Interaction of rocuronium with human liver cytochromes P450

Anzenbacherová, Eva; Špičáková, Alena; Jourová, Lenka; Ulrichová, Jitka; Adamus, Milan; Bachleda, Petr; Anzenbacher, Pavel

doi:10.1016/j.jphs.2014.12.006

Cited by 8 publications

(16 citation statements)

References 24 publications

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“…Firstly, patients taking different statins have varying effects on CYP3A4 isoenzyme. Atorvastatin has the strongest effect, simvastatin has a moderate, while fluvastatin has a weak effect [38,40]. Secondly, this study was not randomized and the sample size was small.…”

Section: Discussionmentioning

confidence: 95%

“…A moderate inhibition was observed for CYP2C19. Meanwhile, rocuronium displayed no or weak inhibition of CYP1A2, 2A6, 2B6, 2C9, 2D6 and 2E1 activities . Anzenbacherova et al .…”

Section: Discussionmentioning

confidence: 99%

“…Anzenbacherova et al . showed that the interaction of rocuronium and other drugs with CYP3A4 may prolong the effect of rocuronium.…”

Section: Discussionmentioning

confidence: 99%

“…A moderate inhibition was observed for CYP2C19. Meanwhile, rocuronium displayed no or weak inhibition of CYP1A2, 2A6, 2B6, 2C9, 2D6 and 2E1 activities [38]. Anzenbacherova et al [38] showed that the interaction of rocuronium and other drugs with CYP3A4 may prolong the effect of rocuronium.…”

Section: Discussionmentioning

confidence: 99%

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Neuromuscular Effects of Rocuronium Bromide in Patients in Statin Therapy for at least Three Months

Ren

2016

Basic Clin Pharma Tox

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Statins cause skeletal muscle myopathy. However, the neuromuscular effects of non-depolarizing neuromuscular-blocking agent in patients in long-term statin therapy remain unclear. Hence, we investigated the neuromuscular effects of rocuronium and muscle injury in patients in long-term statin therapy. Eighteen statin users using statins for at least 3 months were included in the statin group and 18 non-statin users were included in the non-statin group. General anaesthesia was induced with intravenous midazolam, etomidate, sufentanil and rocuronium 0.9 mg/kg (3ED ) for intubation. Anaesthesia was maintained with 1% propofol and remifentanil. The onset time and duration 10% T and 25% T of rocuronium were recorded. Blood samples were obtained before induction and 5 min., 1 hr, 2 hr, 4 hr, 12 hr and 24 hr after rocuronium administration to measure creatine kinase (CK), myoglobin and potassium. Myalgia was determined at 2 and 24 hr after surgery. There were no significant differences in the basic clinical characteristics between the two groups. The onset time of the statin group was significantly shorter than that of the non-statin group (p = 0.02), while the duration 10% T and duration 25% T of the statin group were significantly longer than those of the non-statin group (p = 0.006; p = 0.045). The myoglobin and CK concentrations increased after rocuronium administration as compared to baseline in both groups. CK concentration in the statin group was significantly higher than in the non-statin group just at 24 hr (p = 0.000003). However, myoglobin showed no significant difference between the two groups. The onset time of rocuronium decreases and its duration time increases in patients in long-term statin therapy.

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Section: Discussionmentioning

confidence: 95%

“…A moderate inhibition was observed for CYP2C19. Meanwhile, rocuronium displayed no or weak inhibition of CYP1A2, 2A6, 2B6, 2C9, 2D6 and 2E1 activities . Anzenbacherova et al .…”

Section: Discussionmentioning

confidence: 99%

“…Anzenbacherova et al . showed that the interaction of rocuronium and other drugs with CYP3A4 may prolong the effect of rocuronium.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Neuromuscular Effects of Rocuronium Bromide in Patients in Statin Therapy for at least Three Months

