pada penggunaan opioid pasien saat ini. Ped Harus diberikan hanya
untuk pasien ped pasien opioid toleran (> 2 thn) yang sudah menerima setidaknya 30 mg atau
morfin oral equiv / hari.
Kewaspadaan Khusus Penggunaan dalam manajemen nyeri pasca-op akut dapat menyebabkan
hipoventilasi / depresi resp yang serius, status toleran opioid-naif & non-opioid, penyakit paru
kronis, ketergantungan obat, peningkatan tekanan intrakranial; penyakit jantung, hati & ginjal;
demam. Anak Tua.
Efek Samping Hipoventilasi, mual, muntah, konstipasi, somnolen, kebingungan, halusinasi,
euforia, pruritus & retensi urin.
Lihat Formulir Pemantauan ADR

Interaksi obat penekan SSP. Ritonavir, ketoconazole, itraconazole, troleandomycin, nelfinavir,

nefazodone, verapamil, diltiazem, amiodarone.
Preg Safety (AS)
C, D (jika penggunaan jangka panjang / dosis tinggi pada jangka waktu)
Kelas MIMS
Analgesik (Opioid)

Klasifikasi ATC N02AB03 - fentanyl; Milik kelas opioid derivatif fenilpiperidin. Digunakan untuk
menghilangkan rasa sakit.
Klasifikasi Regulasi
G
4. Trilac (CORTICOSTEROID)

Manufacturer Novell Pharma

Contents Triamcinolone acetonide
IA: Synovitis of OA, RA, acute & subacute bursitis, acute gouty
arthritis, epicondylitis, acute nonseptic tenosynovitis & post-traumatic
OA. Intradermal: Keloids, discoid lupus erythematosus, necrobiosis
Indications/Uses
lipoidica diabeticorum, alopecia areata & localized hypertrophic,
infiltrated, inflammatory lesions of lichen planus, psoriatic plaques,
granuloma annulare & neurodermatitis.
Dosage/Directions IA/IB Initially 2.5-5 mg for smaller joints & 5-15 mg for larger joints.
for Use Max: ≥20 mg. Intradermal Initially 1 mg/inj site.
Administration Should be taken with food.
Contraindications Systemic fungal infections. Idiopathic thrombocytopenic purpura.
Hypothyroidism, cirrhosis, ocular herpes simplex,
hypoprothrombinemia, nonspecific ulcerative colitis, diverticulitis,
fresh intestinal anastomoses, active or latent peptic ulcer, renal
insufficiency, HTN, osteoporosis, acute glomerulonephritis, vaccinia,
Special Precautions varicella, exanthema, Cushing's syndrome, antibiotic-resistant
infections, DM, CHF, thromboembolitic tendencies, thrombophlebitis,
convulsive disorders, metastatic carcinoma, myasthenia gravis.
Prolonged use & abrupt discontinuation. Renal disease. Pregnancy &
lactation.
Fliud & electrolyte disturbance; musculoskeletal, GI, dermatologic &
endocrine disorders; convulsions, increased intracranial pressure w/
papilloedema, vertigo, headache, neuritis, paresthesias, aggravation of
preexisting psychiatric conditions; posterior subcapsular cataracts,
Adverse Reactions increased IOP, glaucoma, exophthalmos; hyperglycemia, glycosuria, -
ve nitrogen balance, necrotizing angiitis, thrombophlebitis,
thromboembolism, aggravation or masking of infections, syncopal
episodes.
View ADR Monitoring Form
Phenytoin, phenobarb, rifampicin, corticosteroids, diuretics,
Interactions
hypoglycemics, anticholinesterases, salicylates.
Preg Safety (US) C, D (in 1st trimester)
MIMS Class Corticosteroid Hormones
H02AB08 - triamcinolone ; Belongs to the class of glucocorticoids.
ATC Classification
Used in systemic corticosteroid preparations.
Regulatory
G
Classification
Presentation/Packing
Form Packing/Price
Trilac powd for inj 40 mg/mL (vial) 1 mL x 1's (Rp80,000/vial)
Trilac powd for inj 10 mg/mL (vial) 5 mL x 1's (Rp90,000/vial)
Trilac tab 4 mg 3 × 10's (Rp70,000/boks)

