Therapeutic Classification: neuromuscular blocking agents-nondepolarizing
Absorption: Following IV administration, absorption is essentially complete.
Distribution: Rapidly distributes in extracellular fluid; minimal penetration of the CNS.
Metabolism/Excretion: Some metabolism by the liver (20%), with conversion to at least one active metabolite; 35% excreted unchanged by the kidneys.
Half-life: Infants: 65 min; Children: 41 min; Adults: 65–75 min (↓ near term in pregnant patients, ↑ in hepatic impairment).
Contraindicated in:
- Hypersensitivity
- Hypersensitivity to bromides
Use Cautiously in:
- Dehydration or electrolyte abnormalities (should be corrected)
- Fractures or muscle spasm
- Hyperthermia (↑ duration/intensity of paralysis)
- Significant hepatic impairment
- Shock
- Extensive burns (may be more resistant to effects)
- Low plasma pseudocholinesterase levels (may be seen in association with anemia, dehydration, cholinesterase inhibitors/insecticides, severe liver disease, pregnancy, or hereditary predisposition)
- Obese patients
- OB: Lactation: Safety not established (use only if benefit outweighs potential risk to fetus)
- Pedi: Children <7 wk (safety and effectiveness not established)
Exercise Extreme Caution in:
- Neuromuscular diseases such as myasthenia gravis (small test dose may be used to assess response).