Pharmacopoeias. In Europe and International.
European Pharmacopoeia, 6th ed., 2008 and Supplements 6.1 and 6.2 (Alcuronium Chloride). A white or slightly greyish-white, crystalline powder. Freely soluble in water and in methyl alcohol; soluble in alcohol; practically insoluble in cyclohexane. Store under nitrogen in an airtight container. Protect from light.
Alcuronium chloride is a benzylisoquinolinium competitive neuromuscular blocker (see Atracurium) that is used for endotracheal intubation and to provide muscle relaxation in general anaesthesia for surgical procedures (see Anaesthesia). It can induce histamine release to some degree. Anaphylactoid reactions have been associated with the use of alcuronium. It has some vagolytic action and may produce tachycardia; hypotension may also occur.
Doses of neuromuscular blockers need to be carefully titrated for individual patients according to response, and may vary with the procedure, the other drugs given, and the state of the patient; monitoring of the degree of block is recommended in order to reduce the risk of overdosage. An initial dose of 150 to 250 micrograms/kg has been given intravenously. Muscle relaxation occurs after about 2 minutes and the effect lasts for about 20 to 30 minutes. Supplementary doses of 30 micrograms/kg have been given to provide additional periods of muscle relaxation.
Porphyria. Alcuronium is considered to be unsafe in patients with porphyria because it has been shown to be porphyrinogenic in animals.
Pregnancy. Alcuronium crosses the placenta. No evidence of neuromuscular block was seen in any of the neonates born to 12 women who received alcuronium 15 to 30 mg by intravenous injection, 5 to 10.5 minutes before delivery but caution was advised if alcuronium was given in obstetrics in high doses or for a prolonged period.
Renal impairment. Alcuronium is excreted mainly by the kidneys and accumulation, with prolonged paralysis, may therefore be expected in patients with renal impairment given large or repeated doses. A prolonged elimination half-life has been reported in anuria. However, doses of 160 micrograms/kg have been used without any problems in patients with chronic renal failure undergoing renal transplantation. The average duration of action of this dose was 37 minutes and any residual neuromuscular blockade at the end of surgery was successfully reversed using atropine and neostigmine.
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