Description
Doxacurium chloride is an injectable, noncumulative, nondepolarizing neuromuscular
blocking agent which exhibits no significant cardiovascular effects. It is a mixture of
(lR, l′S, 2S, 2′R), (lR, l′R, 2S, 2′s) and (lS, l′S, 2R, 2′R) isomers of a
bis-benzylisoquinolinium diester.Doxacurium chloride provides satisfactory
intubation with duration of action similar to d-tubocurarine or pancuronium. However,
it is reported to be 2 to 3 times as potent as pancuronium.
Originator
Wellcome (United Kingdom)
Uses
Neuromuscular blocking agent.
Brand name
Nuromax (Abbott).
General Description
The molecular structure of doxacuriumchloride, 1,2,3,4-tetrahydro-2-(3-hydroxypropyl)-6,7,8-trimethoxy2-methyl-1-(3,4,5-trimethoxybenzyl) isoquinoliniumchloride succinate (Nuromax), provides thepossibility for 10 stereoisomers: 4 d,l pairs and two mesoforms. Of the 10 stereoisomers, 3 are all-trans configuration,and these are the only active ones. Doxacurium chlorideis a long-acting nondepolarizing blocking agent. The drugdiffers from drugs such as gallium and pancuronium in thatit has no vagolytic activity. It is used as a skeletal musclerelaxant in surgical procedures expected to last longer than90 minutes.
Pharmacokinetics
Doxacurium is a mixture of three trans, trans-stereoisomers, a dl pair [(1R,1′R,2S,2′S) and (1S,1′S,2R,2′R)] and a meso form (1R,1′S,2S,2′R).
Doxacurium is hydrophilic, has a small volume of distribution, and is distributed primarily to extracellular fluids. It is not metabolized by plasma
cholinesterase or hepatic enzymes and does not undergo Hofmann elimination.
;