Cisatracurium Impurities

Cisatracurium is a skeletal muscle relaxant used to facilitate tracheal intubation, muscle relaxation in surgery, or mechanical ventilation. Nimbex. Generic Name Cisatracurium DrugBank Accession Number DB00565 Background. Cisatracurium besylate is a bisquaternary benzylisoquinolinium stereoisomer of atracurium with intermediate onset and duration of neuromuscular blockade. It produces predictable, dose-dependent nondepolarizing blockade after intravenous administration, with clinical onset typically within 2 to 3 minutes and recovery in roughly 30 to 90 minutes depending on dose and monitoring methods. Elimination is largely organ independent via Hofmann elimination and ester hydrolysis, yielding degradation products including a monoquaternary acrylate intermediate and the tertiary amine metabolite laudanosine; because clearance does not depend on renal or hepatic function to the same extent as many other neuromuscular blockers, cisatracurium is preferred in patients with organ impairment. Pharmacodynamically it has a lower propensity for histamine release than atracurium and is monitored using peripheral nerve stimulation and quantitative neuromuscular transmission techniques for dose titration and reversal decisions.