Manufacturer: Novell Pharma

Isi Triamcinolone acetonide

Indikasi / Penggunaan IA: Sinovitis OA, RA, bursitis akut & subakut, arthritis gout akut,
epikondilitis, tenosinovitis akut nonseptik & OA pasca trauma. Intradermal: Keloid, diskoid
lupus eritematosus, nekrobiosis lipoidika diabeticorum, alopecia areata & lokal hipertrofik,
infiltrasi, lesi inflamasi lichen planus, plak psoriasis, granuloma annulare & neurodermatitis.
Dosis / Petunjuk Penggunaan IA / IB Awalnya 2,5-5 mg untuk sendi yang lebih kecil & 5-15 mg
untuk sendi yang lebih besar. Max: ≥20 mg. Intradermal Awalnya 1 mg / inj situs.
Administrasi Harus diambil dengan makanan.
Kontraindikasi Infeksi jamur sistemik. Idiopathic thrombocytopenic purpura.
Kewaspadaan Khusus Hypothyroidism, sirosis, ocular herpes simplex, hypoprothrombinemia,
kolitis ulseratif nonspesifik, diverticulitis, anastomosis usus segar, ulkus peptikum aktif atau
laten, insufisiensi ginjal, HTN, osteoporosis, glomerulonefritis akut, vaccinia, varicella,
eksantema, sindrom Cushing, antibiotik-tahan infeksi, DM, CHF, kecenderungan
tromboembolitik, tromboflebitis, gangguan konvulsif, karsinoma metastatik, miastenia gravis.
Penggunaan jangka panjang & penghentian mendadak. Penyakit ginjal. Kehamilan & laktasi.
Adverse Reaksi Fliud & gangguan elektrolit; gangguan muskuloskeletal, GI, dermatologi &
endokrin; kejang, peningkatan tekanan intrakranial dg papilledema, vertigo, sakit kepala,
neuritis, parestesia, kejengkelan kondisi psikiatri yang sudah ada sebelumnya; katarak
subkapsular posterior, peningkatan TIO, glaukoma, eksoftalmos; hiperglikemia, glikosuria,
keseimbangan nitrogen -ve, angiitis nekrotikan, tromboflebitis, tromboemboli, kejengkelan atau
masking infeksi, episode sinkop.
Lihat Formulir Pemantauan ADR
Interaksi Fenitoin, fenobarb, rifampisin, kortikosteroid, diuretik, hipoglikemik,
antikolinesterase, salisilat.
Preg Safety (AS)
C, D (di trimester 1)
Kelas MIMS
Hormon Kortikosteroid

Klasifikasi ATC H02AB08 - triamcinolone; Milik kelas glukokortikoid. Digunakan dalam persiapan
kortikosteroid sistemik.
5. Epineprin + Lidokain

Indications Listed in Dosage.

