Alcuronium is a synthetic derivative of toxiferine, an alkaloid of calabash curare, and is a non-depolarizing relaxant with properties and adverse effects similar to those of D-tubocurarine. It is about twice as potent as D-tubocurarine, 0.15-0.25 mg/kg usually being adequate for abdominal relaxation, and has a similar onset time and a slightly shorter duration of action. It is bound to albumin (40%), and requirements for alcuronium are less if the plasma albumin levels are low, as may occur in hepatic disease.
Like D-tubocurarine, alcuronium does not undergo biotransformation. Excretion occurs mainly in the urine (80-85%), but, as with D-tubocurarine, some is also excreted in the bile (15-20%) (1). Persistent relaxation has been reported in renal insufficiency (2) and the drug is relatively contraindicated in this condition.
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