Rapacuronium

Table of contents

  • Brand Names
  • Chemistry
  • Pharmacologic Category
  • Mechanism of Action
  • Therapeutic Use
  • Pregnancy and Lactation Implications
  • Contraindications
  • Warnings and Precautions
  • Adverse Reactions
  • Toxicological Effects
  • Genes that may be involved
  • Drug Interactions
  • Dosage
  • Pharmacokinetics and Pharmacodynamics
  • Special Considerations

Brand Names

North America

USA: Raplon (d).

Drug combinations

Chemistry

Rapacuronium Bromide: C~37~H~61~BrN~2~O~4~. Mw: 677.78. 1-[(2β,3α,5α,16β,17β)-3-(Acetyloxy)-17-(1-oxopropoxy)-2-(1-piperidinyl)androstan-16-yl]-1-(2-propenyl) piperidinium bromide. CAS-156137-99-4.

Pharmacologic Category

Skeletal Muscle Relaxants; Neuromuscular-Blocking Agents, Nondepolarizing. (ATC-Code: M03AC).

Mechanism of action

Rapacuronium bromide for injection is a nondepolarizing neuromuscular-blocking agent with a rapid onset of action and a dose-dependent duration of action (the recommended dose in adults has a short clinical duration of action). Acts by competing for cholinergic receptors at the motor end plate. Profound neuromuscular blockade induced by rapacuronium can be reversed by neostigmine.

Therapeutic use

Short-acting neuromuscular blocking agent, indicated as an adjunct to general anesthesia to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgical procedures.

Pregnancy and lactiation implications

Should not be used during pregnancy unless potential benefit to mother outweighs potential risk to fetus (this warning does not apply to its use during cesarean section, but appropriate monitoring of the infant is recommended after delivery). Caution should be exercised during lactation.

Unlabeled use

Contraindications

Contraindicated in patients known to have hypersensitivity to rapacuronium bromide.

Warnings and precautions

Doses of rapacuronium bromide for injection should be individualized and a peripheral nerve stimulator should be used to measure neuromuscular function during administration in order to monitor drug effect, to determine the need for additional doses and to confirm recovery from neuromuscular block. Has no known effect on consciousness, pain threshold, or cerebration (to avoid distress to the patient, neuromuscular block should not be induced before unconsciousness; must be accompanied by adequate anesthesia or sedating agents). Dose-related increases in heart rate and dose-related decreases in mean arterial pressure (MAP) were observed. Potential adverse ECG effects in humans should be considered when rapacuronium is given in a high bolus dose or following prolonged infusion. Dose-related increases in plasma histamine levels and events possibly related to histamine release (e.g. erythema, bronchospasm) have occurred. Intraocular pressure decreased following a single bolus dose of rapacuronium. Severe anaphylactic reactions to neuromuscular-blocking agents, including rapacuronium, have been reported (precautions should also be taken in those individuals who have had previous anaphylactic reactions to other neuromuscular-blocking agents, since cross-reactivity between neuromuscular-blocking agents, both depolarizing and non-depolarizing, has been reported). Rapacuronium bromide for injection should not be administered by infusion, particularly in the intensive care unit (ICU) or during long surgical procedures. Accumulation of rapacuronium bromide following repeat dosing is likely to occur (may have a potential for prolonged block). Should not be mixed with alkaline solutions (e.g. barbiturate solutions) in the same syringe or administered simultaneously during intravenous infusion through the same needle. Contains benzyl alcohol; not intended for use in newborns.

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