Details of the Drug

General Information of Drug (ID: DMUZPJ5)

Drug Name

Cisatracurium

Synonyms

Cisatracurium Besylate; Cisatracurium Besylate Preservative Free; Nimbex; Nimbex Preservative Free

Indication

Disease Entry	ICD 11	Status	REF
Muscle spasm	MB47.3	Approved	[1]

Drug Type

Small molecular drug

Structure

3D MOL is unavailable

2D MOL

#Ro5 Violations (Lipinski): 4

Molecular Weight (mw)

929.1

Topological Polar Surface Area (xlogp)

7.9

Rotatable Bond Count (rotbonds)

Hydrogen Bond Donor Count (hbonddonor)

Hydrogen Bond Acceptor Count (hbondacc)

ADMET Property

Clearance: The drug present in the plasma can be removed from the body at the rate of 5.4 mL/min/kg [2]
Elimination: 8.5% of drug is excreted from urine in the unchanged form [3]
Half-life: The concentration or amount of drug in body reduced by one-half in 22 minutes [2]
Metabolism: The drug is metabolized via the liver [4]
MRTD: The Maximum Recommended Therapeutic Dose (MRTD) of drug that ensured maximising efficacy and moderate side effect is 0.6457 micromolar/kg/day [5]
Unbound Fraction: The unbound fraction of drug in plasma is 0.62% [2]
Vd: Fluid volume that would be required to contain the amount of drug present in the body at the same concentration as in the plasma 0.14 L/kg [2]

Chemical Identifiers

Formula: C53H72N2O12+2
IUPAC Name: 5-[3-[(1R,2R)-1-[(3,4-dimethoxyphenyl)methyl]-6,7-dimethoxy-2-methyl-3,4-dihydro-1H-isoquinolin-2-ium-2-yl]propanoyloxy]pentyl 3-[(1R,2R)-1-[(3,4-dimethoxyphenyl)methyl]-6,7-dimethoxy-2-methyl-3,4-dihydro-1H-isoquinolin-2-ium-2-yl]propanoate
Canonical SMILES: C[N@@+]1(CCC2=CC(=C(C=C2[C@H]1CC3=CC(=C(C=C3)OC)OC)OC)OC)CCC(=O)OCCCCCOC(=O)CC[N@+]4(CCC5=CC(=C(C=C5[C@H]4CC6=CC(=C(C=C6)OC)OC)OC)OC)C
InChI: InChI=1S/C53H72N2O12/c1-54(22-18-38-32-48(62-7)50(64-9)34-40(38)42(54)28-36-14-16-44(58-3)46(30-36)60-5)24-20-52(56)66-26-12-11-13-27-67-53(57)21-25-55(2)23-19-39-33-49(63-8)51(65-10)35-41(39)43(55)29-37-15-17-45(59-4)47(31-37)61-6/h14-17,30-35,42-43H,11-13,18-29H2,1-10H3/q+2/t42-,43-,54-,55-/m1/s1
InChIKey: YXSLJKQTIDHPOT-LJCJQEJUSA-N

Cross-matching ID

PubChem CID: 62887
ChEBI ID: CHEBI:140621
CAS Number: 96946-41-7
DrugBank ID: DB00565
TTD ID: D08ALK
ACDINA ID: D00949

Molecular Interaction Atlas of This Drug

Drug Therapeutic Target (DTT)

DTT Name	DTT ID	UniProt ID	MOA	REF
Cholinergic receptor unspecific (CHR)	TTUPDWN	NOUNIPROTAC	Antagonist	[6]
Neuronal acetylcholine receptor alpha-2 (CHRNA2)	TTF4E0J	ACHA2_HUMAN	Antagonist	[7], [8]

------------------------------------------------------------------------------------

Molecular Interaction Atlas (MIA)

MIA Detail

Jump to Detail Molecular Interaction Atlas of This Drug

Drug-Drug Interaction (DDI) Information of This Drug

Coadministration of a Drug Treating the Same Disease as Cisatracurium

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Disease	REF
Vecuronium	DMP0UK2	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Vecuronium.	Tonus and reflex abnormality [MB47]	[13]
-----------

Coadministration of a Drug Treating the Disease Different from Cisatracurium (Comorbidity)

