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The most frequent adverse effect of nondepolarizing blocking agents as a class consists of an extension of the pharmacological action beyond the time needed for surgery and anesthesia. This effect may vary from skeletal muscle weakness to profound and prolonged skeletal muscle paralysis resulting in respiratory insufficiency and apnea which require manual or mechanical ventilation until recovery is judged to be clinically adequate (see OVERDOSAGE). Inadequate reversal of neuromuscular block from NUROMAX (doxacurium chloride) is possible, as with all nondepolarizing agents. Prolonged neuromuscular block and inadequate reversal may lead to postoperative complications.
Observed in Clinical Trials
Adverse experiences were uncommon among the 1034 surgical patients and volunteers who received NUROMAX (doxacurium chloride) and other drugs in US clinical studies in the course of a wide variety of procedures conducted during balanced or inhalational anesthesia. The following adverse experiences were reported in patients administered NUROMAX (doxacurium chloride) (all events judged by investigators during the clinical trials to have a possible causal relationship):
Incidence Greater than 1%
Incidence Less than 1%
|Cardiovascular:*||Hypotension,† flushing,† ventricular fibrillation, myocardial infarction|
|Dermatological:||Urticaria, injection site reaction|
|Nonspecific:||Difficult neuromuscular block reversal, prolonged drug effect, fever|
|* Reports of ventricular fibrillation (n
= 1) and myocardial infarction (n = 1) were limited to ASA Class 3-4 patients
undergoing cardiac surgery (n = 142).
† 0.3% incidence. All other reactions unmarked were ≤ 0.1%.
Observed During Clinical Practice
There have been post-marketing reports of severe allergic reactions (anaphylactic and anaphylactoid reactions) with the use of neuromuscular blocking agents of which NUROMAX (doxacurium chloride) is a member. These reactions, in some cases, have been life threatening and fatal. Because these reactions were reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency (see WARNINGS and PRECAUTIONS).
Read the Nuromax (doxacurium chloride) Side Effects Center for a complete guide to possible side effects
Prior administration of succinylcholine has no clinically important effect on the neuromuscular blocking action of NUROMAX (doxacurium chloride) .
The use of NUROMAX (doxacurium chloride) before succinylcholine to attenuate some of the side effects of succinylcholine has not been studied.
There are no clinical data on concomitant use of NUROMAX (doxacurium chloride) and other nondepolarizing neuromuscular blocking agents.
Isoflurane, enflurane, and halothane decrease the ED50 of NUROMAX (doxacurium chloride) by 30% to 45%. These agents may also prolong the clinically effective duration of action by up to 25%.
Other drugs which may enhance the neuromuscular blocking action of nondepolarizing agents such as NUROMAX (doxacurium chloride) include certain antibiotics (e.g., aminoglycosides, tetracyclines, bacitracin, polymyxins, lincomycin, clindamycin, colistin, and sodium colistimethate), magnesium salts, lithium, local anesthetics, procainamide, and quinidine.
As with some other nondepolarizing neuromuscular blocking agents, the time of onset of neuromuscular block induced by NUROMAX (doxacurium chloride) is lengthened and the duration of block is shortened in patients receiving phenytoin or carbamazepine.
Last reviewed on RxList: 1/4/2011
This monograph has been modified to include the generic and brand name in many instances.
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