No

Neuromuscular Blocker Agent, Nondepolarizing

Adjunct to anesthesia to induce skeletal muscle relaxation

C

Hypersensitivity to tubocurarine or any component; patients in whom histamine release is a definite hazard

Use with caution in patients with renal impairment, respiratory depression, impaired hepatic or endocrine function, myasthenia gravis, and the elderly; ventilation must be supported during neuromuscular blockade; rapid administration may cause histamine release resulting in respiratory depression and bronchospasm

1% to 10%: Cardiovascular: Hypotension

<1%: Edema, circulatory collapse, cardiac arrhythmias, increased heart rate or bradycardia, skin flushing, rash, itching, erythema, increased salivation, decreased GI motility, bronchospasm, hypersensitivity reactions, allergic reactions

Symptoms of overdose include prolonged skeletal muscle weakness and apnea, cardiovascular collapse

Use neostigmine, edrophonium or pyridostigmine with atropine to antagonize skeletal muscle relaxation; support of ventilation and the cardiovascular system through mechanical means, fluids, and pressors may be necessary.

Increased effect/toxicity with aminoglycosides, ketamine, magnesium sulfate, verapamil, quinidine, clindamycin, furosemide

Refrigerate; incompatible with barbiturates

Blocks acetylcholine from binding to receptors on motor endplate inhibiting depolarization

Elimination: ~33% to 75% of parenteral dose is excreted unchanged in urine in 24 hours; ~10% excreted in bile

I.V.:

Alternative adult dose: 6-9 mg once daily, then 3-4.5 mg as needed to maintain paralysis

Dosing adjustment/comments in renal impairment: May accumulate with multiple doses and reductions in subsequent doses is recommended

Cl_cr 50-80 mL/minute: Administer 75% of normal dose

Cl_cr 10-50 mL/minute: Administer 50% of normal dose

Cl_cr <10 mL/minute: Avoid use

Dosing comments in hepatic impairment: Larger doses may be necessary

May also give I.M.; administer I.V. undiluted over 60-90 seconds and flush I.V. cannula with NS or D₅W

Mean arterial pressure, heart rate, respiratory status, serum potassium

None reported

None reported

Parenteral: May infuse direct I.V. without further dilution over a period of 1-11/2 minutes

Injection, as chloride: 3 mg/mL [3 units/mL] (5 mL, 10 mL, 20 mL)