indication

Used to provide skeletal muscle relaxation as an adjunct to general anesthesia, for endotracheal intubation or to facilitate mechanical ventilation.

pharmacology

Doxacurium chloride is a long-acting, nondepolarizing skeletal muscle relaxant. The neuromuscular block produced by doxacurium chloride may be antagonized by anticholinesterase agents. As with other nondepolarizing neuromuscular blocking agents, the more profound the neuromuscular block at reversal, the longer the time and the greater the dose of anticholinesterase required for recovery of neuromuscular function. Doxacurium chloride is approximately 2.5 to 3 times more potent than pancuronium and 10 to 12 times more potent than metocurine.

mechanism of action

Doxacurium chloride binds competitively to cholinergic receptors on the motor end-plate to antagonize the action of acetylcholine, resulting in a block of neuromuscular transmission (non-depolarizing). This action is antagonized by acetylcholinesterase inhibitors, such as neostigmine.

toxicity

Overdosage with neuromuscular blocking agents may result in neuromuscular block beyond the time needed for surgery and anesthesia.

biotransformation

In vivo data from humans suggest that doxacurium chloride is not metabolized and that the major elimination pathway is excretion of unchanged drug in urine and bile.

half life

99 minutes in normal healthy adults.

route of elimination

In vivo data from humans suggest that NUROMAX is not metabolized and that the major elimination pathway is excretion of unchanged drug in urine and bile.

drug interactions

Amikacin: The agent increases the effect of muscle relaxant

Aminophylline: Theophylline decreases the effect of muscle relaxant

Azathioprine: The agent decreases the effect of the muscle relaxant

Carbamazepine: Decreases the effect of muscle relaxant

Clindamycin: The agent increases the effect of muscle relaxant

Fosphenytoin: Phenytoin decreases the effect of muscle relaxant

Gentamicin: The agent increases the effect of muscle relaxant

Lincomycin: The agent increases the effect of muscle relaxant

Mercaptopurine: The agent dereases the effect of the muscle relaxant

Netilmicin: The agent increases the effect of muscle relaxant

Oxtriphylline: Theophylline decreases the effect of muscle relaxant

Phenytoin: Phenytoin decreases the effect of the muscle relaxant

Piperacillin: The agent increases the effect of the muscle relaxant

Theophylline: Theophylline decreases the effect of the muscle relaxant

Tobramycin: The agent increases the effect of the muscle relaxant