No

Neuromuscular Blocker Agent, Nondepolarizing

Adjunct to general anesthesia; provides skeletal muscle relaxation during surgery. Doxacurium is a long-acting nondepolarizing neuromuscular blocker with virtually no cardiovascular side effects. The characteristics of this agent make it especially useful in procedures requiring careful maintenance of hemodynamic stability for prolonged periods.

C

Hypersensitivity to doxacurium or any component

Use with caution in the elderly, effects and duration are more variable; product contains benzoyl alcohol; use with caution in newborns; use with caution in patients with neuromuscular diseases such as myasthenia gravis; resistance may develop in burn patients; ensure proper electrolyte balance prior to use; use with caution in patients with renal or hepatic impairment

<1%: Hypotension, fever, urticaria, skeletal muscle weakness, diplopia, respiratory insufficiency and apnea, wheezing, produces little, if any, histamine release

Overdosage is manifested by prolonged neuromuscular blockage

Treatment is supportive; reverse blockade with neostigmine, pyridostigmine, or edrophonium

Decreased effect: Phenytoin, carbamazepine (decreases neuromuscular blockade)

Increased effect: Magnesium, lithium

Prolonged neuromuscular blockade:

Corticosteroids

Inhaled anesthetics

Local anesthetics

Calcium channel blockers

Antiarrhythmics (eg, quinidine or procainamide)

Antibiotics (eg, aminoglycosides, tetracyclines, vancomycin, clindamycin)

Immunosuppressants (eg, cyclosporine)

Stable for 24 hours at room temperature when diluted, up to 0.1 mg/mL in dextrose 5% or normal saline; compatible with sufentanil, alfentanil, and fentanyl

Doxacurium is a long-acting nondepolarizing skeletal muscle relaxant. The drug is a bis-quaternary benzylisoquinolinium diester, with a chemical structure similar to that of atracurium. Similar to other nondepolarizing neuromuscular blocking agents, doxacurium produces muscle relaxation by competing with acetylcholine for cholinergic receptor sites on the postjunctional membrane; significant presynaptic depressant activity is also observed.

Onset of effect: 5-11 minutes

Duration: 30 minutes (range: 12-54 minutes)

Protein binding: 30%

Elimination: Primarily as unchanged drug via the kidneys and biliary tract

Recovery time is longer in elderly patients

I.V. (in obese patients, use ideal body weight to calculate dose):

Adults: Surgery: 0.05 mg/kg with thiopental/narcotic or 0.025 mg/kg with succinylcholine; maintenance doses of 0.005-0.01 mg/kg after 60-100 minutes

Dosing adjustment in renal or hepatic impairment: Reduce initial dose and titrate carefully as duration may be prolonged

May be given rapid I.V. injection undiluted

Blockade is monitored with a peripheral nerve stimulator, should also evaluate EKG, blood pressure, and heart rate

Blockade is monitored with a peripheral nerve stimulator, should also evaluate EKG, blood pressure, and heart rate

Injection, as chloride: 1 mg/mL (5 mL)

Coursin DB, Meyer DA, and Prielipp RC, "Doxacurium Infusion in Critically Ill Patients With Atracurium Tachyphylaxis," Am J Health Syst Pharm, 1995, 52(6):635-9.

Faulds D and Clissold SP, "Doxacurium. A Review of Its Pharmacology and Clinical Potential in Anaesthesia," Drugs, 1991, 42(4):673-89.

Marik PE, "Doxacurium-Corticosteroid Acute Myopathy: Another Piece to the Puzzle," Crit Care Med, 1996, 24(7):1266-7.

Murray MJ, Coursin DB, Scuderi PE, et al, "Double-Blind, Randomized, Multicenter Study of Doxacurium vs Pancuronium in Intensive Care Unit Patients Who Require Neuromuscular-Blocking Agents," Crit Care Med, 1995, 23(3):450-8.