decamethonium

Action and Spectrum

Actions and Spectrum: 

Actions: 

Decamethonium is employed in anesthesia to induce paralysis, functioning as a short-acting depolarizing muscle relaxant. Resembling acetylcholine it acts as a partial agonist of the nicotinic acetylcholine receptor. 

Spectrum: 

Decamethonium is a depolarizing muscle relaxant characterized by a quaternary ammonium ion structure featuring a decane-1,10-diamine core, with each amino group bearing three methyl substituents. Its origin traces back to a hydride of decane, and it serves the functions of a muscle relaxant and an agonist for the nicotinic acetylcholine receptor. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Allergic reactions 

Prolonged paralysis 

Skin rash 

Bradycardia 

Respiratory depression 

Neurotoxic effects 

Black Box Warning

Black Box Warning: 

N/A 

Contraindication / Caution

Contraindication/Caution: 

Contraindications 

• Hypersensitivity 

Cautions 

• Renal impairment 
• Potassium deficiency 
• Dehydration 
• Respiratory distress syndrome 
• Hypothermia 
• Hepatic impairment 
• Drug interactions 
• Pregnancy  
• Breastfeeding 

Pregnancy / Lactation

Pregnancy consideration:  

No data is available regarding the administration of the drug during pregnancy. 

Breastfeeding warnings:  

No data is available regarding the excretion of drug in breast milk. 

Pregnancy category: 

Category A: well-controlled and satisfactory studies show no risk to the fetus in the first or later trimester. 

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: No data is available for the drug under this category. 

Pharmacology

Pharmacology: 

Decamethonium is a brief-acting muscle relaxant belonging to the depolarizing neuromuscular blocking agent class, commonly employed in anesthesia to initiate paralysis. Its mechanism closely resembles that of acetylcholine, acting as a partial agonist for the nicotinic acetylcholine receptor. 

Pharmacodynamics: 

Among the series of polymethylene bisquaternaries, decamethylene disquaternary salts exhibited the strongest curariform action. These salts had a ten-carbon (C10) chain between the quaternary groups. For a brief period of time, decamethonium was used clinically as a neuromuscular blocking medication.

Decamethonium caused a temporary increase in contraction, which distinguished it from d-tubocurarine. C10 causes an active response in the muscle fiber or endplate, which results in neuromuscular block. Anticholinesterase medications did not reverse decamethonium, in contrast to d-tubocurare. 

Pharmacokinetics: 

Absorption 

N/A 

Distribution 

N/A 

Metabolism 

N/A 

Elimination and Excretion 

N/A 

Adminstartion

Administration: 

When given, decamethonium is typically administered intravenously, meaning it is directly injected into the bloodstream. The specific dosage and rate of administration depend on factors such as the particular medical procedure, patient characteristics, and the desired degree of muscle relaxation. This medication is utilized to induce temporary paralysis, aiding in specific medical interventions like facilitating intubation during surgical procedures or electroconvulsive therapy. 

Given the potential for side effects and complications associated with decamethonium, which include prolonged paralysis and sensitivity reactions, its use necessitates careful consideration and monitoring. Healthcare professionals decide to use decamethonium based on factors such as the patient’s medical condition, the nature of the procedure, and a comprehensive assessment of the associated risks and benefits. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: decamethonium 

Pronounced: dee-ka-METH-oh-nee-um 

Why do we use decamethonium? 

Decamethonium, a neuromuscular blocking agent, was historically employed as a skeletal muscle relaxant in surgical settings. Its mechanism of action involves blocking the transmission of nerve impulses to the muscles, inducing temporary paralysis. This property proved beneficial in various medical contexts, particularly during surgical procedures where muscle relaxation facilitated intubation, reduced muscle spasms, and facilitated surgical interventions.

Additionally, decamethonium found application as a muscle relaxant in electroconvulsive therapy (ECT), a treatment for specific psychiatric conditions. Nevertheless, the use of decamethonium has waned over time due to several factors, notably the development of newer and safer neuromuscular blocking agents. Decamethonium is associated with side effects and complications, including prolonged paralysis and sensitivity reactions, contributing to its limited use in contemporary medical practice.

In modern medicine, the selection of muscle relaxants often leans toward drugs with a more favorable risk-benefit profile. Importantly, the administration of such medications is always conducted under the supervision and prescription of qualified healthcare professionals.