Pharmacy World and Science

, Volume 19, Issue 1, pp 13–34 | Cite as

Part 2: Pharmacology of neuromuscular blocking agents

  • L.H.D.J. Booij


Clinically, neuromuscular blockade is induced with either depolarizing or non‐depolarizing relaxants. Suxamethonium is the only depolarizing relaxant still in use. It is hydrolysed in the plasma by pseudo‐cholinesterase (plasma cholinesterase). In some patients and in particular diseases the plasma cholinesterase activity is low and hence the effect of suxamethonium prolonged. Suxamethonium is characterized by side‐effects such as myalgia, fasciculations and increase in intraocular, intracranial and intragastric pressure. More serious adverse reactions are masseter muscle spasm and potassium release, in patients with some neuromuscular diseases and increase in extrajunctional acetylcholine receptors. As non‐depolarizing muscle relaxants benzylisoquinolines and steroidal compounds are mainly used. Each relaxant has its own pharmacological characteristics. The effect of most relaxants depends on liver and renal function because the pharmacokinetic behaviour is strongly dependent on these organs. Also, acid‐base balance disturbances, change in temperature, and neurological diseases have an effect on the profile of the relaxants. A number of drugs (anaesthetics, antibiotics, antiepileptics, etc.) have an effect on neuromuscular transmission, and thus interact with the relaxants. Some non-depolarizing relaxants cause histamine release and cardiovascular effects.

Aminosteroids Benzylisoquinolines Cardiovascular effects Depolarizing relaxants Drug interactions Histamine release Muscle relaxants Non-depolarizing relaxants Effect of hepatic diseases Effect of renal diseases Neuromuscular diseases 


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Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • L.H.D.J. Booij
    • 1
  1. 1.Department of AnaesthesiologyCatholic University NijmegenNijmegenThe Netherlands

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