n-Butyl-2-cyanoacrylate

Usage

• Medical Conditions: n-Butyl-2-cyanoacrylate is primarily used as a surgical tissue adhesive for closing wounds, lacerations, and surgical incisions. It is also used to control bleeding, particularly in cases of gastric varices (dilated veins in the stomach). Additionally, it can be employed to treat arteriovenous malformations (abnormal connections between arteries and veins) in the brain and spine.

• Pharmacological Classification: Tissue adhesive, hemostatic agent, embolic agent.

• Mechanism of Action: n-Butyl-2-cyanoacrylate polymerizes rapidly upon contact with moisture, forming a strong bond that holds tissues together and seals bleeding vessels. It undergoes slow biodegradation.

Alternate Names

• Enbucrilate
• Histoacryl
• Glubran

How It Works

• Pharmacodynamics: n-Butyl-2-cyanoacrylate acts locally, creating a physical barrier to bleeding and promoting wound closure. Its effect is rapid and localized to the application site.

• Pharmacokinetics: The adhesive polymerizes almost instantly upon contact with tissue fluids. It is slowly biodegraded via hydrolysis and eliminated through normal metabolic pathways. Absorption into the systemic circulation is minimal.

• Mode of Action: Polymerization occurs through an anionic mechanism triggered by water or other nucleophiles on the tissue surface. This results in the formation of long polymer chains, creating a solid adhesive matrix.

Dosage

Standard Dosage

Adults:

• The recommended dosage is typically 0.25 ml per ampoule. Multiple ampoules may be used depending on the size and nature of the wound or lesion.

Children:

• Dosage should be adjusted based on the child’s weight and the size of the area being treated. Use with caution in children.

Special Cases:

• Elderly Patients: No specific dosage adjustments are typically required.
• Patients with Renal Impairment: No specific dosage adjustments are typically required due to minimal systemic absorption.
• Patients with Hepatic Dysfunction: No specific dosage adjustments are typically required due to minimal systemic absorption.

Clinical Use Cases

• Surgical Procedures: Applied directly to wound edges or surfaces to achieve hemostasis and wound closure.
• Endoscopic Procedures: Used to inject and embolize bleeding gastric varices. Dosage is determined by the size and number of varices. Typically, a mixture of n-butyl-cyanoacrylate and Lipiodol is used for injection.

Dosage Adjustments

• Dosage adjustments are primarily based on the size and characteristics of the area being treated rather than patient-specific factors due to the localized action of the drug.

Side Effects

Common Side Effects

• Skin irritation or inflammation at the application site.
• Foreign body sensation.

Rare but Serious Side Effects

• Allergic reactions.
• Embolization (if used intravascularly).

Contraindications

• Known hypersensitivity to cyanoacrylates.
• Contaminated wounds, bites, or punctures.
• Use near the eyes or inside the mouth.

Drug Interactions

• Avoid concomitant use of other topical adhesives, especially octyl cyanoacrylate.
• Alcohol and strong surfactants may interfere with polymerization.

Pregnancy and Breastfeeding

• Use with caution during pregnancy. Data on safety during breastfeeding are limited.

Drug Profile Summary

• Mechanism of Action: Rapid polymerization upon contact with moisture, forming a strong adhesive bond.
• Side Effects: Skin irritation, inflammation, foreign body sensation, rare allergic reactions.
• Contraindications: Hypersensitivity to cyanoacrylates, contaminated wounds, use near eyes or mouth.
• Drug Interactions: Other topical adhesives, alcohol, strong surfactants.
• Pregnancy & Breastfeeding: Use with caution in pregnancy; limited data for breastfeeding.
• Dosage: 0.25 ml per ampoule, adjusted based on the treatment area.
• Monitoring Parameters: Observe the application site for signs of infection, inflammation, or dehiscence.

Popular Combinations

• Often used in combination with Lipiodol for endoscopic injection of gastric varices.

Precautions

• General Precautions: Ensure proper wound preparation and avoid contact with eyes and mucous membranes.
• Specific Populations (Pregnant Women, Breastfeeding Mothers, Children & Elderly): Use with caution.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for n-Butyl-2-cyanoacrylate?

A: The standard dosage is 0.25 ml per ampoule, but this can be adjusted based on the size of the area being treated.

Q2: How is n-Butyl-2-cyanoacrylate administered?

A: It is applied topically to the wound or lesion. For endoscopic procedures, it is injected using a specialized catheter.

Q3: What are the common side effects?

A: Common side effects include skin irritation, inflammation, and a foreign body sensation at the application site.

Q4: Is n-Butyl-2-cyanoacrylate safe for use in children?

A: It should be used with caution in children, with dosage adjustments based on weight and treatment area.

Q5: Can n-Butyl-2-cyanoacrylate be used on infected wounds?

A: No, it is contraindicated for use on infected wounds.

Q6: What are the contraindications for n-Butyl-2-cyanoacrylate use?

A: Contraindications include known hypersensitivity to cyanoacrylates, contaminated wounds, and use near the eyes or mouth.

Q7: How does n-Butyl-2-cyanoacrylate interact with other medications?

A: It may interact with other topical adhesives, alcohol, and strong surfactants.

Q8: Is there any special precaution for pregnant or breastfeeding women?

A: Use with caution in pregnant women. Limited data are available regarding breastfeeding; therefore, caution is advised.

Q9: How long does it take for n-Butyl-2-cyanoacrylate to biodegrade?

A: It biodegrades slowly via hydrolysis over several weeks or months.