Nondepolarizing Neuromuscular Blockers include- Pipercuranium, Vecuronium,Doxacuranium, Tobocurane, Mivacuranium,Rocuronium, Cisatracurarium, Atracurarium,Pancuronium

Refer- Pancuronium

Drug Lab interaction-

In patients with tetanus, continuous administration of tubocurarine in large doses results in production of a factor that interferes with detection of catecholamine in urine when assayed fluorimetrically

Nondepolarizing Neuromuscular Blockers include- Pipercuranium, Vecuronium,Doxacuranium, Tobocurane, Mivacuranium,Rocuronium, Cisatracurarium, Atracurarium,Pancuronium Refer - Pancuronium 

Most frequent- Prolongation of the drugs pharmacologic action. Profound or prolonged muscle relaxation with consequent respiratory depression to the point of apnea

. Rare- Hypersensitivity, isolated cases of allergy or anaphylactic type of reactions, idiosyncracy, interference with the physical signs of anesthesia, circulatory depression, ganglionic blockade and histamine release can occur.

Metocurine- Allergic or hypersenstivity reactions to the drug or its iodide content and histamine release when large doses are administered rapidly.

Signs of histamine release include erythema, dema, skin rash, flushing, tachycardia, hypotension, bronchospasm, and circulatory collapse.

Cardiovascular- Cardiac arrhthmias, cardiac arrest, bradycardia and hypotension. Premature children and neonates may experience a higher frequency of these reactions.

GI- Excessive salivation very light anesthesia, (particularly in absence of anticholinergic medication)

Allergic hypersensitivity

Special precaution:

Histamine release- Use with caution in patients in whom a sudden increase of histamine release is a definite hazard

Concomittant conditions- Use with caution in patients with respiratory depression or impaired cardiovascular, renal, hepatic, pulmonary, endocrine function

Drug accumulation- Tubocurarine accumulates and may be present for several hours after the effects are not clinically apparent. Keep this mind and should a patient require successive doses or a second anesthesia after having previously received this drug.

Warnings-

Respiratory effects- these drugs may cause respiratory depression and should be used only by those experienced in artificial respiration and administratin of oxygen under positive pressure.

Myasthenia gravis- use with extreme caution in patients with kown myasthenia gravis since prolonged respiratory paralysis may occur.

Elderly- dosage requirements and recovery times may be increased. Pregnancy- Use in early pregnancy only when needed and when the potential hazards to fetus.

Lactation- Excercise caution when administering to a nursing woman.

Children- premature infants and neonates may be more sensitive to these drugs. Infants and children exhibit the same widely variable response as do adults.

Approved by FDA on January 22, 1992

Dosage:

Administer IV only. Individualise doses.

Overdosage-

Symptoms

Extended skeletal muscle weakness, decreased respiratory reserve, lower tidal volume, prolonged apnea, cardiovascular collapse and sudden release of histamine. sufficiently excessive . doses of nondepolarizing muscle relaxants have no antidote.

Treatment

1. A peripheral nerve stimulator may be used to assesss the degree of residual neuromuscular blockade

2. For residual neuromuscular blockade with respiratory paralysis or inadequate ventilation, maintain airway and administer manual or mechanical ventilation.

 Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

Pharmacology:

Mivacurarium is a short acting non-depolarizing skeletal muscle relaxant for IV administration.

Pregnancy-

Use in early pregnancy only when needed and when the potential hazards to fetus.

Lactation-

Excercise caution when administering to a nursing woman.

Children-

Premature infants and neonates may be more sensitive to these drugs. Infants and children exhibit the same widely variable response as do adults.