Tubocurarine

What is Tubocurarine

Tubocurarine chloride is a naturally occurring quaternary ammonium salt that acts as a long-acting, nondepolarizing, neuromuscular blocking agent. d-tubocurarine chloride is derived from a plant extract of Chondodendron tomentosum. 

Tubocurarine is longer-acting than succinylcholine and causes greater histamine-release than other neuromuscular blockers.

Tubocurarine also has ganglionic blocking properties. In addition to promoting skeletal muscle relaxation during surgery, tubocurarine facilitates mechanical respiration, prevents trauma during electroconvulsive therapy, and helps to diagnose myasthenia gravis.

Tubocurarine was approved by the FDA in 1945.

Indications

  • electroconvulsive therapy (ECT)
  • myasthenia gravis diagnosis
  • neuromuscular blockade

Side Effects

  1. angioedema
  2. apnea
  3. bradycardia
  4. bronchospasm
  5. dyspnea
  6. edema
  7. erythema
  8. flushing
  9. hypersalivation
  10. hypotension
  11. malignant hyperthermia
  12. muscle paralysis
  13. pruritus
  14. rash
  15. respiratory depression
  16. sinus tachycardia
  17. urticaria
  18. wheezing

Monitoring Parameters

  • arterial blood gases (ABGs)
  • peripheral nerve stimulation
  • serum electrolytes
  • serum magnesium

Contraindications

  • acid/base imbalance
  • asthma
  • benzyl alcohol hypersensitivity
  • breast-feeding
  • burns
  • cardiac disease
  • dehydration
  • electrolyte imbalance
  • geriatric
  • hepatic disease
  • hypotension
  • hypothermia
  • lung cancer
  • malignant hyperthermia
  • myasthenia gravis
  • neonates
  • pregnancy
  • pulmonary disease
  • renal disease
  • renal failure
  • renal impairment
  • respiratory depression
  • shock
  • sulfite hypersensitivity

Interactions

  • Acebutolol
  • Acetazolamide
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Amide local anesthetics
  • Aminoglycosides
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Atenolol
  • Atenolol; Chlorthalidone
  • Bacitracin
  • Bendroflumethiazide; Nadolol
  • Beta-blockers
  • Betaxolol
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Botulinum Toxins
  • Brimonidine; Timolol
  • Calcium
  • Calcium Acetate
  • Calcium Carbonate
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Carbonate; Risedronate
  • Calcium Carbonate; Simethicone
  • Calcium Chloride
  • Calcium Gluconate
  • Calcium-channel blockers
  • Calcium; Vitamin D
  • Capreomycin
  • Carbonic anhydrase inhibitors
  • Carteolol
  • Carvedilol
  • Chromium
  • Clevidipine
  • Colistimethate, Colistin, Polymyxin E
  • Corticosteroids
  • Cyclosporine
  • Demeclocycline
  • Dextromethorphan; Quinidine
  • Diltiazem
  • Dorzolamide; Timolol
  • Doxycycline
  • Enalapril; Felodipine
  • Esmolol
  • Ester local anesthetics
  • Felodipine
  • Fosphenytoin
  • Hetastarch; Dextrose; Electrolytes
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Indapamide
  • Isradipine
  • Labetalol
  • Levobetaxolol
  • Levobunolol
  • Lincosamides
  • Lithium
  • Loop diuretics
  • Magnesium
  • Methazolamide
  • Metoprolol
  • Minocycline
  • Nadolol
  • Nebivolol
  • Nebivolol; Valsartan
  • Nicardipine
  • Nifedipine
  • Nimodipine
  • Nisoldipine
  • Omadacycline
  • Penbutolol
  • Perindopril; Amlodipine
  • Phenytoin
  • Pindolol
  • Polymyxin B
  • Polymyxins
  • Procainamide
  • Propranolol
  • Quinidine
  • Quinine
  • Sarecycline
  • Sotalol
  • Spironolactone
  • Tetracycline
  • Tetracyclines
  • Theophylline, Aminophylline
  • Thiazide diuretics
  • Timolol
  • Trandolapril; Verapamil
  • Vancomycin
  • Verapamil
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