A1,
A2,
B,
C1,
C2,
D,
E,
F,
G-H,
I-K,
L,
M,
N,
O,
P1,
P2,
Q-R,
S,
T,
U-V,
W-Z
Nuromax Side Effects, and Drug Interactions - Doxacurium Chloride
Nuromax Side Effects, and Drug Interactions - Doxacurium Chloride
SIDE EFFECTS
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 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 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 (all events judged by investigators during
the clinical trials to have a possible causal relationship):
Incidence Greater than 1%: None
Incidence Less than 1%:
Cardiovascular:* Hypotension†, flushing†,
ventricular fibrillation, myocardial infarction
Respiratory: Bronchospasm, wheezing
Dermatological: Urticaria, injection site reaction
Special Senses: Diplopia
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%.
DRUG INTERACTIONS
Prior administration of succinylcholine has no clinically important effect
on the neuromuscular blocking action of NUROMAX.
The use of NUROMAX 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 and other nondepolarizing
neuromuscular blocking agents.
Isoflurane, enflurane, and halothane decrease the ED50 of
NUROMAX 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 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 is lengthened
and the duration of block is shortened in patients receiving phenytoin
or carbamazepine.
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