Names and pronunciation
Byfavo
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Drug reference
Byfavo
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Func. class.: Sedative/anesthetic Chem class.: Benzodiazepine Controlled Substance Schedule IV
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ACTION Binds to benzodiazepine sites in the brain
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USES: Ultra-short-acting IV sedation for proce- dures lasting ≤30 min
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CONTRAINDICATIONS: Hypersensitivity to this product, dextran 40; child <18 yr Precautions: Pregnancy, lactation, elderly, severe hepatic disease, breast- feeding, dementia, labor, sleep apnea
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Black Box Warning: Requires a special- ized care setting, requires an experienced clinician, respiratory depression Black Box Warning: Continuously moni- tor for hypotension, airway obstruction, hypoventilation, apnea, O2 desaturation, hypoxia, bradycardia; adverse reactions are more common in sleep apnea, the elderly, ASA-PS III/ IV patients; provide O2 during recovery period, have flumazenil available; have emergency equipment, including resuscitative drugs, appropri- ate equipment for assisted ventilation available • Continuously monitor vital signs, dur- ing sedation and through the recovery period. Titrate the dose when giving with opioids, sedative/hypnotics, other CNS depressants Black Box Warning: Only those trained in the use of procedural sedation should give this product Black Box Warning: CNS depressants: Increased sedation and respiratory de- pression may occur with opioids, other R sedatives/hypnotics • Hypersensitivity: Assess for hyper- sensitivity (rash, urticarial, pruritus), do not use in those allergic to dextran 40 • Hepatic disease: Titrate carefully in hepatic disease • Pregnancy/breastfeeding: Avoid use in pregnancy and breastfeeding, if breastfeeding, consider pumping and discarding during treatment and for 5 hr after use
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SIDE EFFECTS CV: Hypo/hypertension, bradycardia, tachycardia, hypoxia RESP: Increased respiratory rate, respi- ratory depression GI: Nausea CNS: Fever, headache
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INTERACTIONS Increased CNS depression: Other CNS depressants (opioid analgesics, other benzodiazepines, sedatives/hypnotics)
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DOSAGE AND ROUTES Adult: IV direct 5 mg over 1 min, mainte- nance doses of 2.5 mg over a 15-sec time period, ≥2 min before additional dose
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Available forms: Lyophilized powder single use 20 mg (2.5 mg/mL) Administration IV direct route • Use strict aseptic technique • This product does not contain preser- vative • Protect vials from light after removed from packaging • Each single-patient-use vial contains 20 mg lyophilized powder for reconstitu- tion. The product must be prepared im- mediately before use • To reconstitute, add 8.2 mL Sterile 0.9% NaCl Injection, directing the stream of solution toward the wall of the vial. Swirl (do not shake) until dissolved (final concentration of 2.5 mg/mL) • Check for particulate matter and dis- coloration before use. The solution should be a clear, colorless pale yellow, discard if particulate matter or discolor- ation is present • If not used immediately, reconstituted solution may be stored up to 8 hr at room temperature at 20°C to 25°C (68°F to 77°F), after 8 hr, discard • Do not admix Solution compatibilities • 0.9% NaCl, D5 Injection, D20 Injec- tion, D5/0.45% NaCl, Ringer’s
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Assess:
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Evaluate: • Therapeutic response: Sedation with- out adverse effects Teach patient/family • Reason for use and expected result • Hypersensitivity: To notify provider if allergic to dextran 40 • CNS depressants: To notify provider if taking other CNS depressants, alcohol • To notify provider of sleep apnea, respiratory conditions • Pregnancy/breastfeeding: To notify provider if pregnancy is suspected or if breastfeeding HIGH ALERT
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CLINICAL CONSIDERATIONS
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PHARMACOKINETICS Onset immediate, peak 3-3.5 min, half- life 37-53 min
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