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Comorbidity	REF
Clindamycin	DM15HL8	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Clindamycin.	Acne vulgaris [ED80]	[14]
Magnesium Sulfate	DMVEK07	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Magnesium Sulfate.	Acute pain [MG31]	[15]
Framycetin	DMF8DNE	Major	Additive neuromuscular blocking effects by the combination of Cisatracurium and Framycetin.	Alcoholic liver disease [DB94]	[16]
Paromomycin	DM1AGXN	Major	Additive neuromuscular blocking effects by the combination of Cisatracurium and Paromomycin.	Amoebiasis [1A36]	[16]
Trimethaphan	DMHF4IQ	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Trimethaphan.	Aneurysm/dissection [BD50]	[17]
Terbutaline	DMD4381	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Terbutaline.	Asthma [CA23]	[17]
Spectinomycin	DM0MQ35	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Spectinomycin.	Bacterial infection [1A00-1C4Z]	[17]
Kanamycin	DM2DMPO	Major	Additive neuromuscular blocking effects by the combination of Cisatracurium and Kanamycin.	Bacterial infection [1A00-1C4Z]	[16]
Streptomycin	DME1LQN	Major	Additive neuromuscular blocking effects by the combination of Cisatracurium and Streptomycin.	Bacterial infection [1A00-1C4Z]	[16]
Gentamicin	DMKINJO	Major	Additive neuromuscular blocking effects by the combination of Cisatracurium and Gentamicin.	Bacterial infection [1A00-1C4Z]	[16]
Oxytetracycline	DMOVH1M	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Oxytetracycline.	Bacterial infection [1A00-1C4Z]	[17]
Netilmicin	DMRD1QK	Major	Additive neuromuscular blocking effects by the combination of Cisatracurium and Netilmicin.	Bacterial infection [1A00-1C4Z]	[16]
Tobramycin	DMUI0CH	Major	Additive neuromuscular blocking effects by the combination of Cisatracurium and Tobramycin.	Bacterial infection [1A00-1C4Z]	[16]
Minocycline	DMVN5OH	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Minocycline.	Bacterial infection [1A00-1C4Z]	[17]
Tetracycline	DMZA017	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Tetracycline.	Bacterial infection [1A00-1C4Z]	[17]
Demeclocycline	DMZEPFJ	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Demeclocycline.	Bronchitis [CA20]	[17]
Irinotecan	DMP6SC2	Minor	Antagonize the effect of Cisatracurium when combined with Irinotecan.	Colorectal cancer [2B91]	[18]
Procaine	DM4LSNE	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Procaine.	Corneal disease [9A76-9A78]	[17]
Alfentanil	DMVO0UB	Moderate	Increased risk of bradycardia by the combination of Cisatracurium and Alfentanil.	Corneal disease [9A76-9A78]	[19]
Fosphenytoin	DMOX3LB	Moderate	Increased metabolism of Cisatracurium caused by Fosphenytoin mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[20]
Ethotoin	DMXWOCP	Moderate	Increased metabolism of Cisatracurium caused by Ethotoin mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[20]
Nadolol	DMW6GVL	Moderate	Additive cardiorespiratory depression effects by the combination of Cisatracurium and Nadolol.	Essential hypertension [BA00]	[21]
Amphotericin B	DMTAJQE	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Amphotericin B.	Fungal infection [1F29-1F2F]	[22]
Metipranolol	DMJMVKI	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Metipranolol.	Glaucoma [9C61]	[23]
Levobetaxolol	DMSREPX	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Levobetaxolol.	Glaucoma [9C61]	[23]
Levobunolol	DMTNFCQ	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Levobunolol.	Glaucoma [9C61]	[23]
Lincomycin	DMVTHER	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Lincomycin.	Gram-positive bacterial infection [1B74-1F40]	[14]
Carvedilol	DMHTEAO	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Carvedilol.	Heart failure [BD10-BD1Z]	[21]
Acebutolol	DM0TI4U	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Acebutolol.	Hypertension [BA00-BA04]	[21]
Bisoprolol	DM3UZ95	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Bisoprolol.	Hypertension [BA00-BA04]	[21]
Penbutolol	DM4ES8F	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Penbutolol.	Hypertension [BA00-BA04]	[21]
Nebivolol	DM7F1PA	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Nebivolol.	Hypertension [BA00-BA04]	[21]
Pindolol	DMD2NV7	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Pindolol.	Hypertension [BA00-BA04]	[21]
Labetalol	DMK8U72	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Labetalol.	Hypertension [BA00-BA04]	[21]
Chloroquine	DMSI5CB	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Chloroquine.	Malaria [1F40-1F45]	[17]
Propranolol	DM79NTF	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Propranolol.	Migraine [8A80]	[21]
Metoclopramide	DMFA5MY	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Metoclopramide.	Nausea/vomiting [MD90]	[17]
Ranitidine	DM0GUSX	Minor	Antagonize the effect of Cisatracurium when combined with Ranitidine.	Peptic ulcer [DA61]	[24]
Colistimethate	DMZ9BMU	Major	Additive neuromuscular blocking effects by the combination of Cisatracurium and Colistimethate.	Respiratory infection [CA07-CA4Z]	[25]
Fentanyl	DM8WAHT	Moderate	Additive hypotensive effects by the combination of Cisatracurium and Fentanyl.	Sensation disturbance [MB40]	[19]
Bacitracin	DM5OHYE	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Bacitracin.	Skin and skin-structure infection [1F28-1G0Z]	[26]
Plazomicin	DMKMBES	Major	Additive neuromuscular blocking effects by the combination of Cisatracurium and Plazomicin.	Urinary tract infection [GC08]	[16]
Procainamide	DMNMXR8	Moderate	Additive neuromuscular blocking effects by the combination of Cisatracurium and Procainamide.	Ventricular tachyarrhythmia [BC71]	[17]
-----------


