CLINICAL USE

Muscle relaxant in general anaesthesia, medium duration

DOSE IN NORMAL RENAL FUNCTION

IV injection: intubation dose: 0.6 mg/kg; maintenance: 0.15 mg/kg

IV infusion

: 0.6 mg/kg loading dose, followed by 0.3–0.6 mg/kg/hour

PHARMACOKINETICS

  • Molecular weight                           :609.7
  • %Protein binding                           :25–30
  • %Excreted unchanged in urine     : 40
  • Volume of distribution (L/kg)       :0.2
  • half-life – normal/ESRD (hrs)      :1.2–1.4 /Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function. See ‘Other Information’
  • <10           : Dose as in normal renal function. See ‘Other Information’

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Unknown dialysability. Dose as in GFR< 10 mL/min
  • HD                     :Unknown dialysability. Dose as in GFR< 10 mL/min
  • HDF/high flux   :Unknown dialysability. Dose as in GFR< 10 mL/min
  • CAV/VVHD      :Unknown dialysability. Dose as in GFR=
  • 10 to 20     : mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Anaesthetics: enhanced muscle relaxant effect
  • Anti-arrhythmics: procainamide enhances muscle relaxant effect
  • Antibacterials: effect enhanced by aminoglycosides, clindamycin, polymyxins and piperacillinBotulinum toxin: neuromuscular block enhanced (risk of toxicity)

    ADMINISTRATION

    Reconstition

    –

    Route

    IV

    Rate of Administration

    Slow bolus or continuous infusion

    Comments

    Compatible with sodium chloride 0.9% and glucose 5%

    OTHER INFORMATION

    Use with caution in renal failure: variable duration of action (range: 22–90 minutes)Use the lowest possible dose in patients with GFR<20 mL/min, as at risk of prolonged paralysis

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