Dosage Adult : Inj Local or regional anesth; Nerve blocks; Epidural and
caudal anesth Per mL preparation contains lidocaine HCl 20 mg and
epinephrine 5 mcg: Dosage depends on factors such as route, type and
extent of surgical procedure, duration of anesth and patient's condition
and age. Max dose of lidocaine given w/ epinephrine: 7 mg/kg and not
>500 mg.
Dewasa: Inj Anestesi lokal atau regional; Blok saraf; Anestesi
epidural dan kaudal Per mL persiapan mengandung lidocaine HCl
20 mg dan epinefrin 5 mcg: Dosis tergantung pada faktor-faktor
seperti rute, jenis dan tingkat prosedur pembedahan, durasi anestesi
dan kondisi pasien dan usia. Dosis lidokain maksimal diberikan
dengan epinefrin: 7 mg / kg dan tidak> 500 mg.
Dosage Details Injection
Local or regional anaesthesia, nerve blocks, epidural and caudal
anaesthesia
Adult: Per ml prep contains lidocaine HCl 20 mg and epinephrine 5 mcg.
Dosage depends on several factors such as route, type and extent of
surgical procedure, duration of anaesthesia and patient's condition and
age. Max dose of lidocaine given with epinephrine: 7 mg/kg and not >500
mg.
Child: 3 mth-12 yr: Per ml prep contains lidocaine HCl 20 mg and
epinephrine 5 mcg. Dosage depends on several factors such as route, type
and extent of surgical procedure, duration of anaesthesia and patient's
condition and age. Max dose 3 mg/kg. Ideal body weight should be used
in children with high body weight.
Injeksi
Anestesi lokal atau regional, blok saraf, anestesi epidural dan kaudal
Dewasa: Persiapan per ml mengandung lidocaine HCl 20 mg dan
epinefrin 5 mcg. Dosis tergantung pada beberapa faktor seperti rute,
jenis dan tingkat prosedur pembedahan, durasi anestesi dan kondisi
dan usia pasien. Dosis lidokain maksimal diberikan dengan
epinefrin: 7 mg / kg dan tidak> 500 mg.
Anak: 3 mth-12 thn: Persiapan per ml mengandung lidocaine HCl 20
mg dan epinefrin 5 mcg. Dosis tergantung pada beberapa faktor
seperti rute, jenis dan tingkat prosedur pembedahan, durasi anestesi
dan kondisi dan usia pasien. Dosis maksimal 3 mg / kg. Berat badan
ideal harus digunakan pada anak-anak dengan berat badan tinggi
Reconstitution Can be diluted if necessary in glucose 5%, sodium chloride 0.9% and
lactated Ringer's solution.
Incompatibility Y-site administration: ampicillin, thiopental, ampthotericin B cholesteryl
sulphate complex; in syringe: cefazolin, sodium bicarbonate; when
admixed: aminophylline, hyaluronidase, mephentemine, amphotericin B,
decarbazine, methohexital and thiopental.
Contraindications Tachycardia, hypertension, cerebral arteriosclerosis, ischaemic heart
disease, IV admin, anaesthetise digits or appendages, myasthenia
gravis
 Rekonstitusi Dapat diencerkan jika perlu dalam glukosa 5%,
natrium klorida 0,9% dan larutan Ringer laktat.
Ketidaksesuaian Y-site administration: ampicillin, thiopental,
ampthotericin B cholesteryl sulphate complex; dalam syringe:
cefazolin, natrium bikarbonat; ketika dicampurkan: aminofilin,
hyaluronidase, mephentemine, amphotericin B, decarbazine,
methohexital dan thiopental.
Kontraindikasi Takikardia, hipertensi, arteriosklerosis serebral,
penyakit jantung iskemik, IV admin, anestesi digit atau pelengkap,
miastenia gravi
Special Epilepsy, impaired cardiac conduction, CHF, DM, closed angle
Precautions glaucoma, impaired liver function (if site of admin is likely to result in
high blood levels), severe renal dysfunction. Local anaesthetic effect may
be reduced if injected into an inflamed or infected area. Cerebrovascular
insufficiency, hyperthyroidism. Neonates, elderly, patients in poor
general condition (optimise patient's condition before major block),
pregnancy.

