Edrophonium
Template:Short description Template:Drugbox Edrophonium, formerly sold under the brand name Tensilon among others, is a readily reversible acetylcholinesterase inhibitor. It prevents breakdown of the neurotransmitter acetylcholine and acts by competitively inhibiting the enzyme acetylcholinesterase, mainly at the neuromuscular junction.
Medical uses
Edrophonium (by the so-called Tensilon test) is used to differentiate myasthenia gravis from cholinergic crisis and Lambert-Eaton myasthenic syndrome. In myasthenia gravis, the body produces autoantibodies which block, inhibit or destroy nicotinic acetylcholine receptors in the neuromuscular junction. Edrophonium—an effective acetylcholinesterase inhibitor— reduces the muscle weakness by blocking the enzymatic effect of acetylcholinesterase enzymes, prolonging the presence of acetylcholine in the synaptic cleft. It binds to a Serine-103 allosteric site, while pyridostigmine and neostigmine bind to the acetylcholinesterase active site for their inhibitory effects. In a cholinergic crisis, where a person has too much neuromuscular stimulation, edrophonium will make the muscle weakness worse by inducing a depolarizing block. However, the edrophonium and ice pack tests are no longer recommended as first-line tests due to false positive results. In practice, the edrophonium test has been replaced by testing for autoantibodies, including acetylcholine receptor autoantibodies and muscle specific tyrosine kinase autoantibodies.<ref name="pmid22882218">Template:Cite journal</ref><ref name="pmid19846306">Template:Cite journal</ref>
The Tensilon test may also be used to predict if neurotoxic paralysis caused by snake envenomation is presynaptic or postsynaptic. If it is postsynaptic, then paralysis will be temporally reversed, indicating that can be reversed by adequate antivenom therapy. If the neurotoxicity is presynaptic, then the Tensilon test will show no response and antivenom will not reverse such paralysis. In this instance reversal of paralysis will not occur until the damaged terminal axons at the neuromuscular junction have recovered, this may take days or weeks.<ref>Template:Cite book</ref>
The drug may also be used for reversal of neuromuscular blockade at the end of a surgical procedure.<ref name=trip>Template:Cite book</ref>
Chemistry
Edrophonium, ethyl-(3-hydroxyphenyl)dimethylammonium chloride, is made by reacting 3-dimethylaminophenol with ethyl bromide, which forms ethyl(3-hydroxyphenyl)dimethylammonium bromide, the bromine atom of which is replaced with a chlorine atom by reacting it with silver chloride, giving edrophonium.<ref>Template:Cite patent</ref>
File:Edrophonium synthesis.png
Pharmacokinetics
The drug has a brief duration of action, about 10–30 mins.<ref name=trip/>