⏷ Show the Full List of 43 DDI Information of This Drug

Drug Inactive Ingredient(s) (DIG) and Formulation(s) of This Drug

DIG

DIG Name	DIG ID	PubChem CID	Functional Classification
Benzyl alcohol	E00010	244	Antimicrobial preservative; Solvent
Benzenesulfonic acid	E00147	7371	Acidulant
Water	E00035	962	Solvent
--------------------

Pharmaceutical Formulation

Formulation Name	Drug Dosage	Dosage Form	Route
Cisatracurium 20mg/10ml injectable	20mg/10ml	Injectable	Injection
Cisatracurium 10mg/5ml injectable	10mg/5ml	Injectable	Injection

Jump to Detail Pharmaceutical Formulation Page of This Drug

References

1	Drugs@FDA. U.S. Food and Drug Administration. U.S. Department of Health & Human Services. 2015
2	Trend Analysis of a Database of Intravenous Pharmacokinetic Parameters in Humans for 1352 Drug Compounds
3	BDDCS applied to over 900 drugs
4	FDA approval: ado-trastuzumab emtansine for the treatment of patients with HER2-positive metastatic breast cancer. Clin Cancer Res. 2014 Sep 1;20(17):4436-41.
5	Estimating the safe starting dose in phase I clinical trials and no observed effect level based on QSAR modeling of the human maximum recommended daily dose
6	Bradycardia produced by pyridostigmine and physostigmine. Can J Anaesth. 1997 Dec;44(12):1286-92.
7	Pharmacological characteristics of the inhibition of nondepolarizing neuromuscular blocking agents at human adult muscle nicotinic acetylcholine receptor. Anesthesiology. 2009 Jun;110(6):1244-52.
8	Synergy between pairs of competitive antagonists at adult human muscle acetylcholine receptors. Anesth Analg. 2008 Aug;107(2):525-33.
9	Clinical pipeline report, company report or official report of the Pharmaceutical Research and Manufacturers of America (PhRMA)
10	Synthesis and pharmacological evaluation of novel 9- and 10-substituted cytisine derivatives. Nicotinic ligands of enhanced subtype selectivity. J Med Chem. 2006 May 4;49(9):2673-6.
11	Pharmacology of the agonist binding sites of rat neuronal nicotinic receptor subtypes expressed in HEK 293 cells. Bioorg Med Chem Lett. 2004 Apr 19;14(8):1845-8.
12	URL: http://www.guidetopharmacology.org Nucleic Acids Res. 2015 Oct 12. pii: gkv1037. The IUPHAR/BPS Guide to PHARMACOLOGY in 2016: towards curated quantitative interactions between 1300 protein targets and 6000 ligands. (Target id: 463).
13	Pandit SK, Ferres CJ, Gibson FM, Mirakhur RK "Time course of action of combinations of vecuronium and pancuronium." Anaesthesia 41 (1986): 151-4. [PMID: 2869710]
14	Alahdal O, Bevan DR "Clindamycin-induced neuromuscular blockade." Can J Anaesth 42 (1995): 614-7. [PMID: 7553999]
15	Fuchs-Buder T, Wilder-Smith OH, Borgeat A, Tassonyi E "Interaction of magnesium sulphate with vecuronium-induced neuromuscular block." Br J Anaesth 74 (1995): 405-9. [PMID: 7734259]
16	Burkett L, Bikhazi GB, Thomas KC Jr, Rosenthal DA, Wirta MG, Foldes FF "Mutual potentiation of the neuromuscular effects of antibiotics and relaxants." Anesth Analg 58 (1979): 107-15. [PMID: 571233]
17	Multum Information Services, Inc. Expert Review Panel.
18	Product Information. Camptosar (irinotecan). Pharmacia and Upjohn, Kalamazoo, MI.
19	Product Information. Alfenta (alfentanil). Janssen Pharmaceutica, Titusville, NJ.
20	Liberman BA, Norman P, Hardy BG "Pancuronium-phenytoin interaction: a case of decreased duration of neuromuscular blockade." Int J Clin Pharmacol Ther Toxicol 26 (1988): 371-4. [PMID: 3220609]
21	Chapple DJ, Clark JS, Hughes R "Interaction between atracurium and drugs used in anaesthesia." Br J Anaesth 55 Suppl 1 (1983): s17-22. [PMID: 6688011]
22	Cushard WG, Kohanim M, Lantis LR "Blastomycosis of bone." J Bone Joint Surg Am 51A (1969): 704-12. [PMID: 5819086]
23	Harrah MD, Way WL, Katzung BG "The interaction of d-tubocurarine with antiarrhythmic drugs." Anesthesiology 33 (1970): 406-10. [PMID: 5512329]
24	Katende RS, Dimich I "Resistance to nondepolarizing muscle relaxants in a patient treated with ranitidine." Mt Sinai J Med 54 (1987): 330-1. [PMID: 2955219]
25	Agencia Espaola de Medicamentos y Productos Sanitarios Healthcare "Centro de informacion online de medicamentos de la AEMPS - CIMA.".
26	Huang KC, Heise A, Shrader AK, Tsueda K "Vancomycin enhances the neuromuscular blockade of vecuronium." Anesth Analg 71 (1990): 194-6. [PMID: 1973882]