Epilepsi, gangguan konduksi jantung, CHF, DM, glaukoma sudut

tertutup, gangguan fungsi hati (jika situs admin cenderung
menghasilkan kadar darah tinggi), disfungsi ginjal berat. Efek
anestesi lokal dapat dikurangi jika disuntikkan ke area yang
meradang atau terinfeksi. Insufisiensi serebrovaskular,
hipertiroidisme. Neonatus, lanjut usia, pasien dalam kondisi umum
yang buruk (mengoptimalkan kondisi pasien sebelum blok utama),
kehamilan.
Adverse Drug Severity of adverse effects in CNS and CVS are directly related to blood
Reactions levels of lidocaine; the effects are more likely to occur after systemic
administration rather than infiltration; dizziness; muscle twitching; local
anaesthetic of mouth/throat impairs swallowing and increases the risk of
aspiration (patients cautioned against eating or drinking for 3-4 hr after
anaesthesia); transient effect on auditory system of neonate; erythema;
pigmentation; pain; headache; palpitations; local necrosis; pulmonary
oedema; hyperglycaemia; bradycardia; reduced cardiac output; anxiety.
Epidural may cause hypotension, bradycardia, nausea and vomiting.
Intraoral inj may cause stress reactions such as diaphoresis, palpitation,
hyperventilation, generalised pallor and faintness. Topically: papules,
burns, rash, skin irritation, burning sensation and blanching.
Potentially Fatal: Severity of adverse effects in CNS and CVS related to
blood levels of lidocaine; effects more likely to occur after systemic
administration rather than infiltration. CNS toxicity (due to inadvertent
IV admin), medullary depression with tonic & clonic convulsions;
ventricular fibrillation; severe hypertension with cerebral haemorrhage
and pulmonary oedema; unconsciousness; possibly respiratory arrest.
Allergic reactions including anaphylactic symptoms and possibly life
threatening asthmatic episodes in susceptible patients may occur due to
sodium metabisulphate constituent. Central nerve blocks may cause CV
depression (especially in hypovolaemia). Retrobulbar inj may reach
subarachnoid space causing CV collapse, apnoea, convulsions, temporary
 blindness. Paracervical block may cause foetal bradycardia/tachycardia
(careful monitoring of foetal heart rate is necessary).
Keparahan efek samping di CNS dan CVS secara langsung berkaitan
dengan tingkat lidokain darah; efeknya lebih mungkin terjadi
setelah pemberian sistemik daripada infiltrasi; pusing; kedutan otot;
anestesi lokal dari gangguan mulut / tenggorokan menelan dan
meningkatkan risiko aspirasi (pasien yang memperingatkan untuk
makan atau minum selama 3-4 jam setelah anestesi); efek sementara
pada sistem pendengaran neonatus; eritema; pigmentasi; rasa sakit;
sakit kepala; palpitasi; nekrosis lokal; edema paru; hiperglikemia;
bradikardia; mengurangi curah jantung; kegelisahan. Epidural
dapat menyebabkan hipotensi, bradikardia, mual dan muntah. Injra
intraoral dapat menyebabkan reaksi stres seperti diaforesis,
palpitasi, hiperventilasi, pucat dan pingsan umum. Secara topikal:
papula, luka bakar, ruam kulit, iritasi kulit, sensasi terbakar dan
blanching.
Berpotensi fatal: Keparahan efek samping di CNS dan CVS terkait
dengan kadar lidokain darah; efek lebih mungkin terjadi setelah
pemberian sistemik daripada infiltrasi. Toksisitas SSP (karena
admin IV yang tidak disengaja), depresi medula dengan kejang tonik
& klonik; fibrilasi ventrikel; hipertensi berat dengan pendarahan
otak dan edema paru; ketidaksadaran; mungkin penahanan
pernapasan. Reaksi alergi termasuk gejala anafilaksis dan
kemungkinan episode asma yang mengancam jiwa pada pasien yang
rentan dapat terjadi karena konstituen natrium metabisulfat. Blok
saraf sentral dapat menyebabkan depresi CV (terutama pada
