Medical Pharmacology Chapter 20:  Neuromuscular Blocking Agents and Muscle Relaxants

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Pharmacokinetics: Neuromuscular Blocking Drugs

 

 

 

Neuromuscular Blocking Drugs

 

Isoquinoline derivatives

Drug

Elimination mechanism

Duration of action (minutes)

Atracurium (Tracrium)

Ester hydrolysis (enzymatic and nonenzymatic)

20-35

Cisatracurium (Nimbex)

Spontaneous (Hoffmann elimination)

25-44

Doxacurium (Nuromax)

Renal

> 35

Metocurine (Metubine Iodide)

Renal (40%)

> 35

Mivacurium (Mivacron)

Plasma pseudocholinesterase

10-20

Tubocurarine

Renal (40%)

> 35

 

Steroid Derivatives

Drug

Elimination mechanism

Duration of action (minutes)

Pancuronium (Pavulon)

Renal (80%)

> 35

Pipecuronium (Arduan)

Renal (60%) and hepatic

> 35

Rocuronium (Zemuron)

Hepatic (75-90%) and renal

20-35

Cecuronium (Norcuron)

Hepatic (75-90%) and renal

20-35

 

Other Drugs of Interest

Drug

Elimination mechanism

Duration of action (minutes)

Gallamine (Flaxedil)

Renal (100%)

> 35

Succinylcholine (Anectine)

Plasma pseudocholinesterase

< 8

*-- adapted from Table 27-1: Miller, R.D., Skeletal Muscle Relaxants, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, p. 438

 

Introductory comments about specific nondepolarizing agents

NMJ blockers: Steroid derivatives,  Vecuronium (Norcuron)

NMJ blockers: Steroid derivatives,  Pancuronium (Pavulon)

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