Ren

2016

Basic Clin Pharma Tox

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“…added that the elevated infusion requirements in patients on CAT were independent of serum levels of phenytoin and while not significant, also reported that recovery from neuromuscular block was faster in the CAT group as compared to controls [ 40 ]. Additional studies have found that utilization of ROC in patients on CAT may be due in part to long term effects of CAT on liver hypertrophy and higher levels of cytochrome P450 (CYP) [ 41 ], and CYP3A4 was found to interact with ROC [ 42 ], suggesting that the elevated need for ROC in patients on CAT may be associated with elevated liver enzymes that sequester ROC. While it has been shown that CAT can affect NMBA dosing requirements, the variability among patients is not well understood, and it remains unclear why patients with CP who are not on CAT might require more ROC for intubation than controls [ 32 , 39 ].…”

Section: Introductionmentioning

confidence: 99%

Resistance to Neuromuscular Blockade by Rocuronium in Surgical Patients with Spastic Cerebral Palsy

Lee

Robinson

Lodge

et al. 2021

JPM

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: Individuals with spastic cerebral palsy (CP) often exhibit altered sensitivities to neuromuscular blocking agents (NMBAs) used for surgical intubation. We assessed usage of the NMBA rocuronium in patients with spastic CP and evaluated potential modifiers of dosing including gross motor function classification system (GMFCS) level, birthweight, gestational age, and the use of anticonvulsant therapy. In a case-control study, surgical patients with spastic CP (n = 64) or with idiopathic or non-neuromuscular conditions (n = 73) were enrolled after informed consent/assent. Patient data, GMFCS level, anticonvulsant use, and rocuronium dosing for intubation and post-intubation neuromuscular blockade were obtained from medical records. Findings reveal participants with CP required more rocuronium per body weight for intubation than controls (1.00 ± 0.08 versus 0.64 ± 0.03 mg/kg; p < 0.0001). Dosing increased with GMFCS level (Spearman’s rho = 0.323; p = 0.005), and participants with moderate to severe disability (GMFCS III-V) had elevated rocuronium with (1.21 ± 0.13 mg/kg) or without (0.86 ± 0.09 mg/kg) concurrent anticonvulsant therapy. Children born full-term or with birthweight >2.5 kg in the CP cohort required more rocuronium than preterm and low birthweight counterparts. Individuals with CP exhibited highly varied and significant resistance to neuromuscular blockade with rocuronium that was related to GMFCS and gestational age and weight at birth.

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Polymorphisms contribute to differences in the effect of rocuronium in Chinese patients

Zhu

Wang

et al. 2021

Basic Clin Pharma Tox

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Rocuronium is widely utilized in clinical general anaesthesia, and individual differences in pharmacology and clearance have been observed. Two hundred thirty‐six Chinese patients undergoing selective thyroid/breast mass resection were studied. Total intravenous anaesthesia was induced with a single dose of propofol (2 mg·kg−1), sufentanil (0.5 μg·kg−1), and rocuronium (0.6 mg·kg−1) and maintained with propofol (3–5 mg·kg−1·h−1) and remifentanil (0.2–0.4 μg·kg−1·min−1). Intubation conditions and a train‐of‐four index of patients were utilized to assess the effects and duration of rocuronium. The data from 228 patients were analysed and reported. Genotypes NR1I2 rs2472677 C > T, NR1I2 rs6785049 G > A, SLCO1B1 rs4363657 T > C, SLCO1A2 rs4762699 T > C, and UGT1A1 rs4148323 G > A contributed to individual variation in rocuronium. Of the clinical variables tested, age, BMI, total dose of propofol, NR1I2 rs2472677, and SLCO1A2 rs4762699 correlated significantly (P < 0.05 for all) with the clinical duration or total clinical action time of rocuronium in a multiple linear regression model. No significant interactions were observed in intubation conditions. Genetic variations in NR1I2 rs2472677, NR1I2 rs6785049, SLCO1B1 rs4363657, SLCO1A2 rs4762699, and UGT1A1 rs4148323 were related to extensive interindividual variability in the clinical duration and total clinical action time of rocuronium.

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Interaction of rocuronium with human liver cytochromes P450

Cited by 8 publications

References 24 publications

Neuromuscular Effects of Rocuronium Bromide in Patients in Statin Therapy for at least Three Months

Neuromuscular Effects of Rocuronium Bromide in Patients in Statin Therapy for at least Three Months

Resistance to Neuromuscular Blockade by Rocuronium in Surgical Patients with Spastic Cerebral Palsy

Polymorphisms contribute to differences in the effect of rocuronium in Chinese patients

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