hipovolemia). Inj Retrobulbar dapat mencapai ruang subarachnoid
yang menyebabkan CV kolaps, apnea, kejang, kebutaan sementara.
Blok paracervical dapat menyebabkan bradikardia / tachycardia
janin (pemantauan yang cermat terhadap denyut jantung janin
diperlukan).
Overdosage Lidocaine has a narrow therapeutic index. Symptoms: dizziness,
paresthesia, sedation, confusion, coma, seizures, ataxia; respiratory
arrest, pulmonary oedema; arrhythmias, cardiac toxicity (sinus arrest, AV
block, asystole, and hypotension); QRS and QT intervals are usually
normal, although they may be prolonged after massive overdose; renal
failure; metabolic acidosis and hypertension which may result in
subarachnoid haemorrhage and hemiplegia. Treatment: supportive and
symptom specific. Lidocaine not removed by haemofiltration.
Lidocaine memiliki indeks terapeutik yang sempit. Gejala: pusing,
paresthesia, sedasi, kebingungan, koma, kejang, ataksia; tahanan
pernapasan, edema paru; aritmia, toksisitas jantung (penahanan
sinus, blok AV, asistol, dan hipotensi); Interval QRS dan QT
biasanya normal, meskipun mungkin diperpanjang setelah overdosis
besar; gagal ginjal; asidosis metabolik dan hipertensi yang dapat
menyebabkan perdarahan subarakhnoid dan hemiplegia.
Pengobatan: mendukung dan gejala spesifik. Lidocaine tidak
dihilangkan dengan haemofiltrasi.
Drug Interactions Significance of interaction depends on route of delivery and systemic
exposure; lidocaine prolongs duration of action of suxamethonium;
benzodiazepines & barbiturates raise the convulsive threshold to
lidocaine; vasopressors potentiate pressor effects of adrenaline; BP may
increase with non-selective β-blockers, TCAs, halogenated inhalational
anaesthetics and α-blockers; general anaesthetics may increase sensitivity
of myocardium to dysrhythmic effects of epinephrine; lidocaine may
increase levels and effects of benzodiazepines, calcium channel blockers,
ciclosporine, aminophylline, fluvoxamine, mexiletine, mirtazapine,
ropinirole, theophylline, trifluoperazine, dextromethorphan, fluoxetine,
nefazodone, paroxetine, risperidone, TCAs and venlafaxine. Levels and
effects of lidocaine may be increased by propranolol, chlorpromazine,
delavirdine, fluoxetine, miconazole, pergolide, quinidine, quinine,
ritonavir, ropinirole, cimetidine, azole antifungals, clarithromycin,
diclofenac, doxycycline, erythromycin, isoniazid, nicardipine and
verapamil. Lidocaine may decrease levels and effects of codeine,
hydrocodone, oxycodone, tramadol, carbamazepine, nafcillin,
nevirapine, phenobarbital, phenytoin and rifamycins. Midazolam,
cisapride, ergot alkaloids, lovastatin and simvastatin are not
recommended in combination with lidocaine.
Potentially Fatal: Possible additive cardiac effects with amiodarone
(ECG monitoring should be considered).
Signifikansi interaksi tergantung pada rute pengiriman dan paparan
sistemik; lidocaine memperpanjang durasi kerja suxamethonium;
benzodiazepin & barbiturat meningkatkan ambang konvulsif ke
lidokain; vasopressors mempotensiasi efek pressor dari adrenalin;
BP dapat meningkat dengan non-selektif β-blocker, TCA, anestesi
inhalasi terhalogenasi dan α-blocker; anestesi umum dapat
meningkatkan sensitivitas miokardium terhadap efek disritmia
epinefrin; lidocaine dapat meningkatkan tingkat dan efek dari
benzodiazepin, calcium channel blockers, ciclosporine,
aminophylline, fluvoxamine, mexiletine, mirtazapine, ropinirole,
theophylline, trifluoperazine, dextromethorphan, fluoxetine,
nefazodone, paroxetine, risperidone, TCAs dan venlafaxine. Tingkat
dan efek lidocaine dapat ditingkatkan oleh propranolol,
klorpromazin, delavirdine, fluoxetine, miconazole, pergolide,
quinidine, quinine, ritonavir, ropinirole, cimetidine, antijamur azole,
