Doxacurium

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. 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. This action is antagonized by acetylcholinesterase inhibitors, such as neostigmine.

Brands
Adult Dose
Neonatal
Paedriatic
Characteristics
Doxacurium also known as Isoquinolinium dichloride. Doxacurium Chloride is the derivative of Doxacurium. It is of Synthetic origin and belongs to Isoquinolinium. It belongs to Anticholinesterase agent pharmacological group on the basis of mechanism of action and also classified in Neuromuscular Blocking Agent, Nondepolarizing pharmacological group.The Molecular Weight of Doxacurium is 1106.14.
Contraindications
Doxacurium is contraindicated in conditions like Hypersensitivity to the drug.
Effects
The severe or irreversible adverse effects of Doxacurium, which give rise to further complications include Fever, Wheezing, Muscular weakness, Dizziness, Hives.The symptomatic adverse reactions produced by Doxacurium are more or less tolerable and if they become severe, they can be treated symptomatically, these include Pain, Redness, Flushing, Light headedness, Respiratory insufficiency, Apnea, Skeletal muscle paralysis.
Indications
Doxacurium is primarily indicated in conditions like Adjunct to anesthesia, Painful musculoskeletal conditions.
Interactions
Doxacurium is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementCarbamazepineNeuromuscular blocking effect of doxacurium is reduced by carbamazepine.ModerateNeuromuscular blocking effect should be closely monitor.EnfluraneEnflurane may initiate non depolarizing muscle relaxant effect.ModerateEnflurane dosage must be adjusted and administered by specially trained anesthologist.HalothaneHalothane may initiate non depolarizing muscle relaxant effect.ModerateHalothane dosage must be adjusted and administered by specially trained anesthologist.LithiumLlithium potentiate the pharmacological effect of doxacurium.Prolong apnea and delayed recovery from anesthesia occurs when they administered in combination.ModerateClose monitoring for the development of respiratory depression.NeomycinBoth drugs are neuromuscular blocking agents, so, their coadministration results in severe or prolonged respiratory depression MajorClosely monitor for vital signs.Adjust the dose of drug accordingly.Ventilatory support should be readily available in case of repiratory depression.Phenytoin (Na)Long-term administration of phenytoin reduces the efficacy of doxacurium by inducing hepatic enzyme and thus enhances hepatic clearence.ModerateIncrease the dose of doxacurium and closely monitor for altered effect of doxacurium These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Risks
Drug should not be given to patients suffering from Kidney dysfunction, and patients suffering from Liver Malfunction.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Warnings
'Should be administered in carefully adjusted dosage by or under the supervision of experienced clinicians who are familiar with the drug''s actions and the possible complications of its use. The drug should not be administered unless facilities for intubation, artificial respiration, oxygen therapy, and an antagonist are within immediate reach. It is recommended that clinicians administering long-acting neuromuscular blocking agents employ a peripheral nerve stimulator to monitor drug response, need for additional relaxants, and adequacy of spontaneous recovery or antagonism.'
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