Cisatracurium Besylate

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Cat Number

API96946428

CAS Number

96946-42-8

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CAS Number

96946-42-8

EINECS

620-579-9

Storage

Under -20℃

Synonyms

Cisatracurium besylate; (1r,1'r,2r,2'r)-2,2'-[1,5-pentanediylbis[oxy(3-oxo-3,1-propanediyl)]]bis[1-[(3,4-dimethoxyphenyl)methyl]-1,2,3,4-tetrahydro-6,7-dimethoxy-2-methyl-isoquinolinium dibenzenesulfonate

Molecular Formula

C65H82N2O18S2

Molecular Weight

1243.5

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.C1=CC=C(C=C1)S(=O)(=O)[O-].C1=CC=C(C=C1)S(=O)(=O)[O-]

Appearance

White powder

Melting Point

90-93℃

Standard

USP/EP

General Description

Cisatracurium Besylate is a benzylisoquinolinium non-depolarizing neuromuscular blocker and one of ten stereoisomers of atracurium. It undergoes Hofmann elimination independent of hepatic or renal function.

Mechanism of Action

Cisatracurium occupies nicotinic acetylcholine receptors at the neuromuscular junction without activating them, competitively preventing acetylcholine binding and subsequent sodium channel opening required for muscle contraction.

Application

Used in surgical anesthesia and critical care. Cisatracurium Besylate is indicated for endotracheal intubation, intraoperative muscle relaxation, and mechanical ventilation in patients with compromised organ function.

A multicenter, double-blind, randomized controlled trial evaluated the effect of cisatracurium besylate on mortality in 340 patients with severe ARDS. Patients were randomly assigned to receive either cisatracurium (178 patients) or placebo for 48 hours. The study assessed 90-day mortality as the primary outcome, with secondary outcomes including ventilator-free days, ICU-acquired paresis, and adverse events. The results demonstrated that early administration of cisatracurium improved 90-day survival and increased ventilator-free days without increasing muscle weakness. This study established the clinical utility of cisatracurium infusion as part of early management of severe ARDS in critically ill patients.

Fig. 1 Probability of Survival through Day 90. (Papazian L.; et al. 2010)

References

Papazian L, et al. Neuromuscular blockers in early acute respiratory distress syndrome. New England Journal of Medicine, 2010, 363(12): 1107-1116.

Why is Cisatracurium Besylate preferred over atracurium in critically ill patients?

Cisatracurium produces significantly less histamine release than atracurium and undergoes organ-independent Hofmann elimination, providing more stable hemodynamics.