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Cisatracurium
Systematic (IUPAC) name
5-[3-[(1R,2R)-1-[(3,4-dimethoxyphenyl)methyl]-6,7-
dimethoxy-2-methyl-3,4-dihydro-1H-isoquinolin-2-yl]
propanoyloxy]pentyl 3-[(1R,2R)-1-[(3,4-dimethoxy
phenyl)methyl]-6,7-dimethoxy-2-methyl-3,4-dihydro-
1H-isoquinolin-2-yl]propanoate
Identifiers
CAS number 96946-42-8
ATC code M03AC11
PubChem 62887
DrugBank APRD00874
Chemical data
Formula C 53H72N2O12 +2
Mol. mass 929.145 g/mol
Pharmacokinetic data
Bioavailability N/A - IV use only
Protein binding Unknown due to rapid degradation
Metabolism 80% Hoffman degradation/ Hepatic
Half life 20-29 minutes
Excretion 10-15% unchanged
Therapeutic considerations
Pregnancy cat. B
Legal status
Routes IV only

Cisatracurium (Nimbex) is a neuromuscular-blocking drug. It is one of the ten isomers of atracurium. Its active metabolites contains less laudanosine (which causes hypotension, central nervous system excitement, and seizures) than that of atracurium. It is considered an intermediate-acting agent in terms of duration of action.

Structure

It is a bisbenzyltetrahydroisoquinolinium agent in the quaternary ammonium compound family.

Metabolism

80% is metabolized to laudanosine via Hofmann degradation (which is dependent on the pH and the temperature of the plasma) and 20% is metabolized hepatically or excreted renally. Since Hofmann elimination is organ-independent, the use of cisatracurium may pose less risk in patients with liver or renal disease than other neuromuscular blockers. 10-15% of the dose is excreted unchanged in the urine.

References

Esmaoglu A, Akin A, Mizrak A, Turk Y, Boyaci A (2006). "Addition of cisatracurium to lidocaine for intravenous regional anesthesia.". J Clin Anesth 18 (3): 194–7. doi:10.1016/j.jclinane.2005.08.003. PMID 16731321.   Melloni C, Devivo P, Launo C, Mastronardi P, Novelli G, Romano E (2006). "Cisatracurium versus vecuronium: a comparative, double blind, randomized, multicenter study in adult patients under propofol/fentanyl/N2O anesthesia.". Minerva Anestesiol 72 (5): 299–308. PMID 16675938.   Serra C, Oliveira A (2006). "Cisatracurium: myographical and electrophysiological studies in the isolated rat muscle.". Fundam Clin Pharmacol 20 (3): 291–8. doi:10.1111/j.1472-8206.2006.00395.x. PMID 16671964.  

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