klaritromisin, diklofenak, doksisiklin, eritromisin, isoniazid,
nicardipine dan verapamil. Lidocaine dapat menurunkan tingkat
dan efek kodein, hidrokodon, oxycodone, tramadol, carbamazepine,
nafcillin, nevirapine, phenobarbital, phenytoin dan rifamycins.
Midazolam, cisapride, ergot alkaloid, lovastatin dan simvastatin
tidak dianjurkan dalam kombinasi dengan lidokain.
Berpotensi fatal: Kemungkinan efek jantung tambahan dengan
amiodarone (pemantauan EKG harus dipertimbangkan).
Food Interaction St John's Wort may reduce lidocaine level, avoid; ephedra and yohimbe
may cause CNS stimulation, avoid.
Lab Interference Lidocaine may increase creatinine phosphokinase which may interfere
with diagnosis of MI.
Mechanism of Description: Lidocaine is a local anaesthetic which decreases
Action permeability of sodium ions, blocking induction and conduction of nerve
impulses. Combination with epinephrine restricts systemic spread of
lidocaine, vascular absorption and its duration of local anaesthetic effect.
Onset: Peak effect: approx 5 min.
Duration: Approx 2 hr; dose and anaesthetic procedure dependant.
Pharmacokinetics:
Absorption: Topical: lidocaine: minimal; epinephrine: minimal; readily
absorbed from GI tract, mucous membranes, damaged skin, inj sites
including muscle.
Distribution: Crosses placenta and blood-brain barrier. Volume of
distribution: lidocaine: 1.1-2.1 L/kg, altered by many patient factors eg
CHF, liver disease. Protein binding: lidocaine: 60-80% to α1 acid
glycoprotein.
Metabolism: Lidocaine: 90% via hepatic 1st pass metabolism to active
metabolites which can cause CNS toxicity. Epinephrine: metabolised by
monoamine oxidase and catechol-o-methyltransferase taken up in the
adrenergic neuron; circulating ephedrine is hepatically metabolised.
Excretion: Lidocaine: elimination half life: 2 hr; excreted via urine
(<10% unchanged). Ephedrine: excreted via urine as inactive metabolites
and small amounts of unchanged drug.
Storage Protect from light. Transdermal systems: 20-25 °C. Inj: store at 2-8 °C
and discard within 3 days of opening.
MIMS Class Anaesthetics - Local & General
St John's Wort dapat mengurangi tingkat lidocaine, hindari; ephedra dan yohimbe dapat
menyebabkan stimulasi SSP, hindari.
Lidocaine dapat meningkatkan creatinine phosphokinase yang dapat mengganggu diagnosis MI.
Keterangan: Lidocaine adalah anestesi lokal yang menurunkan permeabilitas ion natrium,
menghambat induksi dan konduksi impuls saraf. Kombinasi dengan epinefrin membatasi
penyebaran lidocaine secara sistemik, penyerapan vaskular dan lamanya efek anestetik lokal.
Onset: Efek Puncak: kira-kira 5 menit.
Durasi: Sekitar 2 jam; dosis dan prosedur anestesi tergantung.
Farmakokinetik:
Absorpsi: Topikal: lidokain: minimal; epinefrin: minimal; mudah diserap dari saluran
pencernaan, selaput lendir, kulit yang rusak, tempat inj termasuk otot.
Distribusi: Melintasi plasenta dan penghalang darah-otak. Volume distribusi: lidokain: 1,1-2,1 L
/ kg, diubah oleh banyak faktor pasien misalnya CHF, penyakit hati. Pengikatan protein:
lidokain: 60-80% untuk glikoprotein asam α1.
Metabolisme: Lidocaine: 90% melalui metabolisme lambung ke-1 ke metabolit aktif yang dapat
menyebabkan toksisitas CNS. Epinefrin: dimetabolisme oleh monoamine oxidase dan catechol-
o-methyltransferase yang diambil di neuron adrenergik; ephedrine yang bersirkulasi secara hati-
hati dimetabolisme.
Ekskresi: Lidocaine: eliminasi setengah hidup: 2 jam; diekskresikan melalui urin (<10% tidak
berubah). Efedrin: diekskresi melalui urin sebagai metabolit tidak aktif dan sejumlah kecil obat
tidak berubah.
Lindungi dari cahaya. Sistem transdermal: 20-25 ° C. Inj: simpan pada 2-8 ° C dan buang dalam
waktu 3 hari sejak pembukaan.