(1R,2R)-1-(3,4-Dimethoxybenzyl)-6,7-dimethoxy-2-(3-methoxy-3-oxopropyl)-2-methyl-1,2,3,4-tetrahydroisoquinolin-2-ium is used in the preparation of cisatracurium compounds and other related derivatives. Cisatracurium (C496700) is an enantiomer of Atracurium Besylate (A794500), a neuromuscular blocking agent.