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Cisatracurium


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	C₅₃H₇₂N₂O₁₂⁺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 elmination/ Hepatic
Half life	20-29 minutes
Excretion	10-15% unchanged
Therapeutic considerations
Pregnancy cat.	B
Legal status
Routes	IV only

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

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Structure

It is a benzyl-isoquinolinium agent in the quaternary ammonium compound family.

Metabolism

80% is metabolized to laudanosine via Hoffman Elimination (which is dependent on the pH and the temperature of the plasma) and 20% is metabolized hepatically or excreted renally. Since Hoffman 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.

v • d • e Muscle relaxants (M03)
Peripherally acting (primarily antinicotinic, neuromuscular-blocking drugs)	curare alkaloids (Alcuronium, Dimethyltubocurarine, Tubocurarine) - choline derivatives (Suxamethonium) - other quaternary ammonium compounds (Atracurium, Cisatracurium, Doxacurium chloride, Fazadinium bromide, Gallamine, Hexafluronium, Mivacurium chloride, Pancuronium, Pipecuronium bromide, Rocuronium bromide, Vecuronium) - other (Botulinum toxin)
Centrally acting	carbamic acid esters (Phenprobamate, Carisoprodol, Methocarbamol, Styramate, Febarbamate), Baclofen, Chlormezanone, Chlorzoxazone, Cyclobenzaprine, Lorazepam, Mephenesin, Orphenadrine, Phenyramidol, Pridinol, Tetrazepam, Thiocolchicoside, Tizanidine, Tolperisone
Directly acting	Dantrolene